Advance Your Career: Health Insurance Specialist at CMS
The Centers for Medicare & Medicaid Services (CMS) is a cornerstone of the American healthcare landscape. If you are an experienced professional with a background in Medicare policies and a passion for financial integrity, the position of Health Insurance Specialist (GS-13) offers an unparalleled opportunity to impact national healthcare standards. Based in Woodlawn, Maryland, this role is at the heart of the Office of Financial Management.
Job Responsibilities
In this role, you will serve as the lead contact for the Comprehensive Error Rate Testing (CERT) Program. Key responsibilities include:
- Providing expert guidance on the Payment Integrity Information Act (PIIA).
- Guiding Medicare Administrative Contractors (MACs) on payment policy.
- Analyzing improper payment root causes.
- Drafting technical and financial reports for senior leadership.
Comparison: General vs. Specialized Experience
| Feature | General Experience | Specialized Experience |
|---|---|---|
| Scope | Broad professional work | Policy-specific (Medicare FFS) |
| Focus | Administrative skills | Technical payment accuracy |
| Required for GS-13 | Not sufficient | Mandatory (52 weeks) |
Requirements
To qualify for this GS-13 position, you must demonstrate at least one year of specialized experience at the GS-12 level. Your resume must clearly outline your experience in Medicare FFS policy, stakeholder education, and the creation of financial reports.
Salary Overview
This position is graded at the GS-13 level, with an annual salary range of $121,785 to $158,322, commensurate with experience and federal pay regulations.
Benefits
CMS provides a robust benefits package, including:
- Competitive federal health and life insurance.
- Generous retirement planning via the Thrift Savings Plan (TSP).
- Ample paid leave and federal holidays.
- Support for professional development and training.
Application Tips
- Focus Your Resume: Since there is a strict two-page limit, prioritize your most relevant accomplishments.
- Quantify Results: Where possible, mention the scope of programs you managed or the scale of audits you conducted.
- Follow Procedures: Ensure your resume includes all required details like salary, hours per week, and supervisor contact info.
This role is an excellent fit for those who want to use their technical knowledge to solve complex payment integrity issues. If you meet the qualifications, we encourage you to submit a polished, concise application to join the CMS team.
Why This Health Insurance Specialist Job Matters
Shape the future of healthcare payment integrity at the Centers for Medicare & Medicaid Services—where your analysis directly impacts national health standards.
Health Insurance Specialist Job Overview
The Office of Financial Management (OFM) at the Centers for Medicare & Medicaid Services (CMS) is seeking a dedicated Health Insurance Specialist to join the Payment Accuracy and Reporting Group. In this vital GS-13 role, you will act as a primary CMS liaison for the Comprehensive Error Rate Testing (CERT) Program. You will be responsible for overseeing program administration, ensuring compliance with the Payment Integrity Information Act (PIIA), and providing expert guidance to Medicare Administrative Contractors. This position offers the opportunity to influence high-level financial reporting and program oversight within a mission-driven federal environment.
Requirements for Health Insurance Specialist
- U.S. Citizenship.
- Resume must be two pages or less.
- Must meet specialized experience equivalent to the GS-12 grade level.
- Experience supporting improper payment measurement contractors on Medicare FFS policies.
- Experience communicating coverage policies to medical professionals or the public.
- Demonstrated success in educating stakeholders on compliance, billing, and operational aspects of Medicare FFS.
- Proven ability to prepare complex briefing materials, financial reports, or agency oversight documentation.
- Must complete all online assessments within 48 hours of notification.
Preferred Qualifications for Health Insurance Specialist
- Experience contributing to the Payment Integrity Report or Agency Financial Reports.
- Strong analytical skills regarding Medicare fee-for-service regulations.
- Proven track record of stakeholder engagement and cross-functional communication.
- Expertise in identifying root causes of improper payments and developing risk mitigation strategies.
Federal Benefits & Perks
- ✓Comprehensive federal health insurance options
- ✓Federal Employees Retirement System (FERS)
- ✓Thrift Savings Plan (TSP) with government matching
- ✓Flexible work schedules and telework opportunities
- ✓Paid annual and sick leave
- ✓Career development and training programs
💡 How to Apply Health Insurance Specialist Job & Insider Tips
Application Steps for Health Insurance Specialist Job
- Create or update your USAJOBS resume to ensure it is two pages or less.
- Click the Apply button and complete all mandatory application questionnaires.
- Upload required documents, including SF-50 if applicable.
- Submit your application package before the closing date of 11/02/2026.
- Monitor your email for a link to complete mandatory USA Hire Assessments.
- Complete all assessments within 48 hours of receiving the access link.
💡 General Tips
- Strictly adhere to the two-page resume limit; excess pages may disqualify you.
- Use the USAJOBS resume builder to ensure all required data points are included.
- Ensure your work experience includes start/end dates in mm/yyyy format and hours worked per week.
- Be specific regarding your role and contributions in previous positions to demonstrate your expertise.
- Set aside at least three hours for the online assessment, though you may finish sooner.
Frequently Asked Questions
What is the primary focus of this role?
This role focuses on administering and overseeing the Comprehensive Error Rate Testing (CERT) program, ensuring Medicare Fee-for-Service payment accuracy, and reporting to agency leadership.
Can I telework in this position?
Yes, this position is eligible for telework; however, it also requires regular and recurring reporting to the CMS office in Woodlawn, Maryland.
What is the page limit for the resume?
Per updated federal guidelines effective September 2025, your resume must be no more than two pages long.
Is a security clearance required?
While this position is in a moderate-risk category, it is not listed as requiring a formal security clearance, though it does undergo suitability and fitness adjudication.
Can I update my application after submission?
You can update your application through the USAJOBS portal until the announcement closing date of November 2, 2026.
Job from Centers For Medicare & Medicaid Services
As part of the Department of Health and Human Services, CMS operates at the intersection of public policy and healthcare operations. The agency provides essential leadership in the healthcare marketplace, working to improve quality, efficiency, and access for millions of Americans. Employees at CMS are part of a dynamic, visible, and dedicated organization committed to safeguarding the integrity of our national health programs.