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
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
Must be a U.S. 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 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. This position is not eligible for inclusion in a bargaining unit
How you will be evaluated
You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), your responses to the application questionnaire, and your responses to all assessments required for this position. You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics): Accountability, Developing Others, Interpersonal Skills, and Strategic Thinking Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on an assessment may also result in your removal from consideration. All qualified Non-Competitive applicants and the best-qualified Merit Promotion applicants will be referred to the hiring manager for consideration. 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 a score of 85 or higher on 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.