Claims Examiner

Job Title

Major duties and responsibilities include:

• Processing foreign medical claims on a complex manual system, without automation or artificial intelligence assistance
• Utilizing an extensive knowledge of diagnostics and medical services
• Performing complex diagnostic and procedure coding
• Independently applying and interpreting laws and regulations set forth in the program policy to adjudicate medical claims
• Examining, developing, and evaluating relevant documentation related to claims submitted for payment
• Independently performing research to determine whether conditions treated on medical claims are service-connected or associated with or aggravated by the Veteran's listed service-connected condition(s)
• Utilizing medical reference books, medical dictionaries, online medical websites, coding software, etc. in performing research related to complex medical claims
• Converting foreign currency to the equivalent amount in United States dollars
• Applying expert understanding of the laws and regulations governing the FMP and all technical aspects of processing FMP claims to perform research and responds to Congressional and White House inquiries.
• Performing other duties as assigned

Work Schedule: To be discussed during interview

Recruitment & Relocation Incentives: Not authorized

Critical Skills Incentive (CSI): Not approved

Telework: This position may be authorized for ad hoc telework. Telework eligibility will be discussed during the interview process. Ad hoc is defined as occasional, non-recurring telework.