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Health Insurance Specialist (Program Integrity)

Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services

in Woodlawn MD / Telecommute

Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services

Open & closing dates: 05/09/2019 to 05/22/2019

Pay scale & grade: GS 13

Salary: $99,172 to $128,920 per year

1 vacancy in the following location(s): Woodlawn, MD

Telework eligible? Yes as determined by agency policy



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) Front Office.

As a Health Insurance Specialist (Program Integrity), GS-0107-13, you will serve as an expert in the development, evaluation, and implementation of policies related to program integrity.


  • Develop policies related to program integrity initiatives in health insurance programs.
  • Develop program improvements to deter or eliminate fraud, waste, or abuse.
  • Draft guidelines related to health care legislation or policies.
  • Initiate and maintain working relationships with stakeholders to plan or execute program initiatives.


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.
  • Time-in-Grade restrictions apply.



In order to qualify for the 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 health insurance program vulnerabilities to detect fraud, waste, or abuse; (2) Collaborating across organizational lines on investigations, audits, or oversight of health insurance programs; AND (3) Proposing policy changes relating to program integrity.

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:


This job does not have an education qualification requirement.

How to Apply

The text above consists of excerpts of a job ad currently online at Important information has not been included, including application instructions and complete qualification requirements.

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This ad has been viewed 415 times. It expires on 5/22/2019.

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