Lead Insurance Specialist (Live Claims)

Summary This position is located in the Department of Veterans Affairs Insurance Center in Philadelphia, PA. The incumbent serves as the Lead Insurance Specialist in the Outreach Section. The mission of the Outreach Section is to ensure that those severely disabled Servicemembers who are separating from military service are making informed decisions about their insurance needs. The VA Regional Office and Insurance Center anticipates that the Outreach Section will be making 800 to 1500 calls per month. This job is open to Internal to an agency Current federal employees of this agency. Career transition (CTAP, ICTAP, RPL) Federal employees who meet the definition of a "surplus" or "displaced" employee. Clarification from the agency Open only to current Career/Career-Conditional Veterans Benefits Administration (VBA) Philadelphia Facility (Insurance or Regional Office) and Career Transition Assistance Plan (CTAP) employees. Duties Major Duties: Coach the team in the selection and application of appropriate problem solving methods and techniques, provide advice on work methods, practices and procedures, and assist the team and/or individual members in identifying the parameters of a viable solution. Lead the team in: identifying, distributing and balancing workload and tasks among employees in accordance with established work flow, skill level and/or occupational specialization; making adjustments to accomplish the workload in accordance with established priorities to ensure timely accomplishment of assigned team tasks; and ensuring that each employee has an integral role in developing the final team product. Make monthly case assignments to Outreach Section Telephone Representatives for calling veterans through the Disabled Outreach Tracking System (DOTS). Monitor and report on the status and progress of work, checking on work in progress and reviewing completed work to see that the supervisor's instructions on work priorities, methods, deadlines and quality have been met Serve as coach, facilitator and/or negotiator in coordinating team initiatives and in consensus building activities among team members Maintain program and administrative reference materials, project files and relevant background documents and make available policies, procedures and written instructions from the supervisor; maintain current knowledge to answer questions from team members on procedures, policies, directives, etc. Prepare reports and maintain records of work accomplishments and administrative information, as required, and coordinate the preparation, presentation and communication of work-related information to the supervisor. Represent the team in dealings with the supervisor or manager for the purpose of obtaining resources (e.g., computer hardware and software, use of overtime or compensatory time), and securing needed information or decisions from the supervisor on major work problems and issues that arise. Report to the supervisor periodically on team and individual work accomplishments, problems, progress in mastering tasks and work processes, and individual and team training needs. Estimate and report to the team on progress in meeting established milestones and deadlines for completion of assignments, projects and tasks, and ensure that all team members are aware of and participate in planning for achievement of team goals and objectives. Handles complex cases in the unit, specifically follow-up actions resulting from the VGLI Pending Report, SDVI with waiver report, and change of address follow-up report, as well as any other newly developed reports. Prepares Administrative Decisions on complex cases for the entire Section to the supervisor. This includes making recommendations on providing coverage and claim payment on exception cases involving SGLI, VGLI, and S-DVI. Counsels veterans, their family, or their agents via telephone regarding their eligibility for VA Life Insurance Benefits. Determines eligibility for Servicemembers' Group Life Insurance (SGLI) Disability Extension, Traumatic SGLI, Veterans' Group Life Insurance, and Service-Disabled Veterans Insurance. Explains the types of documents necessary to facilitate timely processing of applications or claims. Assists veterans in completing applications for benefits. Approves and processes SGLI Disability Extension applications via the Internet. Enters all necessary processing inputs in order to establish coverage and initiate Welcome Kit mailing. Serves as the primary contact with the Office of Servicemembers' Group Life Insurance (OSGLI) on handling complex cases involving issues of customer service, application processing, or claims adjudication. Initiates claims activities for deceased beneficiaries of outreach Veterans. Explains necessary forms and processing for filing claims for SGLI, VGLI, TSGLI and SDVI. Identifies and refers complex cases that require supervisory determinations for approval of coverage or claim. Assists veterans with questions regarding other VA benefits. Researches issue(s) to include direct contact with RO of jurisdiction and follows-up with caller on results of research. Conducts follow-up with veterans by telephone and mail that have not applied for VA Life Insurance benefits after initial contact. Takes ownership of callbacks or return correspondence. Researches issue(s) to include direct contact with the OSGLI or direct contact with the RO of jurisdiction or other VA benefits office. Follows-up with Veteran or call on results of research. Requirements Conditions of Employment You must be a U.S. citizen to apply for this job Selectees are subject to a background/suitability investigation Selective Service registration is required for males born after 12/31/1959 A probationary period may be required for employees and supervisors Qualifications To qualify for this position, applicants must meet all requirements by the closing date of this announcement. Time-in-grade: Applicants who are/were federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements. For a GS-11 position you must have served 52 weeks at the GS-9 level. To support your claim of time in grade, you must submit your most recent appointment, promotion, or within grade increase SF-50 (not an award or general adjustment SF-50). Some applicants may have to submit more than one SF-50 to demonstrate their eligibility. See the required documents section for more information. Specialized Experience: To qualify, applicants must have one year of specialized experience equivalent to at least the next lower grade (GS-9) in the normal line of progression for the occupation in the organization. Specialized experience is defined as work that involves: (1) Experience communicating the complex series of laws, regulations and Federal legislation pertaining to the full range of Veterans benefits. Examples of acceptable specialized experience include responsibility for examination, investigation, or authorization of claims under programs such as life or health insurance, pension plan, disability retirement, income maintenance or other related programs. Such experience is to be substantive and relevant to the position being filled. OR Applicants may substitute education for the experience required for the GS-11 level. 3 years of progressively higher level graduate education leading to a Ph.D. degree or Ph.D. or equivalent doctoral degree. Such education must demonstrate the competencies necessary to do the work. OR Applicants may also combine education and experience to qualify at the GS-11 level: Equivalent combinations of specialized experience and PH.D. graduate education. To compute, divide your total months of qualifying experience by 12. Then divide your semester hours of graduate education beyond two years by 18. Add the two percentages. The total percentage must equal at least 100% to qualify. The Office of Personnel Management's group coverage qualification standards, associated individual occupational requirements (IOR), and individual qualification standards covering white collar occupations in the Federal competitive service can be found here. Education A transcript must be submitted with your application if you are basing all or part of your qualifications on education. 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. 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. Additional information Work Schedule: Monday through Friday, 6:00am - 6:00pm; Flex work schedules are available Title/PD#: Lead Insurance Specialist (Live Claims) GS - 11; PD # Physical Requirements: The work is sedentary. Typically, the employee may sit comfortably to do the work. However, there may be some walking; standing; bending; carrying of light items such as papers, books, small parts; driving an automobile, etc. No special physical demands are required to perform the work. Placement Policy: The posting of this announcement does not obligate management to fill a vacancy or vacancies by promotion. The position may be filled by reassignment, change to lower grade, transfer, appointment, or reinstatement. Management may use any one or any combination of these methods to fill the position. Special Employment Consideration: The 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 for this vacancy. A well-qualified candidate is defined as meeting all of the minimum qualification standards and eligibility requirements as well as possessing skills that clearly exceed the minimum qualifications requirements for this position. Information about CTAP eligibility can be found here. 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. 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. Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer (TJO). Please visit the Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP), Benefits A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits. Review our benefits Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered. How You Will Be Evaluated You will be evaluated for this job based on how well you meet the qualifications above. In describing your experience, please be clear and specific. We will not make assumptions regarding your experience. Applicants who do not fully address the specialized experience needed for the position (as described above in the job announcement) in their resume or who do not possess the education to substitute for it will not be referred for consideration. After you have met the minimum qualifications, you will be rated on the following competencies based on your application for this position: Problem Solving : Identifies problems; determines accuracy and relevance of information; uses sound judgment to generate and evaluate alternatives, and to make recommendations Oral Communication: Expresses information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information (for example, technical, sensitive, controversial); makes clear and convincing oral presentations; listens to others, attends to nonverbal cues, and responds appropriately. Writing : Recognizes or uses correct English grammar, punctuation, and spelling; communicates information (for example, facts, ideas, or messages) in a brief, clear, and organized manner; produces written information, which may include technical material, that is appropriate for the intended audience. Critical Thinking: Objectively analyzes and evaluates an issue in order to form an opinion/judgment/conclusion; Uses logic and reasoning to research, interpret and apply information such as regulatory and/or procedural guidance; Identifies the strengths and weaknesses of alternative solutions, conclusions or approaches to problems; Integrates information into development of a resolution Organizational Awareness: Knows the organizations mission and functions, and how its social, political, and technological systems work and operates effectively within them; this includes the programs, policies, procedures, rules, and regulations of the organization. If you are referred for consideration, you may be asked to submit additional job-related information, which may include, but is not limited to responses to the knowledge, skills, and abilities; completion of a work sample, and/or an interview. Your resume and/or supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect your rating or consideration for employment. Notice to Applicants: It is the policy of the Government not to deny employment simply because an individual has been unemployed or has had financial difficulties that have arisen through no fault of the individual. Information about an individual's employment experience will be used only to determine the person's qualifications and to assess his or her relative level of knowledge, skills, and abilities. Although an individual's personal conduct may be relevant in any employment decision, including conduct during periods of unemployment or evidence of dishonesty in handling financial matters, financial difficulty that has arisen through no fault of the individual will generally not itself be the basis of an unfavorable suitability or fitness determination. Benefits A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits. Review our benefits Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered. Required Documents As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have - whether you're a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you're eligible under their policies. The following documents are required for all applicants: Resume SF-50/ Notification of Personnel Action Review the information below and submit any additional documents (as needed) to demonstrate your eligibility and/or qualifications for the position: Current Federal Employees: If you are applying using your status as a current federal employee or as a VEOA candidate (who is a current federal employee) you must submit your most current SF-50. To support your claim that you have the required time-in-grade, you must submit your most recent promotion, within-grade increase, or appointment SF-50 (not an award or general adjustment SF-50). Some applicants may have to submit more than one SF-50 in order to demonstrate their eligibility. If you previously held a higher grade, you must also submit an SF-50 showing that grade. Resume Your resume may be submitted in any format, however we strongly recommend using USA Jobs resume builder as it contains all of the information required on federal resumes. For qualifications determinations your resume must contain hours worked per week, the dates of employment, and the level of your experience. If your resume does not contain this information you will not receive consideration for this position. If you submit more than one copy of your resume, only the most recent version will be reviewed. The latest timestamp will be used to determine which version of your resume is "most recent." It is your responsibility to check the status and timestamp of all documents you submit as part of your application. If your resume includes a photograph or other inappropriate material or content, it will not be used to make eligibility and qualification determinations and you may not be considered for this vacancy. Transcripts If you are basing all or some of your qualifications on education or if a degree is required for the position, a transcript must be included as part of your application package. Unofficial transcript(s) may be submitted, however it must contain the course names, levels, credits earned, and grades received. Your transcript must contain the degree conferred date if you are substituting a degree for experience. If you are claiming superior academic achievement (SAA) ensure you submit completed transcript(s) to demonstrate it. The requirements for superior academic achievement can be viewed here. A photocopy of your degree is not acceptable in place of a transcript. An official transcript will be required at a later date if you are selected for the position. Applicants claiming CTAP eligibility must also submit: Certification of expected separation, reduction-in-force separation notice, or notice of proposed removal; and your most recent performance evaluation; and an SF-50 demonstrating your separation or the position you will be separated from. Or Worker's compensation separation: agency certification of inability to place employee and notification of separation or a separation SF-50. Or Disability annuity termination: Notification from OPM of disability annuity termination and separation SF-50 of the last position held. Or Military reserve or National Guard technician special disability retirement annuity under 5 U.S.C. 8337(h) or 8456: Certification of special disability retirement annuity from a military department or National Guard bureau and separation SF-50 of the last position held. Failure to submit any of the above mentioned required documents may result in loss of consideration due to an incomplete application package. It is your responsibility to ensure all required documents have been submitted. You will not be contacted for additional information. In addition to the information listed above, please use this checklist to ensure you have included other documents required for your application. If you are relying on your education to meet qualification requirements: Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education. Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating. How to Apply To apply for this position, you must complete the submit the documentation specified in the job announcement. Documents will not be accepted after the closing date of the announcement. The complete application package must be submitted by 11:59 PM (EST) on 11/14/2024 to receive consideration. 1. To begin, click apply online to create a USAJOBS account or log in to your existing account. Follow the prompts to select your USAJOBS resume and/or other supporting documents and complete the occupational questionnaire. 2. Click submit my answers to submit your application package. Note: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date. To verify your application is complete, log into your USAJOBS account, select the application status link and then select the more information link for this position. The details page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process. To return to an incomplete application, log into your USAJOBS accountand click update application in the vacancy announcement. You must re-select your resume and/or other documents from your USAJOBS account or your application will be incomplete. Agency contact information Janelle Phillips Phone (313) Email Address Philadelphia VBA Regional Office 5000 Wissahickon Ave Philadelphia, PA 19144 US Next steps After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. During our review, if your resume and application package do not support your questionnaire answers, we will adjust your rating accordingly. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email (if provided). Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made. You may check the status of your application at any time by logging into your USAJOBS account and clicking on "Application Status." For a more detailed update of your status, click on "more information." Information regarding applicant notification points can be found in the USAJOBS Resource Center. Fair and Transparent The Federal hiring process is set up to be fair and transparent. Please read the following guidance. Criminal history inquiries Equal Employment Opportunity (EEO) Policy Financial suitability New employee probationary period Privacy Act Reasonable accommodation policy Selective Service Signature and false statements Social security number request Required Documents The following documents are required for all applicants: Resume SF-50/ Notification of Personnel Action Review the information below and submit any additional documents (as needed) to demonstrate your eligibility and/or qualifications for the position: Current Federal Employees: If you are applying using your status as a current federal employee or as a VEOA candidate (who is a current federal employee) you must submit your most current SF-50. To support your claim that you have the required time-in-grade, you must submit your most recent promotion, within-grade increase, or appointment SF-50 (not an award or general adjustment SF-50). Some applicants may have to submit more ...

Created: 2024-11-09