Claims Representative

Claims Representative

Are you an experienced professional looking for new opportunities to further your career? The SC Department of Veterans' Affairs is seeking a hardworking and dependable candidate just like you to apply! This position will offer great benefits with the state, including 15 days of annual and sick leave per year or more depending on applicable state service.

The Claims Representative represents Veterans and their family members during the claims and appeals process to obtain benefits under laws administered by the federal government and the Department of Veterans' Affairs; performs duties governed by specific instructions, objectives, and policies that involve frequently changing laws, regulations, conditions, and problems. Successfully attains and maintains accreditation, through the Office of General Counsel (OGC), with multiple service organizations in order to represent Veterans.

Responsibilities of the Claims Representative:

• Reviews claim files to include Veteran's active-duty service medical records (SMRs), and medical evidence by accessing appropriate Veterans Benefits Administration (VBA) applications (i.e. VBMS, SHARES, VACOLS, and Caseflow); contacts the Veteran and/or the County Veterans Affairs Officer (CVAO) as needed to obtain information. Prepares complex and detailed written analysis, correspondence, and other documents to support Veteran's claims. Works vigorously with the VBA and Board of Veterans Appeals (BVA) to request claims are expedited or appeals are advanced on the docket for Veterans or widows that are in unique situations (terminally ill, suffering extreme financial hardship, or elderly (over the age of 73). Utilizes the VetPro electronic claims management tool that is the SCDVA standard for submitting electronic claims to the US DVA.
• Prepares statement of accredited representative in appeal cases. Reviews complete claims file to ensure that all actions have been completed or addressed; reviews all medical evidence, all rating decisions, the statement of the case (SOC), all supplemental information, USC 38 CFR, and M21-21 Ras as it pertains to all rated issues under appeal; provides written argument on behalf of Veteran to the BVA. Prepares arguments; notifies Veteran of date, time, and location of Appeals Hearing; interviews Veteran; presents argument to VA officials to include Administrative Law Judges, Rating Veteran Service Representative (RVSRs), Veterans Service Representatives (VSR}, and Decision Review Officers (DROs).
• Interacts with Veterans, family members, Administrative Law Judges, RVSRs, VSRs, DROs, CVAOs, medical professionals, and congressional in State liaison to personnel that have a wide range of issues. All of this must be done while treating every customer with the utmost respect, dignity, and ensuring the highest level of confidentiality.
• Collaboratively reviews Veteran Home resident applications to assess Veteran status, benefits eligibility, and reviews Veteran files to assess benefits and compensation compared to Veteran health status and needs as applications are received by the Department for long-term health care delivered through State Veteran Homes in South Carolina.
• Other duties as assigned to include serving as a member of the Compliance and Assessment Team.

Minimum and Additional Requirements:

A bachelor's degree and five (5) years of experience in veterans service programs; or an equivalent combination of education, training, and experience.

Applicants indicating college credit or degree(s) on the application will be required to bring a copy of college transcript to the interview. A copy of the transcript may also be uploaded as an attachment to the application, if required by the hiring department or if desired by the applicant. Please note that some areas of the Agency may require an official, certified copy of the transcript prior to hiring or within a specific timeframe required by that area, after hiring. Failure to produce an official, certified transcript may result in not being hired or termination.

Additional Requirements:

• Position may require overnight travel.
• Position may require employee to work evenings, weekends, and during emergency situations.
• Position requires routine driver duties.
• Position requires up-to-date certification(s).
• Position requires non-essential declaration.
• This person may be required to travel frequently, not only home visits (stairs involved), but also rural areas where there is no handicapped access.

The SC Department of Veterans' Affairs is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.

Supplemental questions are considered part of your official application. Any misrepresentation will result in your disqualification from employment. Please complete the state application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position.

The SC Department of Veterans' Affairs offers an exceptional benefits package for full time (FTE) employees:

1. Health, dental, vision, long-term disability, and life insurance for employees, spouse, and children.
2. 15 days annual (vacation) leave per year
3. 15 days sick leave per year
4. 13 paid holidays
5. Paid Parental Leave
6. S.C. Deferred Compensation Program available ( S.C. Deferred Compensation )
7. Retirement benefit choices *
   1. State Retirement Plan ( SCRS )
   2. State Optional Retirement Program ( State ORP )

*Enrollment in one of the listed plans is required for all FTE employees; please refer to the contribution section of hyperlinked retirement sites for the current contribution rate of gross pay.