Job Description

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 06/08/2026. Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-07 position you must have served 52 weeks at the GS-05. For a GS-09 position you have served 52 weeks at the GS-07. The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment. You may qualify based on your experience and/or education as described below: Specialized Experience GS-07: You must have one year of specialized experience equivalent to at least the next lower grade GS-05 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Applied United States Code and Federal Regulations to assist in determining eligibility for Veteran Family Member Programs Assisted claimants in obtaining evidence to substantiate their medical claim submission request. Demonstrated experience utilizing health care industry operations; including claims processing procedures and medical reimbursement techniques. Demonstrated basic experience utilizing medical coding systems (e.g. ICD-9/10, HCPCS, CPT, ADA, DSM) Reviewed and verified health care program documentation and benefits to support eligibility assessments and escalate complex cases to senior staff when required OR, Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have 1 full year of graduate level education or superior academic achievement (see Education section below for additional information). OR, Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education beyond undergraduate level. Specialized Experience GS-09: You must have one year of specialized experience equivalent to at least the next lower grade GS-07 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Interpreted and applied United States Code and Federal Regulations to determine eligibility for Veteran Family Member Programs and to ensure claims were processed in alignment with established policies. Contacted medical providers and other health insurance agencies to assist claimants in the collection of necessary documentation for eligibility or medical claim consideration. Determined what information is necessary to adjudicate claims. Demonstrated experience utilizing health care industry operations; including claims processing procedures and medical reimbursement techniques to resolve claimant or provider issues. Demonstrated experience utilizing medical coding systems (e.g. ICD-9/10, HCPCS, CPT, ADA, DSM) to route claims accurately, validate documentation, and ensure correct processing in accordance with program policies and coding regulations. Applied analytical skills. Reviewed claims for duplicate detection, missing or discrepant data OR, Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have a Master's or equivalent graduate degree OR, 2 full years of progressively higher level graduate education leading to such a degree OR, LL.B. or J.D., if related OR, Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education beyond undergraduate level. 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/.