Health Insurance Specialist

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Consumer Information and Insurance Oversight (CCIIO), Front Office. As a Health Insurance Specialist, GS-0107-14, you will serve as a Health Insurance Specialist and the Operations Lead responsible for designing, governing, and continuously improving the operational infrastructure that enables investigation, and remediation of fraud, waste, and abuse.

Design, establish, and continuously refine the Center’s operational infrastructure to identify, track, and remediate complex fraud, waste, and abuse within the Health Insurance Marketplace.

Develop risk-based operational strategies designed to strengthen program safeguards and mitigate fraud risks across the Marketplace program.

Direct Center-level governance of fraud, waste, and abuse operations, designing and maintaining the cross-group processes by which MPMG, MEEG, MITG, and PPFMG coordinate their respective roles.

Lead Center-level strategic planning initiatives designed to enhance the effectiveness, resilience, and long-term sustainability of fraud prevention, remediation, and enforcement operations supporting Marketplace program integrity.

Serve as the principal liaison and authoritative advisor to senior leadership on complex fraud, waste, and abuse issues affecting the Health Insurance Marketplace.