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Office Of Personnel Management is Hiring a Health Insurance Specialist (Contracts) Near Washington, DC

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 all of the following activities:

• 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.

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 all 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.

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.

Responsibilities:

THIS IS A PUBLIC NOTICE: This Notice is issued under Direct-Hire Authority (DHA) to recruit new talent to these occupations for which there is a severe shortage of candidates. This means that we can hire any qualified candidate, either from this notice or from any source.

These positions will be dedicated to implementing and ongoing operations for the Postal Service Health Benefits (PSHB) Program and will receive on-the-job training from supporting the Federal Employee Health Benefits (FEHB) Program, through our Federal Employee Insurance Operations Division.

Work Schedule: These positions allow for multiple schedules. Work schedule will be determined at the time of selection.

Please note, there may or may not be actual/projected vacancies when you submit your application. Your resume and any supporting documentation will be retained with other applicants and reviewed as vacancies occur.

You will not receive a notice regarding your application's status.

Positions that may be filled are:

Position 24-0301-JT-SPLASH: Health Insurance Specialist (Contracts): As a Health Insurance Specialist (Contracts), you will be part of Healthcare and Insurance (HI), Postal Service Insurance Operations (PSIO). 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 performed include:

• Reviewing and analyzing evidence submitted by health plans applying for participation in the Postal Service Health Benefits Program for compliance with the law, regulations, and office policies and practices.
• Monitoring contracts and recommending remediation and maintaining contract files.
• Advising carriers on difficult enrollment problems and on changes in the law and regulations and preparing letters to the plans setting forth agency decisions and changes in policy.
• Working with carriers to assist them in providing reports and documentation related to their performance in providing services and products to enrollees. Assisting in resolving and documenting actions to resolve any and all negative findings.
• Serving independently in the preparation of the health benefits brochures and other Open Season informational materials each calendar year. Ensuring that the plan's brochures and marketing materials comply with the contract.
• Consulting with other staff offices within the agency to obtain advice on various technical and medical questions.
• Planning and conducting post-award conferences to ensure compliance with, and full understanding of, contractual requirements and to preclude unauthorized changes or alterations in contract provisions. Monitoring contractors' performance and solving problems associated with contract disputes.
• Maintaining productive working relationships with health plan administrators, union officials and underwriters. Issuing carrier letters and other correspondence as needed in support of the contract.
• Conducting regular on-site health plan visits to assess overall operations such as the claims processing procedures, coordination of benefits, customer service, etc.
• Reviewing all documentation, correspondence, and reports submitted by the carrier(s) to ensure that actions taken, services and products provided, and processes/procedures followed are in compliance with the final agreed upon contract.
• Introducing and educating new carriers to the PSHB program on available resources such as program policies and regulations. Explaining the benefit negotiation cycle, process and format for submitting proposals, and due dates.
• Reviewing and approving or rejecting changes carriers have made to the online PSHB system with benefits and guide information that includes any changes in co-pays, service areas, or plan contact information.
• Assisting the Office of the Inspector General (OIG) with obtaining information from carriers to be used in conducting periodic audits.
• Conducting an annual performance assessment of assigned carriers and making recommendations to the Contracting Officer regarding Service Charge or Performance Adjustment Scores.

Job Summary