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New Job Health Insurance Specialist In Virginia

Health Insurance Specialist
Health Insurance Specialist

Health Insurance Specialist

Company : US Centers for Medicare & Medicaid Services
Salary : $81,216 - $105,579 a year
Location : Virginia

Full Description

Duties

  • Serve as an expert in the development, evaluation, and implementation of policies related to claims processing and systems work.
  • Provide technical assistance, consistent with program expertise and experience, to staff in other Federal agencies, State agencies and private sector organizations.
  • Develop, review, and issue specifications, requirements, procedures, and instructional material to process claims from suppliers/providers/insurers.
  • Conduct analytical studies and evaluate the effectiveness of program initiatives by gathering, organizing, and interpreting data.

Requirements

Conditions of Employment

  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.
  • This is a remote position; however, the position reports to a CMS Office on a periodic basis. Requirements to report to the office will vary and can be discussed at the time of interview.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.

Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.

In order to qualify for the GS-13, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-12 grade level in the Federal government, obtained in either the private or public sector, to include: (1) evaluating claims processing activities or systems related to Medicare Inpatient and Outpatient Hospital claims to make recommendations for improvements; (2) developing requirements to process claims from suppliers/providers/insurers; and (3) planning the implementation of claims processing policy or related systems.
B. I do not possess the experience described above..

Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11693914

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: Yes- American Federation of Government Employees, Local 1923
Tour of Duty: Flexible
Recruitment/Relocation Incentive: NotAuthorized
Financial Disclosure: Not Required

To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply.

Remote-Out Positions at CMS: This is a remote position; however, the position reports to a CMS Office on a periodic basis (e.g. 1-2 times per year). Requirements to report to the office will vary and can be discussed at the time of interview. As such, your pay will be based on your home address. For more information on locality and pay scales, please visit here. Your worksite must be within the United States and you must adhere to all regulations and policies regarding remote work at CMS and in the federal government, including the signing of a remote work agreement.

Full-Time Telework Program for CMS Employees: CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.

The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.


  • Benefits

    A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

    Review our benefits

    Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), the responses you provide on the application questionnaire, and the result of the online assessments required for this position. Please follow all instructions carefully. Errors or omissions may affect your rating.

You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics):

  • Analysis
  • Attention to Detail
  • Customer Service
  • Decision Making
  • Flexibility
  • Integrity/Honesty
  • Interpersonal Skills
  • Learning
  • Oral Communication
  • Planning and Evaluating
  • Reading Comprehension
  • Self-Management
  • Stress Tolerance
  • Teamwork
  • Written Communication


In order to be considered for this position, you must complete all required steps in the process. In addition to the application and application questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job.

Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on the online assessment may also result in your removal from consideration.

You will be placed in one of the following categories based on category rating and selection procedures if you meet all of the requirements outlined in this job opportunity announcement:
  • Best Qualified - for those who are superior in the evaluation criteria
  • Well Qualified - for those who excel in the evaluation criteria
  • Qualified - for those who only meet the minimum qualification requirements

If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration.

This is a competitive vacancy announcement advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same.

The category rating process does not add veterans' preference points or apply the "rule of three" but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans' preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher).

Additional selections may be made from this announcement for similar positions within CMS with the same remote/telework designation and same geographical location, if applicable. For example, for Woodlawn, MD vacancies the "same geographical location" includes Baltimore, Maryland; Bethesda, Maryland; and Washington, D.C.

  • Benefits

    A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

    Review our benefits

    Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

  • Required Documents

    As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have - whether you're a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you're eligible under their policies.

    To apply for this position, you must submit a complete Application Package which includes:

    1. Resume showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates. For work in the Federal service, you must include the series and grade level for the position(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/.

    Your resume will be used to validate your responses to the assessment tool(s). We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Determining length of general or specialized experience is dependent on the information provided in the resume. Failure to include ALL of the information listed below on your resume WILL result in a finding of ineligible.

    • Official Position Title (include series and grade if Federal job)
    • Duties (be specific in describing your duties)
    • Employer's name and address
    • Supervisor name and phone number
    • Start and end dates in the month and year format (e.g. June 2007 to April 2008)
    • Full-time or part-time status (include hours worked per week)
    • Salary

    2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.

    3. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments, if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable_Accommodations_for_USA_Hire
  • How to Apply

    Please read the entire announcement and all the instructions before you begin an application. To apply for this position, you must complete the initial online application, to include the initial online assessment and submission of the required documentation specified in the Required Documents section. The complete application package must be submitted by 11:59 PM (ET) on 11/21/2022 of the announcement to receive consideration. The application process is as follows:

    • To begin the application process, click the Apply button. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
    • Follow the system prompts in USAJOBS to select your resume and supporting documents; review your application package; include personal information; and continue the application process in the USA Staffing agency site.
    • Answer the questions presented in the online application and attach all necessary supporting documentation in USA Staffing.
    • Click the Submit Application button prior to 11:59PM (ET) on 11/21/2022.
    • After submitting an online application, you will be notified whether or not you are required to take additional online assessments through the USA Hire Competency Based Assessment system. This message will be delivered to you via email notification. The email may be routed to your "Spam" or "Junk" folder.
    • If you are asked to take the USA Hire Competency Based Assessments, you will be presented with a unique URL to access the USA Hire system. Access to USA Hire is granted through your USAJOBS login credentials. Be sure to review all instructions prior to beginning your USA Hire Assessments. Click here for Computer System Requirements.
    • Note, set aside at least 3 hours to take these assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue at a later time, you can re-use the URL sent to you via email and also found by clicking the Track This Application link located in the application record in your USAJOBS account.

    To update your application, including supporting documentation, at any time during the announcement open period, return to your USAJOBS account (https://my.usajobs.gov/Account/Login). There you will find a record of your application, the application status, and an option to Edit My Application. This option will no longer be available once the announcement has closed.

    To verify the status of your application both during and after the announcement open period, log into your USAJOBS account: https://my.usajobs.gov/Account/Login. All of your applications will appear on the Welcome page. The application record in your USAJOBS account contains a Track This Application link that provides information regarding the documentation you submitted and any correspondence we have sent related to this application, including the invitation to take the USA Hire assessment. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.

    Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to [email protected] in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

    Agency contact information

    Nicol Dean

    Address

    Center for Medicare
    7500 Security Blvd
    Woodlawn, MD 21244
    US

    Next steps

    Based on your application and your responses to the application questionnaire, you may be presented with instructions on how to access the USA Hire system to complete the online assessments. The online assessments must be completed within 48 hours following the close of this announcement. You will have the opportunity to request a testing accommodation for the assessment should you have a disability covered under the Americans with Disabilities Act (ADA).

    Your assessment results will be kept on record for one year and used toward future positions for which you might apply that require the same assessments.

  • Fair and Transparent

    The Federal hiring process is set up to be fair and transparent. Please read the following guidance.

    • Equal Employment Opportunity (EEO) Policy
    • Reasonable accommodation policy
    • Financial suitability
    • Selective Service
    • New employee probationary period
    • Signature and false statements
    • Privacy Act
    • Social security number request

Required Documents

To apply for this position, you must submit a complete Application Package which includes:

1. Resume showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates. For work in the Federal service, you must include the series and grade level for the position(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/.

Your resume will be used to validate your responses to the assessment tool(s). We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Determining length of general or specialized experience is dependent on the information provided in the resume. Failure to include ALL of the information listed below on your resume WILL result in a finding of ineligible.

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer's name and address
  • Supervisor name and phone number
  • Start and end dates in the month and year format (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.

3. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments, if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable_Accommodations_for_USA_Hire


Help

This job is open to

  • Career transition (CTAP, ICTAP, RPL)

    Federal employees who meet the definition of a "surplus" or "displaced" employee.

  • The public

    U.S. Citizens, Nationals or those who owe allegiance to the U.S.