Employee Benefits Investigator (Health), GS-1801-11/12
The Investigator position provides direct support and assistance to higher level investigators and managers and conducts research on policy, program, and case related issues and questions, and gathers and evaluates data relevant to specific cases. Investigator's plan, direct, and administer a program of enforcement to ensure maximum compliance with the Employee Retirement Income Security Act of 1974 (ERISA) and criminal provisions of the U.S. Code as they relate to employee benefit plans.
For the GS-11 level, Applicants must possess 1 year of specialized experience at a level of difficulty and responsibility equivalent to the GS-09 in the Federal Service.
To meet specialized experience, applicants must have at least 1 year of one of the qualifying experiences listed below. Your qualifying experience must be in your resume.
- Experience in conducting internal or external compliance audits of health insurance companies or health plans;
- Supervisory experience in claims processing and claims adjudication for a health insurance company, or, for a self-insured health care plan with more than 1,000 covered lives;
- Management experience in human resources with responsibility for administering a self-insured health plan covering more than 1,000 lives;
- Experience as a practicing attorney working on healthcare regulatory compliance issues;
- Experience as a practicing actuary working on health insurance or healthcare issues;
- Experience on management consulting projects addressing health care administration, health insurance, or pharmacy benefit management.
OR
3 years of progressively higher-level graduate education leading to a Ph.D. degree or Ph.D. or equivalent doctoral degree; in a related field of study that demonstrated the knowledge, skills, and abilities necessary to do the work;
OR
LL.M., if related.
For the GS-12 level, Applicants must possess 1 year of specialized experience at a level of difficulty and responsibility equivalent to the GS-11 in the Federal Service.
To meet specialized experience, applicants must have at least 1 year of one of the qualifying experiences (ERISA-specific) listed below. Your qualifying experience must be in your resume.
- Experience in conducting internal or external compliance audits of health insurance companies or health plans;
- Supervisory experience in claims processing and claims adjudication for a health insurance company, or, for a self-insured health care plan with more than 1,000 covered lives;
- Management experience in human resources with responsibility for administering a self-insured health plan covering more than 1,000 lives;
- Experience as a practicing attorney working on healthcare regulatory compliance issues;
- Experience as a practicing actuary working on health insurance or healthcare issues;
- Experience on management consulting projects addressing health care administration, health insurance, or pharmacy benefit management.
- Experience in a position that requires knowledge of relevant federal legislation governing the operation of health insurance and health plans, including Affordable Care Act ("ACT") and the Mental Health Parity and Addiction Equity Act ("MHPAEA").
There is no substitution of education for experience at the GS-12 level.
Education
Any applicant falsely claiming an academic degree from an accredited school will be subject to actions ranging from disqualification from federal employment to removal from federal service.
If your education was completed at a foreign college or university, you must show comparability to education received in accredited educational institutions in the United States and comparability to applicable minimum course work requirements for this position. Click Evaluation of Foreign Education for more information.
Additional information
This job is not 100% telework; employees will be required to report to their office one or more days per week.