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.

Duties

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. Interprets pertinent Federal laws, FEHB Program regulations, and contract provisions as they relate to disputed claim review. 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. Serves as a senior advisor and subject matter expert on the disputed claim review process. 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. Maintains program and administrative reference materials, project files, and relevant back-ground documents, and makes available policies, procedures and written instructions from the supervisor.

Requirements

Qualifications

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.

Education

There are no educational requirements for this position.

Contacts

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