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Health Insurance Specialist
Centers for Medicare & Medicaid Services · Posted 48 days ago
Hybrid Woodlawn, MD $169K – $197K Apply by Aug 5, 2026 Health Insurance Administration ENTJESFJESTJISTJ Operations
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This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, Data Analytics and Systems Group. As a Health Insurance Specialist, GS-0107-15, you will provide authoritative strategic direction, technical leadership, and operational oversight for all FDOC lead generation activities, analytic operations, and cross-agency program integrity initiatives.
What You'll Do
- →Provide authoritative strategic direction, vision, and performance standards for all FDOC fraud detection lead generation activities across Medicare, Medicaid, and Marketplace programs.
- →Functions as the technical authority on the application of advanced data analytics, artificial intelligence, and machine learning technologies to detect and prevent Medicare fraud, waste, and abuse at scale.
- →Continuously evaluates the effectiveness of existing detection methodologies and leads the development of innovative, data-driven approaches to enhance FDOC performance and reduce improper payments at both the Federal and State levels.
- →Assesses new and revised laws, regulations, and policy directives to determine their potential effects on FDOC operations, resource needs, and risks to program integrity.
- →Delivers final, authoritative recommendations to CMS, HHS, OMB, and Congressional leaders regarding essential program changes, with these suggestions typically accepted as presented without significant alteration.
- →Represents CPI and CMS at the highest levels of Federal, State, Congressional, and industry engagement, navigating sensitive and often controversial program integrity issues through skilled negotiation, mediation, and conflict resolution.
- →Ensures that all relevant equities across CMS Centers, HHS, OMB, Federal law enforcement agencies, and the broader healthcare industry are considered in FDOC decision-making and national policy development.
Personality Fit
Job ID: 23abc345-e471-4f6d-b380-e781d5c8605c
Posted via USAJobs