The purpose of this position is to ensure timely access to healthcare for thousands of beneficiaries domestically and more than six million eligible service-connected Veterans around the world. The position supports beneficiary and Veteran well-being through prompt claim reimbursement to thousands of domestic and international healthcare providers.
This job announcement will remain open for 8 business days. The initial application review cut-off for this job announcement is 50 applications. Applications received up to 11:59pm EST on the date in which 50 applications is reached will receive first consideration (initial cutoff). Applications received after 11:59pm EST on the date in which 50 applications are received may not receive consideration unless otherwise requested by management.
Additional applications will be reviewed in one-day increments at management request. Note: Submitting multiple applications will change the order in which your application is reviewed. Examine claims to consider whether the condition treated is service-connected or associated with and aggravating a service-connected condition.
Review accuracy and completeness of submitted documentation; analyzes the diagnostic and procedure codes (reasons for medical care and procedures performed); considers FDA indications and unlabeled indications for medications; and completes the conversion of foreign currency to U.S. dollars in accordance with FMP 38 U.S.C. §1724. Identify and resolve other issues associated with the request for payment prior to adjudication.
Develops and evaluates relevant documentation related to Veteran/beneficiary claims submitted for payment; the incumbent examines expenditures for accuracy, adequacy of documentation, citations, compliance with regulations, and justifications for Specialty Program payment.
Evaluate and process provider health care claims that are being corrected or reconsidered for payment; this requires extensive research via systems including Customer Relations Manager (CRM), claim adjudication software, document management systems that contain claim attachments, and National Provider Identification (NPI) online.
Handles escalated claims referenced in high-level government inquiries (Congressional, White House, Secretary of VA), reporting findings, analysis, and recommendations for corrective action in professional correspondence. Collect and store vendor data so that the foreign banking information can be used to pay foreign providers by Electronic Funds Transfer (EFT).
Ensure foreign vendors are paid into foreign financial institutions where their company is located to improve payment integrity, address fraud risk concerns brought up by the GAO and SVAC, ensure regulatory compliance with the U.S. Bureau of Fiscal Service International Treasury Service (ITS) and Office of Foreign Assets control (OFAC), and provide greater assurance that U.S. government funds are transferred to legitimate foreign entities in accordance with 38 USC §1724.
Independent research, case management, and customer service techniques when assisting beneficiaries, Veterans, and providers in gathering required information from internal and external sources to complete or correct their applications, vendor forms, and claims, in accordance with the Veterans Claims Assistance Act (Public Law 106-475).
Providing claim forms and instructions to Veterans and providers on how to complete applications and claims; assisting with Direct Deposit Enrollment; and providing notice of incomplete applications and claims with information needed from the Veteran, beneficiary, or provider to substantiate the claim.
Use National Plan and Provider Enumeration System for domestic provider research; VA systems of record for Veteran and beneficiary research; and the VBA and Financial Services Center for banking information. Other duties as assigned Work Schedule: Mon-Fri - Work schedule will be between the hours of 6:00 am - 4:30 pm Compressed/Flexible: : May be available at management's decision. 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. Return to Office (RTO): RTO mandates are in effect and selectees will be required to report to in-person work unless they are approved for an exception or an exemption. Any approval for an RTO exception, exemption, or extension will happen after a tentative job offer, but before a final job offer.
Position Description/PD#: Claims Examiner/PD22768A Relocation/Recruitment Incentives: Not authorized. Critical Skills Incentive (CSI): Not approved. Permanent Change of Station (PCS): Not authorized
There is no educational substitution at this grade level. Note: 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: http://ope.ed.gov/accreditation/.
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. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.
VHANationalRecruitmentCenter@va.gov · (844)456-5208
This position is with Veterans Health Administration, Department of Veterans Affairs.
The posted pay range is $62308 – $80997/yr.
This position is eligible for telework.
Applications close on 2026-09-22.
There are 5 openings for this position.
This position is open under the 'Fed Transition' hiring path.
Source: USAJOBS.gov — U.S. Federal Government
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