This position will be assigned to the Air Force Service Center. This is a regular full-time category position with guaranteed 40 hrs per week. Employees appointed to a regular category position are eligible for benefits.

Duties

Performs complicated technical work adjudicating workers' compensation claims of injured employees of the Air Force (AF) Nonappropriated funds (NAF) instrumentalities. Work involves studying case histories, evaluating data, providing information, preparing determinations regarding benefits, assisting program participants, and handling large volumes of claim documentation. Works under close/general direction with some latitude for independent decisions in accordance with established office policy and procedures with limitation of authority. Adjudicates claims received in the branch. Determines compensability; prepares controversions, calculates income benefits; manages and controls medical benefits; negotiates settlements; attends hearings; prepares reports and congressional inquiries; analyzes and request ancillary services as and when needed; communicates with all parties concerned; documents claim files; and provides assistance to fellow team members and management as needed. Reviews files for compliance with all pertinent laws, regulations, directives, policies, and instructions. Prepares formal factual reports to include congressional responses on file activity documenting all levels of work performed. Accurately prepares training slides and conducts training and briefs field staff regarding workers' compensation policies, procedures and performance trends as and when needed. Assists the Claims Examiner Team Leader with resolution or settlement of complex claims. Assist with claim reviews for compliance and correctness to ensure quality decisions are being made of work performed. Serves as back-up to the team leader in his/her absence, to include, settlement reviews, CMlP's reimbursements, check runs and assist the Claims Technicians (front desk) when needed. If interested in applying for this position you may preview the online application: https://apply.usastaffing.gov/ViewQuestionnaire/12037489

Requirements

• This position requires the incumbent to complete a background investigation with favorable results.

Qualifications

Who May Apply: Open to everyone. Applicants will be categorized by preference(s) and/or priority consideration eligibilities. An applicant's eligibility will be determined based on eligibility claimed in the questionnaire and proof of eligibility MUST be provided with application by the closing date, 07/25/2023 Business Based Action, Military Spouse Preference, Outside Applicant Veteran, Spouse/Widow/Parent of Veteran, and Transition Hiring Preference In order to qualify, you must meet the experience requirements described below. 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). You will receive credit for all qualifying experience, including volunteer experience. Your resume must clearly describe your relevant experience; if the position allows for qualifying based on education, your transcripts will be required as part of your application. Qualifying Experience: Experience with worker's compensation coverage, concepts, claims adjudications procedures, laws, medical cost containment, and claim settlement procedures, dispute resolution, disability determination, negotiation, medical terminology, investigation, internal audit procedures, and written and verbal communication. Experience with managing and executing multiple projects simultaneously. Experience to work effectively and harmoniously with senior management, peers, and subordinates alike. Knowledge, Skills and Abilities (KSA's): Your qualifications will be evaluated on the basis of your level of knowledge, skills, abilities and/or competencies in the following areas: Experience to think independently, analyze problems, apply sound judgement, apply practical application, and provide alternative solutions. Knowledge of medical coding, billing, or terminology. Other type of claims handling experience. **NOTE: Those qualified applicants who meet both the minimum qualification requirement(s) and highly preferred criteria(s) will be considered best qualified for this position and will be referred to the selecting official(s) first for consideration. All other applicants will be referred as needed and requested by the selecting official(s). **Reminder to Applicants: Your experience has to be clearly identified in your resume in order to receive consideration. If your resume does not provide enough information regarding your work history for us to make a creditable qualification determination, your application package may be rendered disqualified and you will no longer be considered for this position.

Education

Some federal jobs allow you to substitute your education for the required experience in order to qualify. This position does not allow for education substitution.

FOREIGN EDUCATION: Education completed in foreign colleges or universities may be used to meet the requirements. You must show proof the education credentials have been deemed to be at least equivalent to that gained in conventional U.S. education program. It is your responsibility to provide such evidence when applying.

Contacts

• Address AFSVC Plans and Force Management AFSVC/SVX, 2261 Hughes Ave, Suite #156 Lackland AFB, TX 78236-9852 US
• Name: JBSA Lackland NAF HR Office
• Email: [email protected]