Summary These positions are assigned to the VA Office of Integrated Veteran Care (IVC), Integrated External Networks, Customer Experience, Customer Service in Denver, CO. Some onsite work will be required. Customer Service is a call center environment where the primary functions of the Contact Representative is advising, counseling, reviewing applications and claims and/or responding to requests regarding business processes for all associated health benefits programs which are administered by the IVC. Responsibilities THIS IS NOT A REMOTE POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION These positions involve a multi-grade career ladder. The major duties listed below represent the full performance level of GS-8. At the GS-5 grade level, you will perform assignments of a more limited scope and with less independence. You will progressively acquire the background necessary to perform at the full performance level of GS-8. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher level work, and availability of funds. The major duties include but are not limited to: Develops, examines, adjusts, reconsiders, recommends settlement of various types of claims, receives and processes requests for authorization of healthcare services, supplies and benefits; Prepares and develops claims and gives advice and assistance in obtaining evidence and supporting documents that are required to complete the transaction; Routinely researches and locates information that is missing or lacking in detail to ensure the packet is complete and adequate for processing; Furnishes information concerning rights and benefits with regard to assigned health benefit programs; Provides customers with advantages and disadvantages to various benefit options and discusses various alternatives; Assists in determining the status of claims for services; Redevelops claims for reprocessing, ensuring that all required information and documents are present and complete to facilitate payment of claims; Explains and advises the basis for payment decisions and reasons for disallowance; Explains payment methodologies used in adjudicating medical claims to resolve questions about allowable amounts and cost shares; Examines claims for errors and initiates action to correct such errors; Works directly with patients, beneficiaries, providers and collection agencies in an effort to mitigate or resolve situations in which the patient or beneficiary has been placed in an adverse credit situation due to non-payment and/or untimeliness of payment of medical claims; Advises, counsels and reviews applications for benefits for assigned health benefit programs administered by the IVC; Conducts telephone interviews and creates responses to inquiries regarding any program administered by the IVC; Records new and/or updated information in computerized database(s) necessary for maintaining, routing and tracking correspondence; Reviews and recommends approval or denial of preauthorization requests based on program guidelines, applicable laws and regulations; Composes responses to inquiries in those cases where replies are required; Conducts and/or assists in the testing of new programs, enhancements to existing processes and new initiatives impacting customer service; Assists with on-the-job training for newly appointed Customer Service Representatives; and Performs other related duties as assigned. Work Schedule: 8 hour shift, Monday through Friday, between 5:45am - 7:15pm MST Recruitment & Relocation Incentives: Not authorized Critical Skills Incentive (CSI): Not Approved Financial Disclosure Report: Not Required Telework: VA supports the use of telework as a way to help attract and retain talented individuals in public service, increase worker productivity, and better prepare the agency to operate during emergencies. This position may be authorized for telework. Telework eligibility will be discussed during the interview process. Requirements Conditions of Employment You must be a U.S. Citizen to apply for this job Selective Service Registration is required for males born after 12/31/1959 You may be required to serve a probationary period Subject to background/security investigation Selected applicants will be required to complete an online onboarding process Qualifications To qualify for this position at the GS-5 level, you must meet one of the following requirements: SPECIALIZED EXPERIENCE: You must have at least one (1) full year of specialized experience equivalent to the GS-4 level in the Federal service that equipped you with the particular knowledge, skills, and abilities to perform successfully the duties of the Contact Representative position, and that is typically in or related to the work of the position. Specialized experience includes: conducting telephone interviews advising and counseling customers with questions regarding healthcare services, medical insurance, and benefit claims; inputting and accessing information through various data systems; analyzing problems and providing an accurate resolution; composing and preparing correspondence; and possessing exceptional interpersonal/communications skills. NOTE: Applicants wishing to receive credit for such experience must clearly indicate the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. OR Education: Successfully completed four (4) years above high school in any field which high school graduation or the equivalent is the normal prerequisite. This education must have been obtained at an accredited business, secretarial or technical school, junior college, college or university NOTE: Transcripts must be submitted with your application materials. Education cannot be credited without documentation. OR Combination: Equivalent combination of successfully completed post-high school education (beyond the second year) and specialized experience, as described above, which meet the total qualification requirements for this grade level. This education must have been obtained at an accredited business, secretarial or technical school, junior college, college or university. NOTE: Your experience must be documented in your resume and transcripts are required. You will be rated on the following Competencies as part of the assessment questionnaire for this position: Analytical Reasoning Communications Customer Service Operating Systems IMPORTANT: A full year of work is considered to be 35-40 hours of work per week. All experience listed on your resume must include the month and year start/end dates. 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. 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. Physical Requirements: The work is primarily sedentary although some walking, stooping, bending, reaching and carrying loads weighing up to 20 pounds is required. Use of computer and telephone is extensive. Work is performed in a fast paced and sometimes stressful professional office environment. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/. Education IMPORTANT: 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: Recognition of Foreign Qualifications | International Affairs Office (ed.gov). Additional Information Receiving Service Credit for Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed. Special Employment Consideration: VA encourages persons with disabilities to apply, including those eligible for hiring under 5 CFR 213.3102(u), Schedule A, Appointment of persons with disabilities (i.e., intellectual disabilities, severe physical disabilities, or psychiatric disabilities), and/or disabled veterans with a compensable service-connected disability of 30% or more. For more information on how to apply using this appointment authority via the Selective Placement Coordinator within the office, contact the facility Human Resources Department at (202) 632-7806. The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced Federal competitive service employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit appropriate documentation and be found well-qualified (have a final rating of 85 or more before any Veterans preference points) for this vacancy. Information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/. This job opportunity announcement may be used to fill additional vacancies. If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement.