Supervisory Legal Administrative Specialist (Claims Examiner)

Supervisory Legal Administrative Specialist (Claims Examiner)

As a Supervisory Legal Administrative Specialist (Claims Examiner) at the GS-0901-13 with a full performance level of GS-13, you will be part of Healthcare and Insurance (HI), Federal Employee Insurance Operations, Office of Personnel Management. The incumbent will serve as a supervisor assisting the Program Manager in effective oversight of assigned employees and functions. The employee will manage a team of Legal Administrative Specialists in the review of disputed health benefits claims.

1. Leads a team of people who review disputed Federal Employees Health Benefits (FEHB) claims to determine if a carrier's actions are in accordance with the provisions of the contract between OPM and the carrier.
2. Interprets pertinent Federal laws, FEHB Program regulations, and contract provisions as they relate to disputed claim review.
3. Performs research and uses all available resources and reference materials (e.g., internal files, medical policies or opinions, and medical guidance) to support a final decision on a disputed claim.
4. Serves as a senior advisor and subject matter expert on the disputed claim review process.
5. Prepares reports and maintains records of work accomplishments and administrative information, as required, and coordinates the preparation, presentation and communication of work-related information to the supervisor.
6. Maintains program and administrative reference materials, project files, and relevant background documents, and makes available policies, procedures and written instructions from the supervisor.

$117,962 - $153,354/year

• Must be a U.S. Citizen or National
• Males born after 12-31-59 must be registered or exempt from Selective Service (see 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 not eligible for inclusion in a bargaining unit

For the GS 13: You must have one year (52 weeks) of specialized experience (equivalent in difficulty and complexity to the GS-12 grade level or comparable pay band in the Federal Service) which demonstrates ALL of the following (Resume must support and elaborate on the experience required):

• Reviewing health insurance claim disputes under a formal appeal process;
• Ensuring that contract provisions adhere to health insurance laws and regulations; AND
• Draft reports and deliver presentations concerning health insurance appeal activities.

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.

There are no educational requirements for this position.

Current OPM employees may be entitled to relocation expenses.
Incentive payments may be considered.
This job opportunity announcement may be used to fill additional similar vacancies across OPM.

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

• 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.
• Other supporting documents:
  • Cover Letter, optional
  • If you are requesting a reasonable accommodation to the USA Hire Competency Based Assessments, submit documentation to support your request including the Reasonable Accommodation Request Form found here.
  • Veterans' Preference documentation, if applicable

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.

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 the required documentation as specified in the How to Apply and Required Documents section. The complete application package must be submitted by 11:59 PM (EST) on 10/21/2024 to receive consideration.

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.