Health Insurance Specialist

About the role

This position is with the Department of Health & Human Services, Centers for Medicare & Medicaid Services, Marketplace Plan Management Group, Division of Benefit and Marketplace Analysis and Policy (DBMAP).

As a Health Insurance Specialist (GS-0107-14), you will manage programs and provide expert guidance on policies impacting government healthcare decisions to include developing operational procedures and regulations for the healthcare community.

What you will do

• Lead strategic planning and day-to-day execution of essential health benefits (EHB) policy and programmatic work, in close coordination with Division leadership.
• Serve as a senior representative of the Division and CMS in engagements with high-level governmental and non-governmental stakeholders, including at national forums, interagency meetings, and external partner convenings.
• Oversee and conduct research and analysis including clinical, legal, policy, and actuarial analyses to support EHB policy development and operations, and lead the drafting of regulations, guidance, and other written work products.
• Apply analysis of federal health insurance laws, regulations, and operational requirements to lead the development and evaluation of policies and processes related to the Health Insurance Marketplace and EHB.
• Provide thought leadership and strategic direction on emerging policy issues; and proactively identify risks, opportunities, and solutions to advance organizational programmatic goals.

How you will be evaluated

You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), the responses you provide on the application questionnaire, and the results of the online assessments required for this position.

A Subject Matter Expert may assist in the resume review process to help determine whether you meet the minimum job qualifications. Please follow all instructions carefully. Errors or omissions may affect your rating.

You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics): Attention to Detail Customer Service Decision Making Flexibility Influencing/Negotiating Integrity/Honesty Interpersonal Skills Learning Reading Comprehension Self-Management Stress Tolerance Teamwork In order to be considered for this position, you must complete all required steps in the process.

In addition to the application and application questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job. Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration.

Cheating on the online assessment may also result in your removal from consideration.

You will be placed in one of the following categories based on category rating and selection procedures if you meet all of the requirements outlined in this job opportunity announcement: Best Qualified - for those who are superior in the evaluation criteria Well Qualified - for those who excel in the evaluation criteria Qualified - for those who only meet the minimum qualification requirements If you are found to be among the top-qualified candidates, you will be referred to the selecting official for employment consideration.

The category rating process does not add veterans' preference points or apply the "rule of three" but protects the rights of veterans by placing them ahead of non-preference eligibles within each category.

Veterans' preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher).

Documents you must provide

• 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).
• For resume and application tips, visit: *** Your resume will be used to validate your responses to the assessment tool(s).
• We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes.
• Determining length of general or specialized experience is dependent on the information provided in the resume.
• Failure to include ALL of the information listed below on your resume WILL result in a finding of ineligible.
• Official Position Title (include series and grade if Federal job) Duties (be specific in describing your duties) Employer's name and address Supervisor name and phone number Start and end dates in the month and year format (e.g. June 2007 to April 2008) Full-time or part-time status (include hours worked per week) Salary 2.
• CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.).
• Required documents may be necessary to be considered for this vacancy announcement.
• Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.
• 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 and 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.
• RPL Eligibility Required Documents: The following documents are required to verify your RPL eligibility:1) Your most recent SF-50 (Notification of Personnel Action), or equivalent, as stated in the job announcement that shows position occupied (block #34 of your SF-50), tenure, grade and step, salary, and full performance level; 2) Your SF-50 showing Separation - RIF.
• If that is not available yet, then official documentation of your Reduction in Force (RIF) separation notice or a proposed removal/separation notice; AND 3) Your latest performance rating and rating of record (if separate documents) showing your rating score as at least fully successful or equivalent.

What to expect next

Based on your application and your responses to the application questionnaire, you may be presented with instructions on how to access the USA Hire system to complete the online assessments. The online assessments must be completed within 48 hours following the close of this announcement.

You will have the opportunity to request a testing accommodation for the assessment should you have a disability covered under the Americans with Disabilities Act (ADA). Your assessment results will be kept on record for one year and used toward future positions for which you might apply that require the same assessments.

Within 30 business days of the closing date, 09/17/2026, you may check your status online by logging into your USAJOBS account (***). We will update your status after each key stage in the application process has been completed.

Additional information

Bargaining Unit Position: Yes - American Federation of Government Employees, Local 1923 Tour of Duty: Flexible Recruitment Incentive: Not Authorized Relocation Incentive: Not Authorized Financial Disclosure: Not Required Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement.

CMS offers flexible working arrangements and allows employees the opportunity to participate in alternative work schedules at the manager's discretion. The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies.

To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position.

Additional information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at ***