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Program Manager

US Office of Personnel Management -
Washington, DC

Apply Now

Job Details

Full-time
$169,279 - $197,200 a year
4 days ago

Qualifications

Contract documentation review
Healthcare financial misconduct investigations
Contract review
Program management
Report writing
Legal analysis
Operations coordination
Writing skills
Regulatory compliance in claims processing
Legal risk management
Investigative financial records analysis
Medical billing compliance checks
Contract performance monitoring
Policy & process development
Health insurance knowledge
Contractual compliance checks
Financial records review
Compliance documentation
Interdisciplinary policy and procedure development experience
Internal compliance assessments
Insurance claim issue resolution
Fraud prevention policy implementation
Case referral
Root cause analysis
Healthcare claims compliance audits
Referral coordination
Financial compliance monitoring
Policy Development
Audit support
Documentation reviews

Full Job Description

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.

Learn more about this agency

This job is open to

The public

U.S. Citizens, Nationals or those who owe allegiance to the U.S.

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

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.
This position is not eligible for inclusion in a bargaining unit

Qualifications

For the GS 15: You must have 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:

Providing administrative program integrity analysis and recommendations to address potential fraud, waste, abuse, improper payment risk, program vulnerabilities, or noncompliance involving public or private health insurance programs;
Coordinating administrative review, referral, corrective-action, compliance, or contract-remedy activities with oversight organizations, legal counsel, contracting officials, health care organizations, carriers, program offices, or other stakeholders;
Analyzing supporting documentation, audit findings, medical claims, billing data, financial records, carrier submissions, or other program information to identify potential Fraud, Waste, Abuse patterns, improper payment risks, control weaknesses, root causes, and options for administrative corrective action or contract remedies;
Preparing referral packages, issue summaries, corrective-action recommendations, recovery or disallowance analyses, sanctions-implementation reviews, contract-remedy options, or other administrative review products supported by program integrity findings and appropriate documentation; AND
Developing policies, procedures, documentation standards, referral protocols, and performance measures that support the prevention, detection, administrative review, referral coordination, corrective action, and resolution of fraud, waste, abuse, improper payment risk, and material control weaknesses 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.

Reasonable Accommodation Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended and Americans with Disabilities Act 1990 as amended, that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a reasonable accommodation in your online application. Requests for Reasonable Accommodations for the USA Hire Competency Based Assessments and appropriate supporting documentation for Reasonable Accommodation must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for Reasonable Accommodations are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments, if you received the link after the close of the announcement. To determine if you need a Reasonable Accommodation, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable_Accommodations_for_USA_Hire

As a condition of employment for accepting this position, you may be required to serve a 1-year probationary period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider:

your performance and conduct;
the needs and interests of the agency;
whether your continued employment would advance organizational goals of the agency or the Government; and
whether your continued employment would advance the efficiency of the Federal service.

Upon completion of your probationary period your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.

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

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.

How you will be evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

For Category Rating: Once the application process is complete, a review of your resume will be made and compared against your responses to the assessment questionnaire to determine if you are qualified for this job. If, after reviewing your resume, a determination is made that you have inflated your qualifications and/or experience, you may lose consideration for this position. Please follow all instructions carefully. Errors or omissions may affect your eligibility. Qualified candidates will be assigned to one of the three quality categories: Qualified, Well Qualified, or Best Qualified. Qualified Category = Does not exceed the basic qualifications requirements described in the "Qualifications" section of this announcement. Well Qualified Category = Meets the basic qualifications requirements described in the "Qualifications" section of this announcement and demonstrates proficiency in the Critical Competencies defined below. (This category must be met to be considered under ICTAP procedures) Best Qualified Category = Meets the basic qualifications requirements described in the "Qualifications" section of this announcement and excels in the Critical Competencies defined below. The category assignment is a measure of the degree in which your background matches the competencies required for this position.

Your qualifications will be evaluated 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.

The Category Rating Procedures require veterans are placed ahead of non-veterans within each category. Preference eligibles who meet the minimum qualification requirements and have a compensable service-connected disability of at least 10 percent or higher will be listed in the highest quality category (except in the case of scientific or professional positions at the GS-09 level or higher).

Required Documents

To apply for this position, you must provide a complete Application Package which includes:

Your Resume showing the applicant's name, email address, work schedule, hours worked per week, dates of employment, and duties performed to include pay plan, series, and grade level for relevant federal experience. Your resume must show complete information for each job entry to support minimum qualifications. Only the first 2 pages of the resume/application will be used to verify minimum qualifications. Please be sure to include specific dates of employment and work schedule(s).

Do not include the following types of information in your resume:
- Classified or government sensitive information
- Social Security Number (SSN)
- Photos of yourself
- Personal information, such as age, sex, religious affiliation, etc.
- Encrypted and digitally signed documents

Other supporting documents:
- Cover Letter, optional
- If you are requesting a reasonable accommodation to the USA Hire Competency Based Assessments, submit documentation to support your request including the Reasonable Accommodation Request Form found here.
- Veterans' Preference documentation, if applicable (e.g. DD-214 Member Copy 4 showing type of discharge/character of service; Current Active Duty members must submit a certification of expected discharge or release from active duty under honorable conditions dated within 120 days; SF-15 Form and related documentation; VA letter.) If you are a veteran and you are claiming 5-point veterans' preference, you must submit a copy of your DD-214 or other proof of eligibility.
  If you are a veteran and you are claiming 10-point veterans' preference, you must also submit an SF-15, "Application for 10-Point Veterans' Preference" plus the proof required by that form. For more information on veterans' preference click here.
- Career Transition Assistance Program/Interagency Career Transition Assistance Program documentation, if applicable (e.g. Certification of Expected Separation, Reduction-In-Force Separation Notice, or Notice of Proposed Removal; SF-50 that documents the RIF separation action; and most recent performance appraisal.)
- Worker's Compensation Separation: Agency certification of inability to place employee AND Notification of Separation OR Separation SF-50.
- Disability Annuity Termination: Notification from OPM of disability annuity termination AND Separation SF-50 of the last position held.
- Military Reserve or National Guard Technician Special Disability Retirement Annuity under 5 U.S.C. 8337(h) or 8456: Certification of special disability retirement annuity from a military department or National Guard Bureau AND Separation SF-50 of the last position held.

Failure to submit any of the above mentioned required documents may result in loss of consideration due to an incomplete application package. It is your responsibility to ensure all required documents have been submitted.

How to Apply

Please read the entire announcement and all the instructions before you begin an application. To apply and be considered for this position, you must complete all required questionnaires, assessments, and the required documentation as specified in the How to Apply and Required Documents section. The complete application package must be submitted by 11:59 PM (EST)on 08/21/2026 to receive consideration.

The application process is as follows:

Click the Apply Online button.

Answer the questions presented in the application and attach all necessary supporting documentation.

Click the "Submit Application" button prior to 11:59pm (ET) on the announcement closing date.

If you are required to complete any USA Hire Assessments, you will be notified after submitting your application. The notification will be provided in your application submission screen and via email. The notification will include your unique assessment access link to the USA Hire system and the completion deadline. Additionally, in USAJOBS you can click "Track this application" to return to your assessment completion notice.

Access USA Hire using your unique assessment link. Access is granted through your USAJOBS login credentials.

Review all instructions prior to beginning your assessments. You will have the opportunity to request a testing accommodation before beginning the assessments should you have a disability covered under the Rehabilitation Act of 1973 as amended.

Set aside at least 3 hours to take the USA Hire assessments; however most applicants complete the assessment in less time. If you need to stop the assessments and continue later, you can re-use your unique assessment link.

Your responses to the USA Hire assessments will be reused for one year (in most cases) from the date you complete an assessment. If future applications you submit require completion of the same assessments, your responses will be automatically used.

For more general information, system requirements, reasonable accommodation information, and to request assistance regarding the use of USA Hire assessments, review the following resources:

https://help.usastaffing.gov/Apply/index.php?title=USA_Hire_Assessments

To update your application, including supporting documentation: During the announcement open period, return to your USAJOBS account, find your application and click Edit My Application. This option will no longer be available once the announcement has closed.

To view the announcement status or application status: Click on this: https://www.usajobs.gov/Help/how-to/application/status/ . Your application status page is where you can view your application status, USA Hire assessment completion status, and review your notifications sent by the hiring agency regarding your application.

You may preview the assessment questionnaire by clicking here: https://apply.usastaffing.gov/ViewQuestionnaire/13031598

Agency contact information

OPM Human Resources

Phone

202-606-9321

[email protected]

Address

OPM Human Resources
1900 E St., NW
Washington, DC 20415
US

Next steps

Once referred, you may be asked to complete a structured interview, written demonstration, and/or fit interview. Deliberate attempts to falsify information may be grounds for not selecting you or for dismissing you from the position/agency during the probationary period.

Once your online application is submitted you will receive a confirmation notification by email. Your application will be evaluated. You will receive another notification about the status of your application.

We expect to make a job offer within 40 days after the closing date of the announcement. After making a tentative job offer, we will conduct a suitability/security background investigation.

Generally, an agency may not request, orally, in writing, or electronically through the USA Jobs website or other electronic means, that an applicant for appointment for a position in the civil service disclose criminal history record information before the appointing agency extends a conditional offer of employment. However, there are exceptions to this rule for positions, such as the one covered by this vacancy announcement, for which the hiring agency is required to make a criminal history inquiry before extending an offer. Accordingly, we may ask about your criminal history for this position before making a conditional job offer. We may ask you to provide or authorize us to collect your criminal history information. We will give you more details on these inquiries, including providing any required release of information form(s).

Overview

Accepting applications

Location

1 vacancy in the following location:

Washington, DC

No matching locations found.

Work site options

Telework eligible

Yes—as determined by the agency policy.

Remote job

Relocation expenses reimbursed

Salary

$169,279 - $197,200 per year

Pay scale & grade

GS 15

Promotion potential

None

Learn more about pay scale and grade

Pay scale and grade determines the salary of the job.

Work schedule

Full-time

Travel Required

Occasional travel - You may be expected to travel for this position.

Appointment type

Permanent

Occupations and job series

0340 Program Management

Supervisory status

Yes

Federal service type

This job is in the Competitive Service

Represented by a union

Drug test

Security clearance

Secret

Position sensitivity and risk

Noncritical-Sensitive (NCS)/Moderate Risk

Jobs require a background check and some require a security clearance. The type depends on the job.

Background check type

Credentialing
Suitability/Fitness

Financial disclosure required

Yes

Some jobs require financial disclosure to identify conflicts of interests.

Announcement number

26-CLD-13031598-DE

Control number

879703100

Apply Now

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Summary

This job is open to

The public

Duties

Requirements

Conditions of employment

Qualifications

Education

Additional information

Benefits

How you will be evaluated

Required Documents

How to Apply

Agency contact information

Next steps

Overview