This Position Is No Longer Available
  1. Overview
  2. Duties
  3. Qualifications & Evaluations
  4. Benefits & Other Info
  5. How to Apply

Job Title:Legal Administrative Specialist (Health Benefits Claims Examiner)

Agency:Office of Personnel Management

Job Announcement Number:13-089-JSP-DE

This position is closed and no longer accepting online applications through USAJOBS.

The contents of the announcement can still be viewed.


$51,630.00 to $81,204.00 / Per Year


Friday, April 05, 2013 to Friday, April 19, 2013




Full Time - Permanent




2 vacancies in the following location:
Washington DC Metro Area, DC United States


United States Citizens



This position is also being announced under the Agency's Merit Promotion Plan to federal employees and non-competitive appointment eligibles. If you wish to be considered under Merit Promotion or Non-Competitive procedures, you MUST apply under the Merit Promotion announcement 13-091-JSP-MP.


NHO was established within Healthcare and Insurance (HI) to administer OPM's responsibilities under the Affordable Care Act (ACA). NHO is charged with developing and administering new programs intended to provide high quality, affordable insurance options to uninsured Americans. Specifically, NHO is responsible for the development and implementation of the Multi-State Plan Program (MSPP) and provides critical support to the Department of Health and Human Services in implementing the Pre-Existing Conditions Insurance Plan (PCIP) Program and the Federal external review process.  In this capacity, the incumbent serves in a confidential role and is involved in issues of direct concern to the Chief of the PCIP/Contracting Team and the Assistant Director of NHO.


The incumbent serves as a Legal Administrative Specialist (Health Benefits Claims Examiner) with the PCIP/Contracting team in NHO.

The incumbent reviews disputed health benefits claims and proceses external appeals.


  • U.S. Citizen
  • Suitable for Federal employment, determined by a background investigation
  • Males born after 12-31-59 must be registered for Selective Service
  • Relevant experience (see Qualifications below)


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  • Review disputed health benefits claims;
  • Determine appropriate resolutions to claims;
  • Research and analyze requests for enrollment reconsideration;
  • Research and analyze requests for eligibility appeals;
  • Interpret pertinent laws, regulations and contractual provisions;
  • Research medical and contractual issues;
  • Interact with the external appeals examiner; and
  • Respond to inquiries, PCIP claims, contracts, and regulations.


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You must have at least one year of specialized experience equivalent to the GS-07 reviewing disputed health benefits claims; interpreting pertinent laws, regulations and contractual provisions as they relate to the claim being reviewed OR

A Master's or equivalent graduate degree or two full years of progressively higher level graduate education leading to such a degree OR LL.B. or J.D., if related in Health Services Administration, Healthcare Management OR Healthcare systems OR

A combination of both education and experience.

You must meet all qualifications and eligibility requirements by the closing date of this announcement.



We will review your application package to ensure you meet the job requirements. Your application package must support your answers to the occupational questionnaire. If your answers cannot be verified, your rating will be changed to an appropriate level. All applicants will be rated on the following Skills or Competencies:

  • Knowledge of the laws, regulations and policies and procedures of health benefits claims
  • Knowledge of the procedures and practices used to interpret pertinent laws, regulations and contracts; and
  • Oral and written communication.

If you meet all of the basic and minimum qualification requirements, your application will be placed in one of three categories: Best Qualified, Well Qualified, or Qualified. Within these categories, applicants eligible for veteran's preference will receive selection priority over non-veterans.


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OPM offers a comprehensive benefits package this link provides an overview of the benefits currently offered.

Relocation expenses will not be paid. Current OPM career employees may qualify as an exception.


This job opportunity announcement may be used to fill additional vacancies.


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To apply for this position, you must complete the occupational questionnaire and submit the documentation specified in the Required Documents section below.

The complete application package must be submitted by 11:59 PM (EST) on April 17, 2013 to receive consideration.

·     To begin, click Apply Online to create a USAJOBS account or log in to your existing account. Follow the prompts to select your USAJOBS resume and/or other supporting documents and complete the occupational questionnaire.

·      Click the Submit My Answers button to submit your application package. It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.

·      To verify your application is complete, log into your USAJOBS account,, select the Application Status link and then select the more information link for this position. The Details page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process.

To return to an incomplete application, log into your USAJOBS account and click Update Application in the vacancy announcement. You must re-select your resume and/or other documents from your USAJOBS account or your application will be incomplete.



You may submit your documents by uploading them to USAJobsAll applicants are required to submit the following supporting document type(s):

Applicants may also submit the following supporting document type(s),which may not be required for all applicants:
   ·Cover Letter
   ·Other Veterans Document

You are encouraged to apply online. Applying online will allow you to review and track the status of your application.

Faxing Applications or Supporting Documents

NOTE: If you applied online and your application is complete, do not fax the paper application (1203FX) as this will overwrite your prior online responses and may result in you being found ineligible.

If you completed the occupational questionnaire online and are unable to upload supporting document(s):

1.    To fax your documents, you must use the following cover page and provide the required information. The Vacancy ID is 831201.

2.    Fax your documents to 1-478-757-3144.

If you cannot complete the Application Package online, you may fax all of your materials. The complete application package must be submitted by 11:59 PM (EST) on April 17, 2013 to receive consideration. Keep a copy of your fax confirmation in the event verification is needed.

To complete the occupational questionnaire and submit via fax:

1.    Click the following link to view to view and print the occupational questionnaire View Occupational Questionnaire

2.    Print the 1203FX form, follow the instructions and provide your responses to the occupational questionnaire items.

3.    Fax all six (6) pages of the completed 1203FX form along with any supporting documents to 1-478-757-3144. Your 1203FX will serve as your cover page for your fax transmission.



Julie R. Chambers-SaintPreux
Phone: (202)606-2891
Agency Information:
OPM Human Resources
1900 E Street NW
Room 1469
Washington, DC


The questionnaire will assess your qualifications for the job, and will be used to identify the best qualified applicants to be referred to the hiring manager for further consideration and possible interviews. Your ratings in this Assessment Questionnaire are subject to evaluation and verification based on the documents and references you submit. Later steps in the selection process are specifically designed to verify your ratings. Deliberate attempts to falsify information may be grounds for not selecting you or for dismissing you from the position/agency during the probationary period.


After making a tentative job offer, we will conduct a suitability/security background investigation.


We expect to make a final job offer within 40 days after the closing date of the announcement.

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