Summary

As a Legal Administrative Specialist (Insurance Benefits Claims Examiner), you will be part of Healthcare and Insurance, Office of Personnel Management. If selected, you will review health insurance disputes between enrollees and participating PSHB carriers to ensure Postal enrollees receive the benefits that OPM negotiated with carriers and respond to general inquiries concerning PSHB Program disputed claim regulations, health insurance coverage, and Federal enrollment eligibility.

This job is open to

• The public
  
  U.S. Citizens, Nationals or those who owe allegiance to the U.S.

Clarification from the agency

Please read this Public Notice in its entirety prior to submitting your application for consideration. You are applying to a resume database. Your resume and any documents submitted will be retained and may be used at any time during the open period of this Public Notice. U.S. Citizenship is REQUIRED. Promotion potential is contingent on the position to which appointed.

Duties

• Respond to Postal Service Health Benefits (PSHB) inquiries from Postal enrollees and/or their authorized representatives, including responses on appeals of disputed health benefit claims, benefits regulations, and other program related inquiries.
• Prepares written directives for the Contracting Officer's signature requiring carriers to provide benefits, as appropriate.
• Respond to general inquiries concerning disputed claim regulations, health insurance coverage, and Federal enrollment eligibility.
• Perform research and obtain additional information from outside sources, including the health benefits Plan and providers.
• Consult with internal clinical advisors (e.g. nurse) to resolve disputed health benefits claims and develop responses to inquiries and correspondence.
• Conduct thorough case analysis on disputed health benefits claims.
• Develop a written appeal response that is based on analysis and PSHB Program benefit policies and guidelines.
• Track trends and systemic claim processing errors that surface from the disputed claim appeal process in order to provide recommendations to the Health Insurance Specialists for carrier to take corrective action or make contract language improvements.

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
• This position is eligible for inclusion in the bargaining unit. The union that represents employees in this position is the American Federation of Government Employees (AFGE) Local 32.

Qualifications

THIS IS A PUBLIC NOTICE: This Notice is issued under Direct-Hire Authority (DHA) to recruit new talent for the positions listed below. This means that we can hire any qualified candidate, either from this notice or from any source.

We will refer qualified applicants to the selecting official for consideration. The organization's hiring need will determine the referral of additional applicants. Applicants will be notified about their application's status if referred or if we fill all vacancies.

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.

Work Schedule: These positions allow for multiple schedules. Work schedule will be determined at the time of selection.

Please note, there may or may not be actual/projected vacancies when you submit your application. Your resume and any supporting documentation will be retained with other applicants and reviewed as vacancies occur. You will not receive a notice regarding your application's status.

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

PLEASE NOTE: Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications (particularly positions with a positive education requirement). Therefore, applicants must report only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education. Applicants can verify accreditation at the following website: http://www.ed.gov/admins/finaid/accred/index.html. All education claimed by applicants will be verified by the appointing agency accordingly. 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

This announcement will be used to fill vacancies through OPM-authorized Direct Hire Authority due to Critical Hiring Need/Severe Shortage of Candidates. Veteran preference and traditional rating/raking of applicants do not apply. For more information on OPM's authorization of Direct Hire Authority, please visit: https://www.opm.gov/policy-data-oversight/hiring-information/direct-hire-authority/

Relocation expenses will not be paid.

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

If you are unable to apply online or need to fax a document that you do not have in electronic form, view the following link for information regarding an Alternate Application: http://help.usastaffing.gov/Apply/index.php?title=Alternate_Application_Information

If you are unable to apply online or need to fax a document that you do not have in electronic form, view the following link for information regarding an Alternate Application. Click the following link for more information, https://help.usastaffing.gov/Apply/index.php?title=Alternate_Application_Information.

• 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.

Once the application process is complete, your resume and supporting documentation will be used to determine whether you meet the job qualifications listed on this announcement. Applicants who meet minimum qualification requirements will be certified for further consideration. The hiring manager may require you to submit a writing sample as part of the consideration process.

• 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. Resume (no more than 5 pages) showing full legal name, email address, identify full or part time status for each job worked, dates of employment and duties performed. Resume must be submitted to the designated email address as an attached Word or PDF document. Submissions that include links to documents being stored in cloud storage will not be considered.
  2. Other documents: College Transcript(s), if qualifying based off education rather than job experience, or if qualifying off a combination of education and experience.
  
  
  
  If you are relying on your education to meet qualification requirements:
  
  Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from
  schools accredited by accrediting institutions recognized by the U.S. Department of Education.
  
  Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
• How to Apply
  
  This Direct Hire Public Notice will be used to build a list/inventory of applicants that may be referred as vacancies become available. You must submit a resume and or transcripts, before your eligibility can be confirmed. Errors or omissions may result in your not being considered for this vacancy. You can modify/complete your application any time before the vacancy date/time deadline.
  
  Email your Resumes and or Transcripts to: hidirecthire1@opm.gov and reference "24-PSIO-LGL-ADM-DMM-SPLASH" in the subject line. In your email, identify which position you are applying for. If no position is identified, you will not be considered.
  
  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
  
  This Notice is issued under Direct-Hire Authority (DHA) to recruit new talent to help with the implementation of the Postal Service Health Benefits Program (PSHBP). To help us fill these jobs, we have been granted "Direct Hire Authority" or DHA. This means that when we have a vacant job, we can hire any qualified candidate, either from this notice or from any source. The benefit of applying to this notice is that your application may be shared with a hiring manager if they request resumes. The following process is used if your application is submitted.
  
  1. ELIGIBILITY/QUALIFICATIONS: Your resume will be reviewed for qualifications and/or transcripts for qualifying off education.
  
  2. REFERRAL TO MANAGEMENT: If you meet all of the requirements, your resume will be passed to the hiring manager. You may be contacted for an interview.
  
  3. SELECTION/TENTATIVE JOB OFFER: If you are selected, you will receive a tentative offer and start the suitability and/or security background investigation process.
  
  4. FINAL JOB OFFER: Once our security office determines your suitability for employment, you will be given a final offer. This process may take up to 6 weeks.
  
  We appreciate the time and effort you have taken to apply with the Office of Personnel Management.
• 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
  • 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. Resume (no more than 5 pages) showing full legal name, email address, identify full or part time status for each job worked, dates of employment and duties performed. Resume must be submitted to the designated email address as an attached Word or PDF document. Submissions that include links to documents being stored in cloud storage will not be considered.
2. Other documents: College Transcript(s), if qualifying based off education rather than job experience, or if qualifying off a combination of education and experience.

If you are relying on your education to meet qualification requirements:

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from
schools accredited by accrediting institutions recognized by the U.S. Department of Education.

Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

How to Apply

This Direct Hire Public Notice will be used to build a list/inventory of applicants that may be referred as vacancies become available. You must submit a resume and or transcripts, before your eligibility can be confirmed. Errors or omissions may result in your not being considered for this vacancy. You can modify/complete your application any time before the vacancy date/time deadline.

Email your Resumes and or Transcripts to: hidirecthire1@opm.gov and reference "24-PSIO-LGL-ADM-DMM-SPLASH" in the subject line. In your email, identify which position you are applying for. If no position is identified, you will not be considered.

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

This Notice is issued under Direct-Hire Authority (DHA) to recruit new talent to help with the implementation of the Postal Service Health Benefits Program (PSHBP). To help us fill these jobs, we have been granted "Direct Hire Authority" or DHA. This means that when we have a vacant job, we can hire any qualified candidate, either from this notice or from any source. The benefit of applying to this notice is that your application may be shared with a hiring manager if they request resumes. The following process is used if your application is submitted.

1. ELIGIBILITY/QUALIFICATIONS: Your resume will be reviewed for qualifications and/or transcripts for qualifying off education.

2. REFERRAL TO MANAGEMENT: If you meet all of the requirements, your resume will be passed to the hiring manager. You may be contacted for an interview.

3. SELECTION/TENTATIVE JOB OFFER: If you are selected, you will receive a tentative offer and start the suitability and/or security background investigation process.

4. FINAL JOB OFFER: Once our security office determines your suitability for employment, you will be given a final offer. This process may take up to 6 weeks.

We appreciate the time and effort you have taken to apply with the Office of Personnel Management.

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
• Financial suitability
• Selective Service
• New employee probationary period
• Signature and false statements
• Privacy Act
• Social security number request