This position is located in Integrated Veterans Care (IVC), Veterans Health Administration (VHA). The primary mission is to efficiently administer health benefits for Veterans and family members. Serves as a Legal Administrative Specialist (Contact Representation) supporting an eligibility and benefits denial notification process, ensuring proper notification of appeals rights to claimants when eligibility and benefits are denied.

Duties

Duties include, but not be limited to: Provides instructions on how to submit supplemental claims for review, requests for higher-level review, or the option to present their appeals before the Board of Veterans' Appeals (BVA) for all VA Family Member programs administered by the wider organization. Reviews operational policy manuals, pertinent laws, Agency regulations and precedents, and claims processing methodology and business rules to determine reason(s) for denial. Coordinates with a policy management team for justification of denials or to provide recommendations for updates to the specific program segment (i.e., Family Member programs) operational policy manuals and/or the automated claims processing and eligibility system (i.e., Claims Processing and Eligibility (CP&E) System). Drafts and creates formal summaries of evidence and guidelines related to benefits denial notifications for routing to claimants or, as necessary, their representatives or medical providers. Notifies claimants of specific benefits denied and includes summaries of evidence and applicable laws and regulations considered, as well as: how to obtain copies of this evidence; identification of any favorable findings, if applicable; and identification of pertinent requirements within the law that were not satisfied. Work Schedule: Monday - Friday, 8:00am - 4:30pm Compressed/Flexible Schedule: Flexible Position Description Title/PD#: Legal Admin Sp (Cont Rep)/PD15090A and PD15090 Relocation/Recruitment Incentives: Not authorized

Requirements

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 11/17/2023. Time-In-Grade Requirements: You qualify for the GS-09 grade level if you possess one year of specialized experience equivalent to the GS-07 grade level and you meet the required time-in- grade of 52 weeks at a GS-07. You qualify for the GS-07 grade level if you possess one year of specialized experience equivalent to the GS-05 grade level and you meet the required time-in- grade of 52 weeks at a GS-05. EXPERIENCE: A specific length of training and experience is not required, but you must show evidence of training or experience of sufficient scope and quality of your ability to do the work of this position. Evidence which demonstrates you possess the knowledge, skills, and ability to perform the duties of this position must be supported by detailed descriptions of such on your resume. Applicants will be rated in accordance with the OPM Federal Wage System Qualification Standards. 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; religions; 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. Note: A full year of work is considered to be 35-40 hours of work per week. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. Physical Requirements/Working Conditions: The work is primarily sedentary, although some walking, stooping, bending, reaching and carrying of loads up to 20 pounds is required . Use of a computer is extensive.

Education

A transcript must be submitted with your application if you are basing all or part of your qualifications on education.

Note: 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: http://ope.ed.gov/accreditation/. 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. For further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

Contacts

• Address Workforce Management - Community Care 120 SE 6th Street Suite 102 Topeka, KS 66603 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]