Legal Administrative Specialist (Contact Representative)

Serves as a Legal Administrative Specialist (Contact Representative) supporting an eligibility and benefits notification process, ensuring proper notification of rights to claimants. Provides administration of benefits provisions for a variety of programs (e.g., Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), Foreign Medical Program (FMP) Camp Lejeune Family Member Program (CLFMP.) Assist claimants in obtaining evidence to substantiate their request.

Duties

Duties include but are not limited to:

• Determines documentation necessary to substantiate benefit coverage under each of the specific program laws, regulations, and/or operational policies.
• Reviews claims for duplicate detection, missing or discrepant data, and medical audits.
• Determines whether criteria for eligibility have been met by or inappropriately awarded to claimants.
• Reviews operational policy manuals, pertinent laws, Agency regulations and precedents, and claims processing methodology and business rules to determine reason(s) for denial.
• Drafts formal summaries of evidence and guidelines related to benefits denial notifications for routing to claimants; identifies pertinent requirements within the law that were not satisfied.
• Provides instructions on how to submit requests for higher-level review, or the option to present appeals before the Board of Veterans' Appeals program.
• Uses system reports, the claims processing and eligibility system (i.e., CP&E), Claims XM, U.S. Code, Code of Federal Regulations, operations policy manuals, benefit applications, and medical claims evidence to determine appropriate decision notifications.
• Contacts claimants medical providers, educational institutions, commercial insurance companies, and a wide variety of government organizations to assist claimants.
• Provides input and assessments on recommended changes and requirements related to appeals modernization to facilitate changes to automated processes.
• Participates in extensive interaction with the supervisor, personnel in other directorates within IVC VFMP and may include commercial and private sector entities.

Promotion Potential: The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met. Selection at a lower grade level does not guarantee promotion to the full performance level.

Work Schedule: Monday- Friday 6:00 a.m.- 4:30 p.m. EST
Telework: This position may be authorized for Ad-Hoc telework. Telework eligibility will be discussed during the interview process.
Virtual: This is not a virtual position.
Position Description/PD#: Legal Administrative Specialist (Contact Representative)/PD36794A and PD15070A
Relocation/Recruitment Incentives: Not Authorized
Critical Skills Incentive (CSI): Not Authorized
Permanent Change of Station (PCS): Not Authorized

Salary

• $56,262 - $89,470/year

Conditions of Employment

• You must be a U.S. Citizen to apply for this job
• To be considered for this position, you must complete all required steps in the process. In addition to the application and questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job.
• Selective Service Registration is required for males born after 12/31/1959
• Physical Requirements: The work required does not inherently include any physical requirements essential for successful job performance that could not otherwise be performed with accommodation or workplace adjustment. A pre-placement physical examination is not required.
• Subject to background/security investigation
• Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued dentification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
• Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP)

As a condition of employment for accepting this position, you will be required to serve a 1-year probationary period or 2-year trial 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.

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 06/08/2026.

Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-07 position you must have served 52 weeks at the GS-05. For a GS-09 position you have served 52 weeks at the GS-07. The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment.


You may qualify based on your experience and/or education as described below:

• Specialized Experience GS-07: You must have one year of specialized experience equivalent to at least the next lower grade GS-05 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to:
  • Applied United States Code and Federal Regulations to assist in determining eligibility for Veteran Family Member Programs
  • Assisted claimants in obtaining evidence to substantiate their medical claim submission request.
  • Demonstrated experience utilizing health care industry operations; including claims processing procedures and medical reimbursement techniques.
  • Demonstrated basic experience utilizing medical coding systems (e.g. ICD-9/10, HCPCS, CPT, ADA, DSM)
  • Reviewed and verified health care program documentation and benefits to support eligibility assessments and escalate complex cases to senior staff when required OR,
• Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have 1 full year of graduate level education or superior academic achievement (see Education section below for additional information). OR,
• Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education beyond undergraduate level.

• Specialized Experience GS-09: You must have one year of specialized experience equivalent to at least the next lower grade GS-07 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to:
  • Interpreted and applied United States Code and Federal Regulations to determine eligibility for Veteran Family Member Programs and to ensure claims were processed in alignment with established policies.
  • Contacted medical providers and other health insurance agencies to assist claimants in the collection of necessary documentation for eligibility or medical claim consideration.
  • Determined what information is necessary to adjudicate claims.
  • Demonstrated experience utilizing health care industry operations; including claims processing procedures and medical reimbursement techniques to resolve claimant or provider issues.
  • Demonstrated experience utilizing medical coding systems (e.g. ICD-9/10, HCPCS, CPT, ADA, DSM) to route claims accurately, validate documentation, and ensure correct processing in accordance with program policies and coding regulations.
  • Applied analytical skills.
  • Reviewed claims for duplicate detection, missing or discrepant data OR,
• Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have a Master's or equivalent graduate degree OR,
• 2 full years of progressively higher level graduate education leading to such a degree OR,
• LL.B. or J.D., if related OR,
• Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education beyond undergraduate level.

For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.

Education A transcript must be submitted with your application if you are basing all or part of your qualifications on education. Note: 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: http://ope.ed.gov/accreditation/. 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. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/. Superior Academic Achievement: (SAA) recognizes students who have achieved superior academic standing as evidenced by one of the three methods described below. In order to be creditable under this provision, superior academic achievement must have been gained in a curriculum that is qualifying for the position to be filled. Applicants who wish to apply under this provision must submit proof from their educational institution that they meet one of the criteria listed below. To qualify for SAA, applicants must have completed all the requirements for a bachelor's degree in a curriculum that is qualifying for the position to be filled and meet one of the following: 1. Rank in the upper one-third of your class in the college, university, or major subdivision. 2. A grade-point average of at least "B" (a GPA of 3.0 or higher out of a possible 4.0) for all completed undergraduate courses, or those completed in the last two years of undergraduate study. 3. A grade point average of at least "B+" (a GPA of 3.5 or higher out of a possible 4.0) average of required courses completed in the major field of study or required courses in your major completed in the last two years of undergraduate study. 4. Membership in a national honor society. Membership in a freshman honor society cannot be used. Honor societies recognized by Association of College Honor Societies. For a list of recognized honor societies please visit https://www.achshonor.org/. For more information regarding SAA please visit https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-policies/#url=General-Policies. Other Information Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA 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 RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments. This job opportunity announcement may be used to fill additional vacancies. The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced VA competitive service employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit appropriate documentation (a copy of the agency notice, your most recent performance rating, and your most recent SF-50 noting current position, grade level, and duty location) and be found well-qualified for this vacancy. To be well-qualified: applicants must possess experience that exceeds the minimum qualifications of the position including all selective factors, and who are proficient in most of the required competencies of the job. Information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/. Required Documents

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

• Resume
• Most recent SF-50 other than an award
• CTAP documentation, if applicable
• If you are a current or former Federal employee applying for a higher grade and your SF-50 has an effective date within the past year, it may not clearly demonstrate you meet the one year time-in-grade requirement so you will need to provide an SF-50 which clearly demonstrates you meet the time-in-grade requirements. Examples of appropriate SF-50's include:
  • Within grade increases at the highest grade held; or
  • Promotions with an effective date more than one year old; or
  • SF-50's at the highest grade held with an effective date more than one year old

The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this position. Please make sure you have included other documents required for your application, such as a copy of your transcript (if using education to qualify), SF-50's (current/former Federal employees), documentation to support Veterans Preference claims, or ICTAP/CTAP documentation (for displaced Federal employees). You will not be contacted for additional information.

• Cover Letter
• DD-214/ Statement of Service
• Disability Letter (Schedule A)
• Disability Letter (VA)
• License
• Other (1)
• Performance Appraisal
• Professional Certification
• Proof of Marriage Status
• Resume
• Separation Notice (RIF)
• SF-15
• SF-50/ Notification of Personnel Action
• Transcript

SF-50, Notification of Personnel Action (if applicable for Time in Grade and/or Eligibility):

• Most recent SF-50 if you are a current or former Federal employee
• An SF-50 showing your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade
• Award 50's do not provide sufficient information and will not be accepted for the purpose of verifying time-in-grade.
• Examples of appropriate SF-50's include:
  • Within grade increases at the highest grade held; or
  • Promotions with an effective date more than one year old; or
  • SF-50's at the highest grade held with an effective date more than one year old.

It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment.

NOTE: Participation in the seasonal influenza program is a condition of employment and a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). It is a requirement that all HCP to receive annual seasonal influenza vaccination or obtain an exemption for medical or religious reasons. Wearing a face mask is required when an exemption to the influenza vaccination has been granted. HCP in violation of this directive may face disciplinary action up to and including removal from federal service. HCP are individuals who, during the influenza season, work in VHA locations or who come into contact with VA patients or other HCP as part of their duties. VHA locations include, but are not limited to, VA hospitals and associated clinics, community living centers (CLCs), community-based outpatient clinics (CBOCs), domiciliary units, Vet centers and VA-leased medical facilities. HCP include all VA licensed and unlicensed, clinical and administrative, remote and onsite, paid and without compensation, full- and part-time employees, intermittent employees, fee basis employees, VA contractors, researchers, volunteers and health professions trainees (HPTs) who are expected to perform any or all of their work at these facilities. HPTs may be paid or unpaid and include residents, interns, fellows and students. HCP also includes VHA personnel providing home-based care to Veterans and drivers and other personnel whose duties put them in contact with patients outside VA medical facilities.

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.

How to Apply

Please read the entire announcement and all the instructions before you begin an application. To apply for this position, you must complete the initial online application, to include the initial online questionnaire and submission of the required documentation specified in the How to Apply and Required Documents section. The complete application package must be submitted by 11:59 PM (ET) on the closing date of the announcement to receive consideration. To preview the application questionnaire, click https://apply.usastaffing.gov/ViewQuestionnaire/12964726. The application process is as follows:

1. To begin, click Apply Online to create a USA JOBS account or log in to your existing account. Follow the prompts to select your USA JOBS resume and/or other supporting documents.
2. Answer the questions presented in the application and attach all necessary supporting documentation.
3. Click the Submit Application button prior to 11:59 PM (ET) on the announcement closing date, 06/08/2026.
4. 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.
5. Access USA Hire using your unique assessment link. Access is granted through your USAJOBS login credentials.
6. 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.
7. Set aside at least 3 hours to take the USA Hire Assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue later, you can re-use your unique assessment link. NOTE: 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 reused.

Visit the USA Hire Applicant Resource Center for practice assessments and assessment preparation resources at https://support-usahire.opm.gov/hc/en-us.

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

To view the announcement status or your application status: https://help.usajobs.gov/how-to. 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.

Beginning September 27, 2025, Federal agencies will only accept resumes up to two pages in length to comply with the Merit Hiring Plan. Resumes longer than two pages will result in ineligibility for further consideration for the position. USAJOBS will not allow you to upload or build resumes longer than two pages, and you will need to update the resumes in your profile before applying for a job. Resumes should include information relevant to the knowledge, skills, abilities, and competencies of the position to which you are applying. VA is unable to make assumptions about qualifications if not clearly listed.

Resumes must be legible so they can be reviewed for eligibility, minimum qualifications and other position requirements listed in the job announcement.

Your resume must be 5MB or less. We recommend saving and uploading your resume as a PDF to maintain formatting and number of pages. We also accept GIF, JPG, JPEG, PNG, RTF, TXT, PDF, ODT or Word (DOC or DOCX). We do not accept PDF portfolio files. We recommend using a sans-serif font size like Lato, if available. Other widely available options are Calibri, Helvetica, Arial, Verdana, Open San Source Sans Pro, Roboto or Noro Sans. Make your page margins 0.5 inches. Consider using 14-point size font for titles and 10-point for the main text in your resume. The resume builder can help you create a resume using these recommendations and uses the information in your USAJOBS profile to help you get started.

Helpful Hints for Creating a Two-Page Resume:

• Prioritize most relevant and recent experience
• Use concise, results focused language
• Align language from the job announcement
• Focus on demonstrating skills and competencies
• Remove outdated or unrelated experience
• Use the USAJOBS resume builder

Additional guidance on this new requirement and resume building tools can be found at https://help.usajobs.gov/faq/application/documents/resume/page-limit