Program Manager

Summary

As a Program Manager, you will be part of Healthcare and Insurance, Office of Personnel Management. If selected, you will lead administrative program integrity operations that safeguard Federal health benefits programs by directing carrier compliance reviews, audit resolution, fraud prevention and detection activities, payment integrity oversight, corrective-action monitoring, contract-remedy support, and a multidisciplinary workforce while collaborating with government and industry partners.

Duties

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• Direct administrative program integrity reviews involving potential fraud, waste, abuse, improper payments, control weaknesses, and other program integrity risks affecting Federal health benefits programs.
• Lead oversight of administrative reviews by evaluating program documentation, audit findings, referral information, claims and payment data, and other relevant materials to recommend corrective actions, recoveries, disallowances, sanctions-implementation steps, or other administrative remedy options.
• Oversee health insurance carriers' compliance with contractual and regulatory requirements by directing carrier compliance reviews, validating corrective actions, and resolving program integrity findings through appropriate administrative processes.
• Analyze program integrity trends, claims data, audit results, carrier submissions, and risk indicators to identify vulnerabilities, improper payment risks, control weaknesses, and opportunities to strengthen fraud prevention and detection efforts.
• Coordinate administrative review, referral, corrective-action, compliance, and contract-remedy activities with Offices of Inspector General, legal counsel, contracting officials, program offices, carriers, health care organizations, and other oversight partners.
• Develop policies, procedures, documentation standards, referral protocols, corrective-action processes, and performance measures that improve health insurance program integrity, accountability, and administrative oversight.
• Supervise a multidisciplinary workforce responsible for administrative program integrity reviews, carrier compliance oversight, audit resolution, payment integrity, corrective-action monitoring, referral coordination, and contract-remedy support.

Requirements

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Conditions of employment

• Must be a U.S. Citizen or National
• Males born after 12-31-59 must be registered or exempt from Selective Service (see https://www.sss.gov/Home/Registration)
• Suitable for Federal employment, determined by a background investigation
• May be required to successfully complete a probationary period
• Candidates will not be hired based on their race, sex, color, religion, or national origin
• Complete the initial online assessment and USAHire Assessment, if required.
• You will be required to report to an OPM assigned office located in Washington, DC.
• This position is not eligible for inclusion in a bargaining unit

Qualifications

For the GS 15: You must have one full year (52 weeks) of specialized experience comparable in scope and responsibility to the GS-14 grade level or pay band in the Federal service (obtained in either the public or private sectors) performing ALL of the following:

• Analyzing or overseeing program integrity and compliance activities in health insurance programs to address potential fraud, waste, abuse, improper payments, program vulnerabilities or non-compliance;
• Coordinating program integrity, compliance, referral or corrective action activities with oversight organizations, legal counsel, contracting officials, health care organizations, carriers, or program offices;
• Preparing referral packages, corrective-action recommendations, recovery or disallowance analyses or contract-remedy options supported by program integrity findings; AND
• Developing policies, procedures, or performance measures that support the prevention, detection, and resolution of fraud, waste, abuse and payment integrity risks in health insurance programs.

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 (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., 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

There are no educational requirements for this position.

Additional information

Current OPM employees may be entitled to relocation expenses.

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 and would like to request information about the Alternate Application process, please use the contact information at the bottom of this announcement.

Career Transition Assistance Programs: These programs apply to employees who have been involuntarily separated from a Federal service position within the competitive service or Federal service employees whose positions have been deemed surplus or no longer needed. To receive selection priority for this position, you must: 1) meet CTAP or ICTAP eligibility criteria; 2) be rated well-qualified for the position (obtain score of 85 or higher on the assessments) and 3) submit the appropriate documentation to support your CTAP or ICTAP eligibility. For more information visit: http://www.opm.gov/rif/employee_guides/career_transition.asp.

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.