Director, Medicare Enrollment and Appeals Group
About This Position
This position is located in the Center of Medicare, Medicare Enrollment and Appeals Group, Centers for Medicare and Medicaid Services (CMS). As the Director, Medicare Enrollment and Appeals Group, you will provide executive leadership for a comprehensive program to develop and implement national policies and procedures of enrollment and disenrollment for both Original Medicare and the Part D and MA programs, claims-related hearing, appeals, and grievances processes for all Medicare Parts.
Qualifications
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. Candidates will not be hired based on their race, sex, color, religion, or national origin. To meet the minimum qualification requirements for this position, you must show that you possess the Executive Core Qualifications (ECQs) and Technical Qualifications (TQs) related to this position within your resume - NOT TO EXCEED 2 PAGES.
Resumes over the 2-page limit will not be reviewed beyond page 2 or may be disqualified.
Your resume should include examples of experience, education, and accomplishments applicable to the ECQ's and TQ's. If your resume does not reflect demonstrated evidence of these qualifications, you may not receive consideration for the position. There is NO requirement to prepare a narrative statement specifically addressing the Executive Core Qualifications (ECQs) or the Technical Qualifications (TQs).
TECHNICAL QUALIFICATIONS (TQs): Your resume should demonstrate accomplishments that would satisfy the technical qualifications. TQ 1: Demonstrated senior-level experience leading complex health care program policy and operations for eligibility, enrollment, and appeals processes for a national or state health care program or large scale health organization in the public and/or private sector. TQ 2: Demonstrated executive leadership experience directing highly skilled, multidisciplinary professional staff, managing large budgets, and creative resourcing activities to delivery high-profile initiatives within a national or state health care program or large-scale health care organization.
EXECUTIVE CORE QUALIFICATIONS (ECQs):
In addition to the Technical Qualification Requirements listed above, all new entrants into the Senior Executive Service (SES) under a career appointment will be assessed for executive competency against the following five mandatory ECQs. If your 2-page resume does not reflect demonstrated evidence of the ECQs and TQs, you may not receive further consideration for the position. There are five ECQs: ECQ 1: Commitment to the Rule of Law and the Principles of the American Founding - This core qualification requires a demonstrated knowledge of the American system of government, commitment to uphold the Constitution and the rule of law, and commitment to serve the American people.
ECQ 2: Driving Efficiency - This core qualification involves the demonstrated ability to strategically and efficiently manage resources, budget effectively, cut wasteful spending, and pursue efficiency through process and technological upgrades. ECQ 3: Merit and Competence - This core qualification involves the demonstrated knowledge, ability, and technical competence to effectively and reliably produce work that is of exceptional quality. ECQ 4: Leading People - This core qualification involves the demonstrated ability to lead and inspire a group toward meeting the organization's vision, mission, and goals, and to drive a high-performance, high-accountability culture.
This includes, when necessary, the ability to lead people through change and to hold individuals accountable. ECQ 5: Achieving Results - This core qualification involves the demonstrated ability to achieve both individual and organizational results, and to align results to stated goals from superiors.
Note: If you are a member of the SES or have been certified through successful participation in an OPM approved SES Candidate Development Program (SESCDP), or have SES reinstatement eligibility, you do not need to respond to the ECQs. Instead, you should attach proof (e.g., SF-50, Certification by OPM's SES Qualifications Review Board (QRB)) of your eligibility for noncompetitive appointment to the SES.
Major Duties
Serves as the principal advisor to CMS leadership on Medicare eligibility, enrollment, entitlement, appeals, grievances, and dispute resolution policies for Medicare Parts A, B, C, and D.
Directs and oversees all functions of the Medicare Enrollment and Appeals Group (MEAG), establishing strategic goals, managing operations, evaluating performance, and resolving complex policy and operational issues.
Promotes quality management principles, including teamwork, customer focus, employee engagement, continuous improvement, and beneficiary-centered service delivery.
Oversees implementation and administration of Medicare statutory requirements, including Limitation on Liability, physician refund requirements, and medical equipment and supplies beneficiary protections.
Directs the development, evaluation, and issuance of regulations, guidance, operational instructions, and manuals governing Medicare appeals, grievances, enrollment, entitlement, and late enrollment penalties.
Provides national policy leadership and operational direction to CMS components, Medicare contractors, Medicare Advantage (MA) organizations, Prescription Drug Plans (PDPs), and other key Medicare stakeholders.
Directs operational policy, business requirements, systems validation, and maintenance activities for the Enrollment Database (EDB) and Medicare Beneficiary Database (MBD).
Develops national policy and oversees operations for the Medicare Part D Low-Income Subsidy (LIS) program, including auto-enrollment, LI-NET, reassignment processes, and beneficiary outreach.
Oversees contracts and performance of external review entities and Qualified Independent Contractors (QICs), ensuring policy compliance, operational effectiveness, and quality assurance.
Maintains strategic partnerships with CMS components, contractors, plans, advocacy organizations, and other stakeholders to support effective implementation of Medicare enrollment and appeals programs.
Directs and coordinates policy implementation with the Social Security Administration, Railroad Retirement Board (RRB), Office of Medicare Hearings and Appeals (OMHA), and the Departmental Appeals Board.
How You Will Be Evaluated
You will be evaluated on the quality and extent of your total accomplishments, experience, and education (if applicable).
Your application will be rated and ranked by a Senior Executive Service (SES) Panel, comprised of at least three SES members, using only the information required within the application package. Applicants who do not demonstrate in their application sufficient possession of the ECQs and TQs will be determined ineligible for further consideration. Once the application process is complete, a review of your resume and supporting documentation will be conducted.
If you meet minimum qualifications, your Application Package will be further reviewed to determine if you possess the Executive Core Qualifications (ECQ's) and Technical Qualifications (TQ's) listed above. ECQs and TQs must be thoroughly addressed within your two (2) page resume. Separate narratives will not be accepted or reviewed.
Highly Qualified applicants may undergo one or more interviews and may be referred to the selecting official for further consideration. Upon selection, if not already a member of the SES serving under a career appointment, the individual selected must have his/her executive qualifications certified by the U.S. Office of Personnel Management's SES Qualifications Review Board (QRB) before appointment to this position.
The selected individual's application will be forwarded to the OPM for review and certification by the QRB, unless the selectee provides evidence of their noncompetitive status (i.e., a current SES, OPM QRB certified SESCDP graduate, or SES reinstatement eligible). Upon QRB certification, the selected individual will be required to serve a one-year probationary period. For more information regarding the SES, go to https://www.opm.gov/policy-data-oversight/senior-executive-service/.
Additional Information
Veterans Preference: Veterans' preference is not applicable to the SES. Mobility: Organizational and geographical mobility is essential in developing and managing SES leaders. Individuals selected for SES positions members may be subject to reassignment across geographical, organizational, and functional lines, and may be required to sign a Reassignment Rights and Obligation Agreement.
Equal Employment Opportunity (EEO) Policy Statement: http://www.eeoc.gov/federal/index.cfm Employment Information Resources - Resource Center: https://help.usajobs.gov/how-to Males born after 12-31-1959 must be registered or exempt from Selective Service (see https://www.sss.gov/RegVer/wfRegistration.aspx) OPM must authorize any employment offers made to current or former (within the last 5 years) political Schedule A, Schedule C, or Non-career SES employees in the executive branch. If you are currently, or have been within the last 5 years, a political Schedule A, Schedule C, or Noncareer SES employee in the executive branch, you must disclose that to the Human Resources Office. Salary for SES positions varies depending on qualifications.
The annual salary range is found at the top of this announcement. The selectee for this position may be eligible for annual performance bonuses and performance-based pay adjustments.
How to Apply
To apply for this position, you must complete this application and submit any required documents specified in the Required Documents section by 11:59 PM (EST) on 07/13/2026 to receive consideration. To begin, click Apply to access the online application.
You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
Follow the prompts to select and upload your reΜsumeΜ and/or other required documents to be included with your application package.
You will have the opportunity to upload additional documents to include in your application before it is submitted.
Your uploaded documents may take several hours to clear the virus scan process.
After acknowledging you have reviewed your application package, complete the "Include Personal Information" section as you deem appropriate and click to continue with the application process.
You will be taken to the online application which you must complete in order to apply for the position.
Complete the online application, verify the required documentation is included with your application package, and submit the application. It is the applicant's responsibility to verify that information entered and uploaded, (i.e., resume and other required documents) is complete, accurate, and submitted by the closing date. Human Resources will not modify or change any part of your application.
Application packages will NOT be accepted via mail. Due to security processes, mail delivery takes approximately 2-3 weeks to process at which time the vacancy announcement will be closed, and no further consideration will be given to additional application packages. Commissioned Corps Officers (including Commissioned Corps professionally boarded applicants) who are interested in applying for this position must send their cover letter and professional resume (not PHS Curriculum Vitae) to [email protected] in lieu of applying through this announcement.
The resume should specifically explain how you are qualified for this position and draw specific attention to your skills and experiences that demonstrate these qualifications. Also send any transcripts, licenses, or certifications as requested in this announcement. Please send all documents in one PDF file.
In the subject line of your e-mail include only the Job Announcement Number. In the body of your e-mail include your current rank, name, and serial number. Failure to provide this information may impact your consideration for this position.
Required Documents
A complete application includes items described below. Please note that if you do not provide all required information, as specified in this announcement, you may not be considered for this position (or may not receive the special consideration for which you may be eligible). Please carefully review the following list to determine what documentation you need to submit. Some documents may not apply to all applicants.
- RESUME: All applicants are required to submit a resume limited to two (2) pages (i.e., 1 page that is double-sided or 2 pages that are one-sided each) showing all relevant experience. Applicants seeking initial career appointment to the Senior Executive Service (SES) must include evidence of the ECQs and TQs. PLEASE DO NOT USE USAJOBS RESUME BUILDER.
- VACANCY QUESTION/ASSESSMENT QUESTIONNAIRE RESPONSES: Responses are automatically submitted through USA Jobs when you apply to this vacancy.
Click the following link to preview the assessment: https://apply.usastaffing.gov/ViewQuestionnaire/12973270.
- ADDITIONAL REQUIRED DOCUMENTS: Applicants are required to submit the following supporting documentation if applicable: CURRENT OR FORMER SES MEMBERS: Must provide your SES appointment SF-50 (Notification of Personnel Action), and an SF-50 showing current career SES status or career SES reinstatement eligibility. SES CANDIDATE DEVELOPMENT PROGRAM (SESCDP) GRADUATES: Verification of successful completion of an OPM-approved SESCDP and OPM SES QRB certification.
CURRENT FEDERAL CIVIL SERVICE EMPLOYEE: Must provide a copy of your Notification of Personnel Action, Standard Form 50 (SF-50) or equivalent personnel action form reflecting you are a current Federal Civil Service employee. STRONGLY RECOMMENDED: Most recent performance evaluation. There are three key documents that contain important information about your rights and obligations.
Please read and retain these documents: Noncriminal Justice Applicant's Privacy Rights, for those who undergo an FBI fingerprint-based criminal history record check for personnel vetting, which includes Rap Back, FD-258 Privacy Act Statement - FBI (this is the same statement used when your fingerprints are submitted as part of your background investigation), and SEAD-3-Reporting-U.pdf (dni.gov), (applicable to those who hold a sensitive position or have eligibility for access to classified information)" Applicants must complete a Declaration for Federal Employment when requested by the agency to assess suitability for Federal employment.