Health Insurance Specialist (Contracts) at U.S. Office of Personnel Management (OPM)

Summary

• As a Health Insurance Specialist (Contracts) at the GS-0301-12/13, you will be part of Healthcare and Insurance, Office of Personnel Management. If selected, you will be responsible for ensuring that health insurance carriers participating in the Postal Service Health Benefits Program (PSHBP) are providing the benefits, programs, and services to enrollees as provided for in the annual contract and are operating within OPM and Federal guidelines.

Duties

• Reviews and analyzes evidence submitted by health plans applying for participation in the Postal Service Health Benefits Program (PSHBP) for compliance with the law, regulations, and office policies and practices. Monitors the contract and recommends remediation and maintains contract files. Advises carriers on difficult enrollment problems and on changes in the law and regulations and prepares letters to the plans setting forth agency decisions and changes in policy. Works with carriers to assist them in providing reports and documentation related to their performance in providing services and products to enrollees. Assists in resolving and documenting actions to resolve any and all negative findings. Serves independently in the preparation of the health benefits brochures and other Open Season informational materials each calendar year. Ensures that the plan's brochure and marketing materials comply with the contract. Plans and conducts post-award conferences to ensure compliance with, and full understanding of, contractual requirements and to preclude unauthorized changes or alterations in contract provisions. Monitors contractors' performance and solves problems associated with contract disputes. Maintains productive working relationships with health plan administrators, union officials and underwriters. Issues carrier letters and other correspondence as needed in support of the contract.

Requiremennts

• Must be a U.S. Citizen or National Males born after 12-31-59 must be registered for Selective Service Suitable for Federal employment, determined by a background investigation May be required to successfully complete a probationary period Complete the initial online assessment and USA Hire Assessment, if required This position is eligible for inclusion in the bargaining unit. if the duty station is finalized in the Washington, DC metropolitan area, employees in this position will be represented by the American Federation of Government Employees (AFGE) Local 32. (BU Code - 2286) if the duty station is finalized outside of the Washington, DC metropolitan area, this position will not be represented by a bargaining unit. (BU Code - 7777)

Qualifications

For the GS-12 Grade Level:

You must have at least one year of specialized experience which is equivalent in difficulty and complexity to the GS-11 grade level in the Federal Service (obtained in either the private or public sector) which demonstrates at least two of the following activities:

• Knowledge of the Federal Acquisition Regulation (FAR), Federal Benefits Acquisition Regulation (FEHBAR), and Federal Employees Health Benefits (FEHB) program policies and/or requirements;
• Experience with and knowledge of the health benefits, insurance industry, or fee-for-service or prepaid medical plans;
• Performing contract administration including oversight;
• Applying knowledge of group health insurance regulations, policies and procedures in the administration of health benefits programs;
• Assisting in the development of health insurance contract requirements.

For the GS-13 Grade Level:

You must have one year of specialized experience comparable in scope and responsibility to the GS-12 grade level in the Federal service (obtained in either the private or public sector) which demonstrates broad knowledge of the Federal Acquisition Regulation (FAR), Federal Employees Health Benefits Acquisition Regulation (FEHBAR), and Federal Employees Health Benefits (FEHB) program policies and/or requirements, and at least two of the following activities:

• Experience with and broad knowledge of health benefits and industry, including fee-for-service or prepaid medical plans;
• Performing contract administration and contract oversight for health benefits or related programs;
• Applying broad knowledge of group health insurance regulations, policies, and procedures in the administration and management of health benefits programs;
• Developing and implementing health insurance or similar program requirements.
• Experience with Medicare integration.
• (Note: Specialized experience must be thoroughly outlined and supported in your resume.)
• You must meet all qualification and eligibility requirements by the closing date of this announcement.
• 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.