Health Insurance Specialist, GS-0107-7/9

Centers for Medicare & Medicaid Services, Center for Program Integrity

About the organization

CPI is CMS’ focal point for all national and State-wide Medicare and Medicaid programs and
integrity fraud and abuse issues related to the Children’s Health Insurance Program (CHIP). It
promotes the integrity of the Medicare and Medicaid programs and CHIP through
provider/contractor audits, policy reviews, identification and monitoring of program
vulnerabilities, and provides support and technical assistance to States. In addition, it
recommends modifications to programs and operations as necessary and works with CMS
Centers, Offices, and the Chief Operating Officer to affect changes as appropriate, and
collaborates with the Office of Legislation on the development and advancement of new
legislative initiatives and improvements to deter, reduce, and eliminate fraud, waste and abuse.


As a Health Insurance Specialist, GS-0107-7/9, you will serve in a trainee capacity performing work concerned with the administration and operation of national health insurance programs, such as Medicare and Medicaid.
o Assist in developing solutions to resolve health insurance program issues by conducting research on the problem area, analyzing the results and making recommendations to management to resolve any problem areas.
o Assist in reviewing, analyzing, and developing program documents for submission to be included in routine issue discussions by senior analysts or the manager.
o Review, evaluate, and analyze private health insurance programs in order to recommend appropriate programs for each State.
o Oversee the review and comment process of draft regulations and responses to CMS' proposed regulations and is the point of contact for electronic rulemaking.
o Perform segments of program audits, being responsible for assigned audit elements, including preparation of necessary documentation.


o Specialized Experience: Demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience, OR
o Substitution of Education for Experience: Possess at least one full year of graduate level education, OR
 Superior Academic Achievement: A bachelor's degree from an accredited college or university with a GPA of 3.0 or higher, GPA of 3.5 or higher for all required courses completed in major field of study, rank in the upper one-third of your class in the college, university, or major subdivision undergraduate courses, OR
Combination of Experience and Education: Equivalent combinations of completed post-high school education and experience.
o Specialized Experience: 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, OR
o Substitution of Education for Experience: Possess a Master's Degree or equivalent graduate degree or at least 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D, OR
o Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-07 grade level may be used to qualify applicants for positions at the GS-09 grade level. Therefore, only education in excess of one full year of graduate level education may be used to combine education and experience.


$47,016 - 74,759

Application instructions

Contact email: [email protected]

Interested applicants must submit resume to [email protected]

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