Health Insurance Specialist (Contracts)
Summary As a Health Insurance Specialist (Contracts), you will be part of Healthcare and Insurance, Federal Employees Insurance Operations.
If selected, you will serve as a representative of the Contracting Officer responsible for ensuring that health insurance carriers participating in the Federal Employees Health Benefits Program are providing the benefits, programs, and services to enrollees as provided for in the annual contract, and are operating within OPM and Federal guidelines.
Responsibilities Reviews and analyzes evidence submitted by health plans applying for participation in the Federal Employees Health Benefits (FEHB) Program for compliance with the law, regulations, and office policies and practices.
Monitors contractors' performance and solves problems associated with contract disputes.
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.
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.
Conducts regular on-site health plan visits to assess overall operations such as the claims processing procedures, coordination of benefits, customer service, etc.
Introduces and educates new carriers to the FEHB program on available resources such as program policies and regulations.
Explains the benefit negotiation cycle, process and format for submitting proposals, and due dates.
Reviews and approves or rejects changes carriers have made to the online FEHB system with benefits and guide information that includes any changes in co-pays, service areas, or plan contact information.
Conducts an annual performance assessment of assigned carriers and makes recommendations to the Contracting Officer regarding Service Charge or Performance Adjustment Scores.
Requirements Conditions of Employment Must be a US 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 This position is eligible for inclusion in the bargaining unit.
The union that represents employees in this position is the American Federation of Government Employees (AFGE) Local 32.
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 that demonstrates 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:
a) Experience with and knowledge of the health benefits and insurance industry, including fee-for-service or prepaid medical plans; b) Perform contract administration for Federal benefits related programs; c) Apply knowledge of group health insurance regulations, policies, and procedures in the administration of large health benefits programs; d) Assist in the development of health insurance contract requirements.
For the GS-13 Grade Level:
You must have at least one year of specialized experience which is equivalent in difficulty and complexity to the GS-12 level in the Federal Service that 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:
a) Experience with and broad knowledge of the health benefits and insurance industry, including fee-for-service or prepaid medical plans; b) Perform contract administration and contract oversight for Federal benefits related programs; c) Apply broad knowledge of group health insurance regulations, policies, and procedures in the administration and management of large health benefits programs; d) Develop and implement health insurance contract requirements.
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 (eg, Peace Corps, AmeriCorps) and other organizations (eg, 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 Additional Information Relocation expenses will not be paid.
Current OPM employees may qualify as an exception.
Incentive payments may be considered.
This job opportunity announcement may be used to fill additional similar vacancies across OPM.
If you are unable to apply online or need to fax a document that you do not have in electronic form, view the following link for information regarding an Alternate Application:
https:
//help.
usastaffing.
gov/Apply/index.
php?title=Alternate_Application_Information If you are a veteran and you are claiming 5-point veterans' preference, you must submit a copy of your DD-214 or other proof of eligibility.
If you are a veteran and you are claiming 10-point veterans' preference, you must also submit an SF-15, Application for 10-Point Veterans' Preference plus the proof required by that form.
For more information on veterans' preference click here.
Males born after 12-31-59 must be registered or exempt from Selective Service (see https:
//www.
sss.
gov/Home/Registration).
If you are unable to apply online or need to fax a document that you do not have in electronic form, view the following link for information regarding an Alternate Application.
Click the following link for more information, https:
//help.
usastaffing.
gov/Apply/index.
php?title=Alternate_Application_Information.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
If selected, you will serve as a representative of the Contracting Officer responsible for ensuring that health insurance carriers participating in the Federal Employees Health Benefits Program are providing the benefits, programs, and services to enrollees as provided for in the annual contract, and are operating within OPM and Federal guidelines.
Responsibilities Reviews and analyzes evidence submitted by health plans applying for participation in the Federal Employees Health Benefits (FEHB) Program for compliance with the law, regulations, and office policies and practices.
Monitors contractors' performance and solves problems associated with contract disputes.
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.
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.
Conducts regular on-site health plan visits to assess overall operations such as the claims processing procedures, coordination of benefits, customer service, etc.
Introduces and educates new carriers to the FEHB program on available resources such as program policies and regulations.
Explains the benefit negotiation cycle, process and format for submitting proposals, and due dates.
Reviews and approves or rejects changes carriers have made to the online FEHB system with benefits and guide information that includes any changes in co-pays, service areas, or plan contact information.
Conducts an annual performance assessment of assigned carriers and makes recommendations to the Contracting Officer regarding Service Charge or Performance Adjustment Scores.
Requirements Conditions of Employment Must be a US 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 This position is eligible for inclusion in the bargaining unit.
The union that represents employees in this position is the American Federation of Government Employees (AFGE) Local 32.
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 that demonstrates 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:
a) Experience with and knowledge of the health benefits and insurance industry, including fee-for-service or prepaid medical plans; b) Perform contract administration for Federal benefits related programs; c) Apply knowledge of group health insurance regulations, policies, and procedures in the administration of large health benefits programs; d) Assist in the development of health insurance contract requirements.
For the GS-13 Grade Level:
You must have at least one year of specialized experience which is equivalent in difficulty and complexity to the GS-12 level in the Federal Service that 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:
a) Experience with and broad knowledge of the health benefits and insurance industry, including fee-for-service or prepaid medical plans; b) Perform contract administration and contract oversight for Federal benefits related programs; c) Apply broad knowledge of group health insurance regulations, policies, and procedures in the administration and management of large health benefits programs; d) Develop and implement health insurance contract requirements.
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 (eg, Peace Corps, AmeriCorps) and other organizations (eg, 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 Additional Information Relocation expenses will not be paid.
Current OPM employees may qualify as an exception.
Incentive payments may be considered.
This job opportunity announcement may be used to fill additional similar vacancies across OPM.
If you are unable to apply online or need to fax a document that you do not have in electronic form, view the following link for information regarding an Alternate Application:
https:
//help.
usastaffing.
gov/Apply/index.
php?title=Alternate_Application_Information If you are a veteran and you are claiming 5-point veterans' preference, you must submit a copy of your DD-214 or other proof of eligibility.
If you are a veteran and you are claiming 10-point veterans' preference, you must also submit an SF-15, Application for 10-Point Veterans' Preference plus the proof required by that form.
For more information on veterans' preference click here.
Males born after 12-31-59 must be registered or exempt from Selective Service (see https:
//www.
sss.
gov/Home/Registration).
If you are unable to apply online or need to fax a document that you do not have in electronic form, view the following link for information regarding an Alternate Application.
Click the following link for more information, https:
//help.
usastaffing.
gov/Apply/index.
php?title=Alternate_Application_Information.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
|
|
 | |
