Summary As a Program Manager, you will be part of Healthcare and Insurance, Office of Personnel Management. If selected, you will lead administrative program integrity operations that safeguard Federal health benefits programs by directing carrier compliance reviews, audit resolution, fraud prevention and detection activities, payment integrity oversight, corrective-action monitoring, contract-remedy support, and a multidisciplinary workforce while collaborating with government and industry partners. Duties
- Direct administrative program integrity reviews involving potential fraud, waste, abuse, improper payments, control weaknesses, and other program integrity risks affecting Federal health benefits programs.
- Lead oversight of administrative reviews by evaluating program documentation, audit findings, referral information, claims and payment data, and other relevant materials to recommend corrective actions, recoveries, disallowances, sanctions-implementation steps, or other administrative remedy options.
- Oversee health insurance carriers' compliance with contractual and regulatory requirements by directing carrier compliance reviews, validating corrective actions, and resolving program integrity findings through appropriate administrative processes.
- Analyze program integrity trends, claims data, audit results, carrier submissions, and risk indicators to identify vulnerabilities, improper payment risks, control weaknesses, and opportunities to strengthen fraud prevention and detection efforts.
- Coordinate administrative review, referral, corrective-action, compliance, and contract-remedy activities with Offices of Inspector General, legal counsel, contracting officials, program offices, carriers, health care organizations, and other oversight partners.
- Develop policies, procedures, documentation standards, referral protocols, corrective-action processes, and performance measures that improve health insurance program integrity, accountability, and administrative oversight.
- Supervise a multidisciplinary workforce responsible for administrative program integrity reviews, carrier compliance oversight, audit resolution, payment integrity, corrective-action monitoring, referral coordination, and contract-remedy support.
Qualifications
For the GS 15: You must have one full year (52 weeks) of specialized experience comparable in scope and responsibility to the GS-14 grade level or pay band in the Federal service (obtained in either the public or private sectors) performing ALL of the following:
- Analyzing or overseeing program integrity and compliance activities in health insurance programs to address potential fraud, waste, abuse, improper payments, program vulnerabilities or non-compliance;
- Coordinating program integrity, compliance, referral or corrective action activities with oversight organizations, legal counsel, contracting officials, health care organizations, carriers, or program offices;
- Preparing referral packages, corrective-action recommendations, recovery or disallowance analyses or contract-remedy options supported by program integrity findings; AND
- Developing policies, procedures, or performance measures that support the prevention, detection, and resolution of fraud, waste, abuse and payment integrity risks in health insurance programs.
Merit promotion applicants must meet the time-in-grade requirement as defined in 5 CFR 300, Subpart F. One year at the GS-14 grade level is required to meet the time-in-grade requirements for the GS15 level.
You must meet all qualification and eligibility requirements within 30 days of 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. Education There are no educational requirements for this position.
Requirements
- 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
- Candidates will not be hired based on their race, sex, color, religion, or national origin
- Complete the initial online assessment and USAHire Assessment, if required
- You will be required to report to an OPM assigned office.
- This position is not eligible for inclusion in a bargaining unit.
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), your responses to the application questionnaire, and your responses to all assessments required for this position. You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics):
Accountability, Developing Others, Interpersonal Skills, and Strategic Thinking
Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on an assessment may also result in your removal from consideration.
All qualified Non-Competitive applicants and the best-qualified Merit Promotion applicants will be referred to the hiring manager for consideration.
Career Transition Assistance Programs: These programs apply to employees who have been involuntarily separated from a Federal service position within the competitive service or Federal service employees whose positions have been deemed surplus or no longer needed. To receive selection priority for this position, you must: 1) meet CTAP or ICTAP eligibility criteria; 2) be rated well-qualified for the position (obtain a score of 85 or higher on assessments); and 3) submit the appropriate documentation to support your CTAP or ICTAP eligibility. For more information visit: http://www.opm.gov/rif/employee_guides/career_transition.asp. How to apply Please read the entire announcement and all the instructions before you begin an application. To apply and be considered for this position, you must complete all required questionnaires, assessments and submit all required documentation as specified in the How to Apply and Required Documents section. The complete application package must be submitted by 11:59 PM (ET) on the closing date of the announcement to receive consideration. The application process is as follows:
- Click the Apply Online button.
- Answer the questions presented in the application and attach all necessary supporting documentation.
- Click the Submit Application button prior to 11:59 PM (ET) on the announcement closing date.
- If you are required to complete any USA Hire Assessments, you will be notified after submitting your application. The notification will be provided in your application submission screen and via email. The notification will include your unique assessment access link to the USA Hire system and the completion deadline. Additionally, in USAJOBS you can click "Track this application" to return to your assessment completion notice.
- Access USA Hire using your unique assessment link. Access is granted through your USAJOBS login credentials.
- Review all instructions prior to beginning your assessments. You will have the opportunity to request a testing accommodation before beginning the assessments should you have a disability covered under the Rehabilitation Act of 1973 as amended.
- Set aside at least 3 hours to take the USA Hire Assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue later, you can re-use your unique assessment link.
- Your responses to the USA Hire Assessments will be reused for one year (in most cases) from the date you complete an assessment. If future applications you submit require completion of the same assessments, your responses will be automatically reused.
For more general information, system requirements, reasonable accommodation information, and to request assistance regarding the USA Hire Assessments, review the following resources: https://help.usastaffing.gov/Apply/index.php?title=USA_Hire_Assessments
To update your application, including supporting documentation: During the announcement open period, return to your USAJOBS account, find your application record, and click Edit my application. This option will no longer be available once the announcement has closed.
To view the announcement status or your application status: Click on this: https://www.usajobs.gov/Help/how-to/application/status/. Your application status page is where you can view your application status, USA Hire assessment completion status, and review your notifications sent by the hiring agency regarding your application.
You may preview the assessment questionnaire by clicking here: https://apply.usastaffing.gov/ViewQuestionnaire/13102826 Other information Current OPM employees may be entitled to relocation expenses by exception.
Incentive payments may be considered.
If you are unable to apply online and would like to request information about the Alternate Application process, please use the contact information at the bottom of this announcement.
This job opportunity announcement may be used to fill additional similar vacancies across OPM.
Veterans Employment Opportunity Act (VEOA): To be eligible for a VEOA appointment under Merit Promotion procedures, the veteran must be a preference eligible or a veteran separated after 3 years or more of continuous active service performed under honorable conditions.
Noncompetitive Appointment Authorities: For more information on noncompetitive appointment authority eligibility
requirements visit the following websites:
- Persons with Disabilities-Schedule A
- Special Hiring Authorities for Veterans
- Special Hiring Authority for Certain Military Spouses
- Other Special Appointment Authorities
Males born after 12-31-59 must be registered or exempt from Selective Service (see https://www.sss.gov/Home/Registration)
Reasonable Accommodation 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 an 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 starting 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 review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable_Accommodations_for_USA_Hire
As a condition of employment for accepting this position, you may be required to serve a 1-year probationary period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider:
- your performance and conduct;
- the needs and interests of the agency;
- whether your continued employment would advance organizational goals of the agency or the Government; and
- whether your continued employment would advance the efficiency of the Federal service.
Upon completion of your probationary period (or trial period) your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.