Claims Assistant

This position is located in the Department of Veterans Affairs Regional Office and Insurance Center (Philadelphia), Insurance Claims Division. The incumbent serves as one of a group of Claims Assistants in the Insurance Claims Division who manage the monthly insurance accounts as well as process adjustments to both enforce and matured life insurance policies.

Duties

Duties include but are not limited to:

• Reviews the insurance master record and/or paper file, determines entitlement and invites claims to beneficiaries. Performs preliminary development work, identifying complicated legal or regulatory issues requiring referral to higher graded employees.
• Authorizes payment of claims where the issues area clear and uncomplicated. Releases account status to claimants involving lapsed policies after extensive review and audit of records. Determines where administrative adjustment may save lapsed insurance policies; refers them to higher-graded employees.
• Performs stop actions, account adjustments and initiates recovery of payments, when advised of the death of a payee who was receiving monthly insurance amounts.
• Conducts quality assurance to ensure clarity and legibility of all scanned documents.
• Receives/manages incoming transfer of funds from Treasury as well as ensure all returned/cancelled monthly payments are properly dated and otherwise accounted for.
• Award maintenance of Direct Deposit and address change updates in ADE and ITS to resume payments of monthly awards.
• Traces missing payments or overpayment's when appropriate using Pacer system and sends replacement payments in accordance with current practices.
• Analyzes incoming insurance award related correspondence with available records and responds with requested information on account status, to include amount of monthly payment.
• Processes address changes for insureds receiving insurance disability benefits or in conjunction with submitted beneficiary designations.
• RPO processing to develop return checks if individual is deceased, frozen accounts (i.e., address confirmation/banking information letters).
• Batches and stores scanned work in date and time sequence for expedient retrieval.
• Analyzes all incoming Beneficiary Designation Forms and correspondence as well as makes determination as to the acceptability of the designation based on Insurance regulations and processes form.
• Responsible for determining proper classification of input to the proper category via the optical imaging system and verifies work is inputted into appropriate profile so that the correct tasks have been generated in the paperless environment.
• Creates an electronic file in the computer system which links with the Insurance system to generate tasks for the paperless office as well as processes work flow tasks that are generated through VICTARS and monitors for any backlogs, failures in indexing or batch processing which would impact VICTARS processing.
• Distributes daily reports and sets up the daily RH application materials as well as generates reports based on scanning data collected daily, weekly, monthly and yearly

Salary

• $43,550 - $56,612/year

Conditions of Employment

• You must be a U.S. citizen to apply for this job
• Selectees are subject to a background/suitability investigation
• Selective Service registration is required for males born after 12/31/1959
• A probationary period may be required for employees and supervisors

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-5 position you must have served 52 weeks at the GS-4 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 for this position, applicants must meet all requirements by the closing date of this announcement.

To qualify, applicants must have one year of specialized experience equivalent to at least the next lower grade (GS-4) in the normal line of progression for the occupation in the organization. Such experience may have been gained by working in an agency or insurance company that had intricate and precise procedures for the processing claims. Examples of specialized experience include, but are not limited to one (1) of the following:

(1) Experience in the preparation of claims for benefits;
(2) Demonstrated experience in the procurement and handling of relevant evidence pertaining to claims for benefits or entitlements programs (the ability to electronically control and maintain pertinent files and documents in the claims process);
(3) Demonstrated experience in which the applicant showed evidence of a working knowledge of claims processing; and
(4) Experience with the use of computers and document imaging systems.
(5) Demonstrated customer service skills daily, a positive attitude, and desire to help others.

OR
Applicants may substitute education for the experience required to qualify at the GS-5 level:

Completed a four year (120 semester hours or 180 quarter hours) course of study from an accredited business, secretarial or technical school, junior college, college, or university, or you have been awarded a bachelor's degree.

OR
Applicants may also combine education and experience to qualify at this level:

You must have an combination of specialized experience and education beyond 4 years of high school education. To combine education and Specialized Experience first determine your total qualifying experience as a percentage of the experience required for the grade level; then determine your education as a percentage of the education required for the grade level; and then add the two percentages. The total percentages must equal at least 100 percent to qualify an applicant for that grade level. To qualify for this position, applicants must meet all requirements by the closing date of this announcement.

The Office of Personnel Management's group coverage qualification standards, associated individual occupational requirements (IOR), and individual qualification standards covering white collar occupations in the Federal competitive service can be found here. 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. Other Information

Work Schedule: Monday through Friday, 6:00am - 6:00pm, Flex schedule available

Title/PD#: Claims Assistant GS - 5; PD 42000-A

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.

Special Employment Consideration: The Interagency Career Transition Assistance Plan (ICTAP) and 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 ICTAP and 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 or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement.

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 (TJO). Please visit the Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP), https://www.va.gov/EMPLOYEE/docs/The-Fair-Chance-to-Compete-Act.pdf."

Required Documents

The following documents are required for all applicants:

• Resume

Review the information below and submit any additional documents (as needed) to demonstrate your eligibility and/or qualifications for the position:

Current Federal Employees:

• If you are applying using your status as a current federal employee or as a VEOA candidate (who is a current federal employee) you must submit your most current SF-50.
• To support your claim that you have the required time-in-grade, you must submit your most recent promotion, within-grade increase, or appointment SF-50 (not an award or general adjustment SF-50). Some applicants may have to submit more than one SF-50 in order to demonstrate their eligibility.
• If you previously held a higher grade, you must also submit an SF-50 showing that grade.

Resume

• Your resume may be submitted in any format, however we strongly recommend using USA Jobs resume builder as it contains all of the information required on federal resumes.
• For qualifications determinations your resume must contain hours worked per week, the dates of employment, and the level of your experience. If your resume does not contain this information you will not receive consideration for this position.
• If you submit more than one copy of your resume, only the most recent version will be reviewed. The latest timestamp will be used to determine which version of your resume is "most recent." It is your responsibility to check the status and timestamp of all documents you submit as part of your application.
• If your resume includes a photograph or other inappropriate material or content, it will not be used to make eligibility and qualification determinations and you may not be considered for this vacancy.

Applicants claiming VEOA:

• A legible copy of your DD Form 214, "Certificate of Release or Discharge from Active Duty," showing all dates of service, as well as character of service (Honorable, General, etc.). The member 4 copy of your DD Form 214 is preferable. Copies of DD-214's can be requested here.
• Current active duty members must submit a signed statement of service from their commander dated within the last 120 days that contains their expected discharge date, their release from active duty under honorable conditions, any medals awarded, and the timeframe of their service so eligibility can be determined.

Transcripts

• If you are basing all or some of your qualifications on education or if a degree is required for the position, a transcript must be included as part of your application package.
• Unofficial transcript(s) may be submitted, however it must contain the course names, levels, credits earned, and grades received.
• Your transcript must contain the degree conferred date if you are substituting a degree for experience.
• If you are claiming superior academic achievement (SAA) ensure you submit completed transcript(s) to demonstrate it. The requirements for superior academic achievement can be viewed here.
• A photocopy of your degree is not acceptable in place of a transcript.
• An official transcript will be required at a later date if you are selected for the position.

Applicants claiming CTAP/ICTAP eligibility must also submit:

• Certification of expected separation, reduction-in-force separation notice, or notice of proposed removal; and your most recent performance evaluation; and an SF-50 demonstrating your separation or the position you will be separated from. Or
• Worker's compensation separation: agency certification of inability to place employee and notification of separation or a separation SF-50. Or
• Disability annuity termination: Notification from OPM of disability annuity termination and separation SF-50 of the last position held. Or
• 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. You will not be contacted for additional information.

In addition to the information listed above, please use this checklist to ensure you have included other documents required for your application.

How to Apply

To apply for this position, you must complete the https://apply.usastaffing.gov/ViewQuestionnaire/12617587 and submit the documentation specified in the job announcement. Documents will not be accepted after the closing date of the announcement.

The complete application package must be submitted by 11:59 PM (EST) on 12/06/2024 to receive consideration.
1. To begin, click apply online to create a USAJOBS account or log in to your existing account. Follow the prompts to select your USAJOBS resume and/or other supporting documents and complete the occupational questionnaire.
2. Click submit my answers to submit your application package.

Note: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.

To verify your application is complete, log into your USAJOBS account, select the application status link and then select the more information link for this position. The details page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process.

To return to an incomplete application, log into your USAJOBS accountand click update application in the vacancy announcement. You must re-select your resume and/or other documents from your USAJOBS account or your application will be incomplete.

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. Learn more about federal benefits.

Review our benefits