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Health Insurance Specialist

Centers for Medicare & Medicaid Services [CMS]

(Seattle WA / Denver CO / Dallas TX / Boston MA / Woodlawn MD / Hybrid)

Open date: May 28, 2026

Closing date: June 3, 2026

Pay scale & grade: GS 9 - 11

Salary: $67,100 - $111,087 per year

Several vacancies in:

• Denver, CO
• Boston, MA
• Woodlawn, MD
• Dallas, TX
• Seattle, WA

Telework eligible? Yes, as determined by agency policy

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), Provider Enrollment & Oversight Group (PEOG).

As a Health Insurance Specialist, GS-0107-9/11, you will serve as the focal point for all Medicare provider and supplier enrollment compliance functions, including identifying and reporting provider enrollment related vulnerabilities that may indicate fraud, waste, or abuse.

Duties

• Reviews financial payment data and provider enrollment records to spot potential fraud, waste, and abuse (FWA). Uses established guidelines and analytical tools to evaluate issues, conduct studies, and identify program vulnerabilities.
• Assists with developing, reviewing, and updating program integrity policies and regulations.
• Identifies policy problems, recommends solutions, and contributes to decisions that may result in new or improved rules, criteria, or agency policies particularly around administrative sanctions and integrity initiatives.
• Coordinates with Internal and external agencies on fraud, waste, and abuse (FWA) matters by compiling case documentation and factual summaries as well as engaging with senior officials across the healthcare industry, nonprofits, and contractors.
• Prepares and delivers briefing materials, summary reports, and analytical findings for senior officials and provides technical advice to internal and external stakeholders on provider enrollment, program vulnerabilities, and integrity issues.

Qualifications

In order to qualify for the GS-09, 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-07 grade level in the Federal government, obtained in either the private or public sector, to include:

1. Gathering and compiling financial program payment data, provider enrollment records, or related documentation to support investigations or inquiries involving fraud, waste, or abuse (FWA) in a health insurance program (e.g., Medicare, Medicaid, or Marketplace); AND
2. Supporting investigations, audits, or compliance activities related to health insurance programs through collaboration with internal teams, external agencies, contractors, or oversight bodies; AND
3. Analyzing federal health care statutes, regulations, and program integrity guidance to identify compliance concerns, program integrity issues, or policy matters related to provider enrollment or health insurance program operations, and preparing findings for reporting purposes.

- OR -

Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 level by possessing a Master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related to the position being filled.

How to Apply

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