Health Insurance Specialist

WHAT WE ARE LOOKING FOR Minimum Qualifications: You must have one year specialized experience to perform successfully the duties of the position.

To be creditable, specialized experience must have been equivalent to at least the GS-11 grade level in the Federal service performing ALL of the following: Administering member services and/or health benefit activities by interpreting program requirements, resolving member-related issues, and preparing correspondence or guidance in accordance with established federal health plan policies and procedures.

Analyzing enrollment, member service, and/or program data to identify trends, evaluate operational processes, and develop recommendations for improving federal health plan program effectiveness. Coordinating with health professionals, medical administrators, and/or program staff to address member service issues and develop recommendations concerning federal health plan services or benefits.

Monitoring program deliverables, preparing administrative or decision support documents, and supporting implementation of initiatives to improve operations of the federal health plan. Documenting experience: IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Qualifications are based on breadth/level of experience.

In addition to describing duties performed, applicants must provide the exact dates of each period of employment (from MM/YY to MM/YY) and the number of hours worked per week if part time. As qualification determinations cannot be made when resumes do not include the required information, failure to provide this information may result in disqualification. Applicants are encouraged to use the USAJOBS Resume Builder to develop their federal resume.

Do not copy and paste the duties, specialized experience, or occupational application questionnaire from this announcement into your resume as that will not be considered a demonstration of your qualifications for this position. In accordance with Office of Personnel Management policy, federal employees are assumed to have gained experience by performing duties and responsibilities appropriate for their official series and grade level as described in their position description.

Experience that would not normally be part of the employee's position is creditable, however, when documented by satisfactory evidence, such as a signed memorandum from the employee's supervisor or an SF-50 or SF-52 documenting an official detail or other official assignment. The documentation must indicate whether the duties were performed full time or, if part time, the "percentage of times" the other duties were performed.

It is expected that this documentation is included in the employee's official personnel record. In order to receive credit for experience in your resume that is not within the official series and grade level of your official position, you must provide a copy of the appropriate documentation of such experience as indicated above.

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; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to gain employment. You will receive credit for all qualifying experience, including volunteer experience.

If such experience is on a part-time basis, you must provide the average number of hours worked per week as well as the beginning and ending dates of the experience so it can be fully credited. OPM Qualification General Policies Website

WHAT YOU'LL BE DOING DAY TO DAY As a Health Insurance Specialist, you will use your knowledge and experience to optimize business results and customer experience by: Overseeing member relations activities to ensure accurate and consistent delivery of health plan services and benefits to program participants. Directing program improvement initiatives by establishing operating procedures, coordinating cross-cutting activities, and incorporating emerging industry practices into member service operations.

Serving as a program liaison to facilitate resolution of member concerns and support consistent administration of health plan services. Coordinating cross-functional program activities to maintain accountability, meet established deadlines, and advance organizational priorities.