About this role
Job Summary
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Consumer Information and Insurance Oversight (CCIIO). As a Health Insurance Specialist, GS-0107-14, you will you will lead technical reviews of Qualified Health Plan (QHP) submissions, improve certification processes and tools, develop operational guidance, and coordinate with CMS, States, issuers, and contractors to resolve complex issues.
Qualifications
ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume (limited to no more than 2 pages) 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 being considered further.
In order to qualify for the GS-14 , 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-13 grade level in the Federal government, obtained in either the private or public sector, to include: Developing or implementing policy, operational, or business requirements related to issuer compliance with Affordable Care Act (ACA) related programs; Reviewing and analyzing Qualified Health Plans (QHPs) in the Federally-Facilitated Marketplaces (FFMs), to ensure compliance with QHP certification; and Overseeing the provision of technical assistance to issuers to ensure compliance with QHP Certification Standards, to include conducting benefit and cost sharing reviews.
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. Time-in-Grade: To be eligible, current Federal employees must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.
Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/13089787
Major Duties
- Leads the review and analysis of qualified health plans (QHPs) issuers and plans, particularly QHPs in the Federally-facilitated Marketplaces (FFMs), to ensure compliance with PPACA provisions related to QHP certification.
- Works in close partnership with Center and Group leadership and managers across to the Center to evaluate the effectiveness of the QHP submission and review processes, develop solutions, and assess the impact of new initiatives.
- Leads the development of and updates to standard operating procedures and other sub-regulatory guidance that instructs issuers on the conduct of benefit review for plans offered in markets under the FFMs.
- Oversees the provision of technical assistance to issuers to ensure compliance with QHP Certification Standards, to include conducting benefit and cost sharing reviews.
- Serves as a technical expert across the Center on the operational development of new QHP reviews and modification of existing reviews.