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.

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

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.

Contacts

• Address OPM Human Resources 1900 E St., NW Washington, DC 20415 US
• Name: OPM Human Resources
• Phone: 202-606-9321
• Email: [email protected]