Contact Representative

Job Title

This is not a virtual position, you must live within or be willing to relocate within a commutable distance of the duty location. This announcement has an applicant count cut-off. Once 300 applications are received, the announcement will be removed from USAJOBS at 11:59pm EST on the day that the applicant count is reached. 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.

Major Duties

• Conducts telephone interactions 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;
• Develops, examines, adjusts, reconsiders, recommends settlement of various types of claims, receives and processes requests for authorization of healthcare services, supplies and benefits;
• Routinely researches and locates information that is missing or lacking in detail to ensure the submission 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;
• 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;
• Works directly with patients/clients, beneficiaries, providers and collection agencies in an effort to mitigate or resolve situations in which the patient/client 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 and/or assists in the testing of new programs, enhancements to existing processes and new initiatives impacting customer service; and
• Performs other related duties as assigned.

Work Schedule: 8-hour tour, Monday-Friday between 5:45 a.m. - 7:15 p.m. (Mountain Standard Time) based on business needs.

• Recruitment/Retention Incentive Approved: To support recruitment and retention in these fast-paced Contact Representative positions, newly appointed VA employees may be eligible for a $4,000 incentive in exchange for a 2-year service agreement.
• Telework: This position may be authorized for ad-hoc telework. Applicant will be required for on-site work. Telework eligibility will be discussed during the interview process.
• Promotion potential to GS-8, Step 10: $80,997.00 per year. Pay may be set at a rate/step above the minimum rate (AMR) for applicants with superior qualifications.
• Paid Time Off: 37-50 days of annual paid time off per year, including 13-26 days of annual leave, 13 days of sick leave, and 11 paid Federal holidays. Selected applicants may qualify for credit toward annual leave accrual based on prior work experience or military service experience.
• Parental Leave: Up to 12 weeks of paid parental leave in connection with the birth, adoption, or foster care placement of a child.
• Child Care Subsidy: After 60 days of employment, full-time employees with a total family income below $144,000 may be eligible for a child care subsidy of up to 25% of eligible child care costs for qualifying children, up to a monthly maximum of $416.66.
• Retirement: Traditional Federal pension (5-year vesting) and Thrift Savings Plan (TSP) with up to 5% matching contributions by VA.
• Insurance: Federal health, vision, dental, term life, and long-term care insurance programs. Many Federal insurance benefits may be carried into retirement.

Critical Skills Incentive (CSI): Not Approved