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Claims Examiner
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Claims Examiner
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Claims Examiner
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Claim Examiner
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Claims Examiner
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Stable & Mature LTD Claims Examiner
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Senior Claims Examiner, D&O
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Health Services Plan
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Attorney
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Trades Helper
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Customer Service Representative
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Management Trainee
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Veterans Claims Examiner - Philadelphia, United States - Veterans Benefits Administration
Description
Summary Incumbent serves as a Senior Veterans Claims Examiner in the Live Claims Section in the Insurance Claims Division, responsible for the administration of insurance claims benefits for Veterans, their beneficiaries and representatives nationwide.
the division issues over 21,000 Service-Disabled Veterans Insurance (S-DVI) policies, grants over 10,000 waiver of premium decisions, maintains over 37,000 running awards and processes over 70,000 beneficiary designations per year.
Responsibilities Major Duties:
This position is located in the Insurance Claims Division, VA Life Insurance Service, Philadelphia, PA.
Major duties include, but are not limited to:
The incumbent determines if the disability on which benefits are granted is traceable to the extra hazards of service.
Conducts all development required to prepare claim for a decision. processes notices of competency/incompetency, appointments, change and or discharge of fiduciaries. Replies to correspondence from insureds, beneficiaries, third parties concerning insurance matters. Responsible for preparing competency determinations in connection with applications for loans and cash surrenders. Reviews each case for any evidence of fraud prior to rendering a decision. Prepares decisions of fraud or no fraud. A fraud decision has the effect of canceling the insured's coverage. Determines if the disability on which benefits are granted is traceable to the extra hazards of service.Collects monthly performance data on GS 07 and GS-09 Veteran Claims Examiners and give the results to the Section Chief Chief.
The incumbent replies to VIPS inquiries and Claims Queue inquiries. Then incumbent performs industrial reviews on certain waiver cases when required. The incumbent reviews all underwriting actions.Review case work for accuracy and evaluating any additional evidence which may be received Controls pending waiver cases advises Claims Examiners how to expedite the adjudication of these cases.
Requirements Conditions of Employment Qualifications Time-in-grade: Applicants who are/were federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements.
For a GS-11 position you must have served 52 weeks at the GS-9 level.To support your claim of time in grade, you must submit your most recent appointment, promotion, or within grade increase SF-50 (not an award or general adjustment SF-50).
Some applicants may have to submit more than one SF-50 to demonstrate their eligibility. See the required documents section for more information.Specialized Experience:
To qualify, applicants must have one year of specialized experience equivalent to at least the next lower grade (GS-09) in the normal line of progression for the occupation in the organization.
Examples of specialized experience would typically include, but are not limited to:positions that have involved experience in the development, examination, investigation, adjudication, and authorization of claims for disability compensation, disability pension, dependency and indemnity-compensation, death pension benefits, life insurance benefits, etc.
Such experience is to be substantive and relevant to the position being filled. OR Applicants may substitute education for the experience required for the GS-11 level. Ph.D.
or equivalent doctoral degree or 3 full years of progressively higher-level graduate education leading to such a degree or LL.M., if related.
Such education must demonstrate the competencies necessary to do the work.OR Applicants may also combine education and experience to qualify at the GS-11 level: Equivalent combinations of specialized experience and PH.D.
graduate education. To compute, divide your total months of qualifying experience by 12. Then divide your semester hours of graduate education beyond two years by 18. Add the two percentages. The total percentage must equal at least 100% to qualify.Education A transcript must be submitted with your application if you are basing all or part of your qualifications on education.
Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for federal employment. You can verify your education here.If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education.
Additional Information Work Schedule:
Monday through Friday 6:30am to 6:30pm; flexible schedule available Veterans Claims Examiner (Live Claims)
GS - 11; PD 00667-A Special Employment Consideration:
Career Transition Assistance Plan (CTAP) provide eligible displaced Federal competitive service employees with selection priority over other candidates for competitive service vacancies.
To be qualified you must submit appropriate documentation and be found well-qualified for this vacancy.A well-qualified candidate is defined as meeting all of the minimum qualification standards and eligibility requirements as well as possessing skills that clearly exceed the minimum qualifications requirements for this position.
Information about CTAP eligibility can be found here.VA supports the use of telework as a way to help attract and retain talented individuals in public service, increase worker productivity, and better prepare the agency to operate during emergencies.
This position may be authorized for telework. Telework eligibility will be discussed during the interview process. This job opportunity announcement may be used to fill additional vacancies. If you are unable to apply online view the following link for information regarding an Alternate Application.Physical Requirements:
The work is sedentary. Typically, the employee may sit comfortably to do the work.
However, there may be some walking; standing; bending; carrying of light items such as papers, books, small parts; driving an automobile, etc.
No special physical demands are required to perform the work.Placement Policy:
The posting of this announcement does not obligate management to fill a vacancy or vacancies by promotion. The position may be filled by reassignment, change to lower grade, transfer, appointment, or reinstatement. Management may use any one or any combination of these methods to fill the position. This job opportunity announcement may be used to fill additional vacancies. If you are unable to apply online view the following link for information regarding an Alternate Application.
