Employee Benefits Investigator (Senior Advisor Health Investigations)

Commander, Navy Installations Command

$95K — $115K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • 5-7 years of specialized experience in health benefit programs and ERISA compliance at the GS-13 level or equivalent.
  • Deep understanding of various federal and state regulations impacting health benefit plans.
  • Experience in auditing, investigative methodologies, and health claims processing.
  • Proficient in legal interpretation related to EBSA's criminal enforcement responsibilities.
  • Knowledge of industry standards and trends relevant to employee benefits.

Responsibilities

  • Serve as a technical expert advising on EBSA's criminal investigations and enforcement programs.
  • Provide guidance on interpreting EBSA's statutory responsibilities under ERISA and related criminal laws.
  • Recommend policy and changes targeting enforcement and prosecution initiatives in alignment with EBSA objectives.
  • Formulate and oversee strategies and accountability systems for the EBSA criminal investigation program.
  • Develop program priorities based on in-depth knowledge of legal requirements and industry challenges.

Benefits

  • Access to a comprehensive benefits package as a federal employee.
  • Eligibility for participation in telework, as per DOL policy.
  • Potential for career advancement within federal guidelines.
  • Job security and stability inherent to federal employment.
  • Ability to contribute to the welfare of American workers through meaningful regulatory roles.
Full Job Description
Summary

EBSA plays a vital role in protecting the retirement, health, and other job-based benefits of America's workers, retirees, and their families. We issue effective regulations, offer comprehensive education and assistance to workers, plan sponsors, fiduciaries, and service providers, and rigorously enforce the law. We serve workers, families, and the broader employee benefits community by protecting the security and integrity of the nation's benefit systems.

Duties

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Major Duties:

  • Serves as a technical expert and program advisor regarding the planning, development, implementation, and evaluation of current and proposed goals, objectives, and strategies about the EBSA criminal investigations, the enforcement program, education, and compliance.
  • The incumbent provides insight and guidance regarding the interpretation and implementation of EBSA's statutory responsibilities under the criminal provisions of Title I of ERISA; Title 18 United States Criminal Code; the Comprehensive Criminal Control Act of 1984; and related criminal laws. As necessary, clarifies EBSA's responsibilities as outlined in the Memorandum of Understanding of 1975 between DOL and the Department of Justice (DOJ). Ensures the development of sound cases and achieves compliance, as appropriate.
  • Recommends significant policy and program change that targets criteria, and enforcement and prosecution initiatives which address EBSA objectives and industry trends and problems; are compatible with the policies, goals, and strategies of other criminal enforcement agencies such as the DOJ; ensures maximum success in the identification and prosecution of criminal
    violations of ERISA.
  • Formulates, recommends, and oversees the implementation of the strategies, methodologies, targeted criteria, procedures, reporting and accountability systems, and guidance that form the basis for the EBSA criminal investigation and enforcement program.
  • The incumbent provides recommendations on program priorities and resource requirements based on an in-depth knowledge of statutory requirements, industry needs, and problems, and concerns and objectives of DOL, Federal and State agencies with which EBSA must coordinate criminal and civil enforcement activities. In conjunction with other EBSA staff, formulates and implements reporting, accountability, and evaluation systems, which provide relevant program and performance data.


The advertised salary reflects the minimum and maximum pay for the listed locations. Upon selection, the salary will be set in accordance with the selectee's assigned duty location. Applicants may select up to two (2) duty locations. Please carefully consider and choose only the location(s) you can reliably and easily commute to on a regular recurring basis, if selected. To view the address of a specific location click here.

Requirements

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Conditions of employment

  • Must be a U.S. Citizen.
  • Must be at least 16 years old.
  • Candidate required to obtain the necessary security/investigation level.
  • Requires a probationary period if the requirement has not been met.


Qualifications

Specialized Experience is the experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform the duties of the position successfully, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level.

Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, GS-13 in the Federal Service.

Qualifying specialized experience for GS-14 includes:

  • Experience with programs, priorities and the civil laws administered by Federal and State agencies which impact health benefit plan activities and health coverage.
  • Experience with the health benefit industry, benefit claims processing, investigative methodology, auditing and accounting systems.
  • Experience with regulatory requirements and sub-regulatory guidance of Employee Retirement Income Security Act (ERISA) including the group health plan requirements under part 7 as amended by HIPAA, MHPA, MHPAEA, WHRCA, Newborn's Act, GINA, Michelle's Law, CHIPRA and the Affordable Care Act.
  • Experience analyzing and measuring the effectiveness and efficiency of the health enforcement programs.


Education

This job does not have an education qualification requirement.

Additional information

The mission of the Department of Labor (DOL) is to protect the welfare of workers and job seekers, improve working conditions, expand high-quality employment opportunities, and assure work-related benefits and rights for all workers.

Refer to these links for more information: GENERAL INFORMATION, REASONABLE ACCOMMODATION, ADDITIONAL DOCUMENTATION, FORMER FEDERAL EMPLOYEES

As a condition of employment, all personnel must undergo a background investigation for access to DOL facilities, systems, information and/or classified materials before they can enter on duty: BACKGROUND INVESTIGATION

For more information, Click here for Career Ladder Promotion Information

For more information, click Telework Position Information. This is not a remote work position. The selectee will report to an assigned DOL office location on a regular basis and is eligible for participation in telework as determined by management in accordance with DOL policy.

Based on agency needs, additional positions may be filled using this vacancy.

The Department of Labor may use certain incentives and hiring flexibilities, currently offered by the Federal government to attract highly qualified candidates. Click here for Additional Information.

Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution.

Benefits

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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

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