Health Insurance Specialist

Summary

We are looking to fill Health Insurance Specialist, GS-0107-7/9, positions in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS). Click on "Learn more about this agency" for more details! What is a Health Insurance Specialist (HIS)? At CMS, an HIS can wear many hats. This series typically works with health insurance policy development, research, analysis, and program development.

Duties

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.
Engage with senior analysts and management in reviewing, analyzing, and developing program documents.
Review, evaluate, and analyze health insurance programs for efficiency and effectiveness.
Review draft regulations and responses to CMS' proposed regulations.
Assist with the administration of health insurance program audits.

Requirements

Qualifications
PROGRAM REQUIREMENTS: You must be ELIGIBLE and QUALIFIED in order to be referred to Hiring Managers. ELIGIBILITY REQUIREMENTS: Am I considered a Recent Graduate? GPA Requirement: You must possess a cumulative GPA of 3.0 on the unweighted 4.0 scale upon completion of your academic degree or certificate program. (GPA 2.95 is rounded to 3.0, and 2.94 is rounded to 2.9.) To be eligible as a Recent Graduate: Individuals who, within the previous 2 years, completed a qualifying associate's, bachelor's, master's, professional, doctorate, vocational, or technical degree or certificate from a qualifying educational institution. Therefore, you must have completed your educational program no earlier than November 5, 2024. Veterans who were precluded from applying due to their military service obligation, begin their 2-year eligibility period upon release or discharge from active duty. Eligibility for veterans cannot exceed 6 years from the date on which they completed their degrees (or certification). Therefore, veterans must have completed your educational program no earlier than November 5, 2020. To verify your eligibility as a Recent Graduate, you must submit the following at the time of application: A copy of your unofficial transcripts from the educational institution you attended attesting to your possession of the required education. Your unofficial transcripts must reflect: (1) your name; (2) overall grade point average (GPA); and (3) Degree Type (e.g., Bachelor's, Master's, etc.) and Degree Major; AND (4) the date your Degree was conferred. Failure to submit proof of degree/certificate completion at the time of application will result in the withdrawal of your application from consideration for this position. To be eligible as a Degree Candidate for Fall 2026: Individuals who are degree candidates for this current semester/term, i.e., Fall 2026, scheduled to complete a qualifying Associate's, Bachelor's, Master's, Doctorate, professional, vocational, or technical degree or certificate program, AND the degree/certificate has not been conferred at the time of application. To verify your eligibility as a Degree Candidate for Fall 2026, you must submit the following at the time of application: A copy of your unofficial transcripts from the educational institution you attended attesting to your education completed to date. Your unofficial transcripts must reflect: (1) your name; (2) overall grade point average (GPA); (3) current enrollment; AND (4) Degree Type (e.g., Bachelor's, Master's, etc.) and Degree Major. If referred and selected, you must submit an additional unofficial transcript that confirms the date your degree was conferred before an Official Offer can be made. Degree must be conferred by January 31, 2027. Failure to submit proof of degree/certificate completion will result in the withdrawal of your application from consideration for this position. Note: For those applying as Degree Candidates for Fall 2026, you will be required to submit an additional transcript that confirms the above major or course requirements and the date your degree was conferred. Degree requirements must be completed during the Fall 2026 semester, and the degree must be conferred by January 31, 2027. Failure to submit proof of degree/certificate completion will result in the withdrawal of your application from consideration for this position. QUALIFICATION REQUIREMENTS: Do I qualify for the GS-07 or GS-09 Grade Level? In order to qualify for the GS-07, you must meet one of the following: Specialized Experience: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-05 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Assisting in performing routine analytical studies; and 2)Preparing written materials (e.g., position papers, briefing materials, procedures) for senior staff. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-07 grade level by possessing at least one full year of graduate-level education. One year of full-time graduate education is considered to be the number of credit hours that the school has determined to represent 1 year of full-time study. If that information cannot be obtained from the school, 18 semester hours should be considered as satisfying the 1 year of full-time study requirement. Part-time graduate education is creditable in accordance with its relationship to a year of full-time study at the school attended - OR - Superior Academic Achievement: A bachelor's degree from an accredited college or university AND one of the following provisions of superior academic achievement: A grade-point average of "B" (3.0 or higher on a 4.0 scale) for all completed undergraduate courses or those completed in the last two years of undergraduate study. For example, 2.95 is rounded to 3.0, and 2.94 is rounded to 2.9. A grade-point average of 3.5 or higher on a 4.0 scale for all required courses completed in your major field of study, or those required courses in your major completed in the last two years of your undergraduate study. Rank in the upper one-third of your class in the college, university, or major subdivision. Membership in a national honor society (other than freshman honor societies) recognized by the Association of College Honor Societies. - OR - Combination of Experience and Education: Equivalent combinations of successfully completed post-high school education and experience may be used to meet total experience requirements at the GS-07 grade level. The percentage of your total qualifying experience the education must equal to 100% to qualify for this grade. In order to qualify for the GS-09, you must meet one of the following: Specialized Experience: 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) Performing routine analytical studies related to healthcare programs or policies; and 2) Assisting with developing health insurance operational guidance policies, reports, or procedures. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 grade level by possessing 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 - 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. ALL TRANSCRIPTS are required at the time of application to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see "Required Documents" section below on what documentation is required. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/13103667

Education
Qualifications, continued: NOTE: If you are using specialized experience to qualify for this position, 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. NOTE: A certificate program is defined as post-secondary education, in a qualifying educational institution, equivalent to at least one academic year of full-time study (30 undergrad credits/18 grad school credits) that is part of an accredited college-level, technical, trade, vocational, or business school curriculum.

Required Documents

To apply for this position, you must submit a complete Application Package, which includes: 1. Resume showing relevant experience; cover letter optional. NOTE: As of September 27, 2025, federal agencies will only accept resumes that are two pages or less in length. Your resume must indicate your citizenship and whether you are registered with the Selective Service if you are a male born after December 31, 1959. Your resume must also list your work experience and education (if applicable), including the start and end dates (mm/yyyy) of each employment, along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips, visit: https://usajobshelp.opm.gov/hc/en-us/articles/52879511643411-How-to-add-a-resume-to-your-profile. 2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Supporting documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required supporting documents. Failure to provide the appropriate documentation WILL result in an ineligible rating OR non-consideration. 3. All College Transcripts. Since this position requires specific education, you must submit a transcript attesting to your possession of the required education. You must submit an unofficial transcript at the time of application. If you have preceding education, ensure that you submit ALL transcripts to potentially receive credit. An official transcript is required if you are selected for the position. If selected, you must provide an original document before the final job offer may be extended. College Transcripts and Foreign Education: Applicants who have completed part or all of their education outside of the U.S. must have their foreign education evaluated by an accredited organization to ensure that the foreign education is comparable to education received in accredited educational institutions in the U.S. For a listing of services that can perform this evaluation, visit the National Association of Credential Evaluation Services website. This list, which may not be all-inclusive, is for informational purposes only and does not imply any endorsement of any specific agency. 4. 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, along with the appropriate supporting documentation for RA, must be received prior to commencing 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, based on your adjudication decision. 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 an RA, please click here to review the Procedures for Requesting a Reasonable Accommodation for Online Assessments.