Summary

As a Legal Administrative Specialist (Claims Examiner) at the GS-0901-9, you will be part of Healthcare and Insurance, Office of Personnel Management. If selected, you will be responsible for health plans claim processing is performed in accordance with provisions of the OPM/health plan contract and regulations of the PSHB. Prioritizing assigned duties, including inquiries from Congressional staff members, or staff members of the White House,

and other sources.

This job is open to

• Career transition (CTAP, ICTAP, RPL)
  
  Federal employees who meet the definition of a "surplus" or "displaced" employee.
• Veterans

Duties

• Reviews health insurance disputes between enrollees and participating PSHB carriers to ensure Postal Service enrollees receive the benefits that OPM has negotiated with carriers.
• Tracks trends and systemic claim processing errors that surface from the disputed claim appeal process in order to provide recommendations to the Health Insurance Specialists.
• Analyzes and prepares responses to inquiries from the White House or congressional staff and other interested parties, such as insurance carriers, or providers of health care.
• Responds to PSHB inquiries from Postal Service employees, retirees, survivors or their authorized representatives which are received by telephone, mail, electronic mail, or in person.

Requirements

Conditions of Employment

• Must be a U.S. Citizen or National
• Males born after 12-31-59 must be registered for Selective Service
• Suitable for Federal employment, determined by a background investigation
• May be required to successfully complete a probationary period
• Complete the initial online assessment and USAHire Assessment, if required
• This position is eligible for inclusion in the bargaining unit.
  
  • if the duty station is finalized in the Washington, DC metropolitan area, employees in this position will be represented by the American Federation of Government Employees (AFGE) Local 32. (BU Code - 2286)
  • if the duty station is finalized outside of the Washington, DC metropolitan area, this position will not be represented by a bargaining unit. (BU Code - 7777)

Qualifications

For the GS-09 Grade Level: Applicants must meet at least ONE of the qualification requirements described under A, B, or C below:

[A] GRADUATE EDUCATION: A master's or equivalent graduate degree or two full years of progressively higher level graduate education leading to such a degree or LL.B or J.D., in Healthcare Administration, Health Policy, Business Administration, Management or other related degree.

[B] EXPERIENCE: You must have one year of specialized experience (equivalent in difficulty and complexity to the GS-07 grade level or comparable pay band in the Federal service) which demonstrates ALL of the following:

• reviewing disputed health benefits claims and appeals;
• responding to general inquiries concerning disputed claim regulations, health insurance coverage, and Federal enrollment eligibility; and
• researching contracts, law or regulation and obtaining additional information from outside sources, including the health benefit plan and providers.

[C] COMBINATION OF EDUCATION AND EXPERIENCE TO QUALIFY AT THIS LEVEL: You must have a combination of successfully completed post-high school education and experience may be used to meet total qualification requirements. To calculate, divide the number of semester hours earned (in excess of 18 semester hours) towards a graduate degree by 18. If your education is in quarter hours, convert to semester hours by multiplying the number of quarter hours earned by 2/3rds. Then divide the number of months of full-time experience by 12. If your experience was part-time, convert to full-time by dividing the number of hours worked per week by 40 then multiply by number of months. Add the two percentages. The total must equal at least 100 percent to qualify.

Applicants must meet applicable time-in-grade requirements to be considered eligible. One year at the GS-7 level is required to meet the time-in-grade requirements for the GS-9 level.

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

This job does not have an education qualification requirement.

Additional information

Relocation expenses will not be paid. Incentive payments may be considered.

This job opportunity announcement may be used to fill additional similar vacancies across OPM.

Veterans Employment Opportunity Act (VEOA): To be eligible for a VEOA appointment under Merit Promotion procedures, the veteran must be a preference eligible or a veteran separated after 3 years or more of continuous active service performed under honorable conditions.

Reasonable Accommodation 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 here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable_Accommodations_for_USA_Hire

• 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.

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; 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.

You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), your responses on the application questionnaire, and your responses to all assessments required for this position. You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics):

• Attention to Detail
• Customer Service
• Decision Making
• Flexibility
• Insurance
• Integrity/Honesty
• Interpersonal Skills
• Knowledge of insurance industry practices
• Learning
• Oral Communication
• Reading Comprehension
• Reasoning
• Research
• Self-Management
• Stress Tolerance
• Teamwork
• Writing

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.

• 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.
• Required Documents
  
  As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have - whether you're a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you're eligible under their policies.
  
  To apply for this position, you must provide a complete Application Package which includes:
  
  1. 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.
  
  
  
  • 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, gender, religious affiliation, etc.
      • Encrypted and digitally signed documents.
  
  
  
  1. Other supporting documents:
     
     
     • Cover Letter, optional
     • College Transcript(s), if qualifying based on education
     • DD-214, SF-15 Form and VA letter, or certification of expected discharge or release from active duty under honorable conditions dated within 120 days: for consideration under Veteran hiring authorities.
     • Career Transition Assistance Program (CTAP)/Interagency Career Transition Assistance Program (ICTAP)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.)
     • Land and Base Management eligibles-Your most recent Promotion, Within Rate Increase (WRI/WGI), or Appointment/Conversion SF-50 or Notification of Personnel Action.
  
  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 submit all required documentation as 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. The application process is as follows:
  
  1. Click the Apply Online button.
  
  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.
  
  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.
  
  8. 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.
  
  For more general information, system requirements, reasonable accommodation information, and to request assistance regarding the 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 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: 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/12403328
  
  Agency contact information
  
  
  
  OPM Human Resources
  
  Phone
  
  202-606-9321
  
  Email
  
  jobs@opm.gov
  
  Address
  
  OPM Human Resources
  
  1900 E St., NW
  
  Washington, DC 20415
  
  US
  
  Next steps
  
  Your ratings in this Assessment Questionnaire are subject to evaluation and verification based on the documents and references you submit. Later steps in the selection process are specifically designed to verify your ratings. 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.
  
  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.
  
  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.
• Fair and Transparent
  
  The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
  
  
  • Equal Employment Opportunity (EEO) Policy
  • Criminal history inquiries
  • Reasonable accommodation policy
  • Financial suitability
  • Selective Service
  • New employee probationary period
  • Signature and false statements
  • Privacy Act
  • Social security number request

Required Documents

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

1. 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.

• 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, gender, religious affiliation, etc.
    • Encrypted and digitally signed documents.

1. Other supporting documents:
   
   
   • Cover Letter, optional
   • College Transcript(s), if qualifying based on education
   • DD-214, SF-15 Form and VA letter, or certification of expected discharge or release from active duty under honorable conditions dated within 120 days: for consideration under Veteran hiring authorities.
   • Career Transition Assistance Program (CTAP)/Interagency Career Transition Assistance Program (ICTAP)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.)
   • Land and Base Management eligibles-Your most recent Promotion, Within Rate Increase (WRI/WGI), or Appointment/Conversion SF-50 or Notification of Personnel Action.

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 submit all required documentation as 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. The application process is as follows:

1. Click the Apply Online button.

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.

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.

8. 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.

For more general information, system requirements, reasonable accommodation information, and to request assistance regarding the 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 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: 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/12403328

Agency contact information



OPM Human Resources

Phone

202-606-9321

Email

jobs@opm.gov

Address

OPM Human Resources

1900 E St., NW

Washington, DC 20415

US

Next steps

Your ratings in this Assessment Questionnaire are subject to evaluation and verification based on the documents and references you submit. Later steps in the selection process are specifically designed to verify your ratings. 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.

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.

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.

Fair & Transparent

The Federal hiring process is set up to be fair and transparent. Please read the following guidance.

• Equal Employment Opportunity (EEO) Policy
• Reasonable accommodation policy
• Criminal history inquiries
• Financial suitability
• Selective Service
• New employee probationary period
• Signature and false statements
• Privacy Act
• Social security number request