This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Offices of Hearings and Inquiries (OHI), Marketplace Appeals Group (MAG), Division of Hearings (DOH). As a Health Insurance Specialist, GS-0107-13, you will apply comprehensive knowledge and skill in reviewing and deciding appeals involving all areas and issues of the exchange eligibility and enrollment process.

Duties

In accordance with the procedures and regulations established by CMS, adjudicates appeals from individuals regarding coverage eligibility under the Affordable Care Act. Fully researches the law, regulations, policy, guidance, and legal precedents related to the facts and the issues of the eligibility appeal. Conducts eligibility appeal hearings to solicit facts from appellants and other applicable parties. Prepares written decisions supporting and communicating the appeal determination in accordance with established CMS protocols and procedures. Confers with legal counsel with CMS and HHS, as appropriate, regarding cases and issues being considered.

Requirements

• 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.
• This position requires appointment by the Secretary of the Department of Health and Human Services (HHS).

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT. 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. In order to qualify for the GS-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: Conducting or supporting administrative appeals adjudication, which may include hearing preparation, case briefs and/or memorandums, pre and post hearing summaries and/or analysis, and hearing decision drafts; AND Developing or researching, and interpreting statutes, regulations and Marketplace, Medicaid, or CHIP eligibility program policies and procedures; AND Communicating with internal and external stakeholders regarding an appeals process and/or appeals case adjudication. 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/12413414

Education

This job does not have an education qualification requirement.

Contacts

• Address Offices of Hearings and Inquiries 7500 Security Blvd Woodlawn, MD 21244 US
• Name: CMS HR Inquiries
• Email: [email protected]