It is the applicant's responsibility to read all sections and associated links in this vacancy announcement.
This vacancy may be used to fill additional positions within 90 days of the closing date.
It is the applicant's responsibility to read all sections and associated links in this vacancy announcement.
This vacancy may be used to fill additional positions within 90 days of the closing date.
As a Claims Adjuster, Examiner, and Investigator, for the Financial Management Banking, Investment, and Insurance team the Senior Claims Specialist is responsible for reviewing insurance claims after they are submitted to make sure that proper filing procedures have been followed, to determine whether or not they are covered under a policy, and to evaluate the extent of a settlement that the Army Central Insurance Fund (ACIF) must pay.
The incumbent will ensure claims adjusters and commercial insurance policy providers are in compliance with the Army Regulation AR 215-1, the Longshore and Harbor Workers' Compensation Act, applicable insurance policy, and the claims service contract. He/she may assist the Chief Banking, Investments, and Insurance in representing the Army at claim disputes conferences and hearings before Department of Labor District Commissioners and Administrative Law Judges, and in developing and presenting educational seminars/workshops for employees, supervisors and managers.
The incumbent investigates, analyzes, and determines the extent of ACIF's liability concerning personal, casualty, or property loss or damages, and attempts to effect settlement with claimants. He/she reviews Workers' Compensation claims to determine that payments and settlements are made in accordance with the Longshore and Harbor Workers' Compensation Act, and acts as alternate Contracting Officer's Representative (COR) for the claims service contract. He/she may calculate benefits, pay and process claims within designated authority level. He/she also verifies and reimburses the unemployment compensation claims.
The incumbent must ensure that the costs of a particular treatment are reasonable depending on the diagnosis a patient received by reviewing police reports, medical treatment records, medical bills, expected hospital stay and disability time or physical property damage to determine the extent of liability. Depending on his findings, he/she may suggest approval or denial of claims to the Chief Banking, Investments and Insurance for consideration.
Other duties of the Senior Claims Specialists include examining, adjudicating and authorizing payments on claims; auditing claim payment; adjusting reserves to ensure that reserve activities are consistent with the claims service contractor's assessment and the actuary recommendations; ensuring timely disbursement of funds to clients; investigating and assessing damage to property and creating or reviewing property damage estimates; identifying claims with possible recovery from third parties; interviewing or corresponding with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review; analyzing information gathered by investigation and report findings and recommendations; negotiating claim settlements and recommending litigation when settlement cannot be negotiated.
QUALIFICATIONS MUST BE CLEARLY VERIFIABLE IN YOUR RESUME. GOVERNMENT POSITIONS MUST INCLUDE PAY PLAN, SERIES, GRADE, TO AND FROM DATES, AND GOVERNMENT AGENCY/DEPARTMENT. Must include at least one year of experience performing duties at a level which equipped the applicant with the particular knowledge, skills, and abilities needed to perform successfully in the position.
MINIMUM QUALIFICATIONS:
A degree with a major course of study in finance, business administration, economics, insurance, risk management, law, banking and credit, real estate operations or other fields related to this position that would demonstrate knowledge of property and casualty insurance, coverages and claims administration, and the ability to examine a workers' compensation claim.
Or
Experience applying laws, regulations, and administrative rulings in the performance of such work as determining the kind and amount of insurance necessary to protect government assets; analyzing rates and risk classifications to determine their reasonableness; medical knowledge of occupational physical and mental impairments, the correlation of occupational hazards to injury, disease and death, and of rehabilitation.
Must have analytical ability and judgment, ability to analyze problems to identify significant factors, gather pertinent data and recognize solutions; strong written and oral communications skills; proficient in Microsoft Word, Excel, and Power Point.
All Qualified applicants will be rated against the highly qualifying criteria by a rating panel for evaluation of the quality and extent of your total accomplishments, experience and education. Those applicants determined to be highly qualified will be referred to the hiring official for consideration. The highly qualified candidates may undergo an interview and reference checks. All answers to the Highly Qualifying Criteria must be demonstrated in your resume to get credit.
HIGHLY QUALIFYING CRITERIA:
Comprehensive working knowledge of the Longshore and Harbor Workers' Compensation Act
Professional certification in Insurance or Risk Management such as Certified Risk Management Professional (CRMP), Associate in Claims (AIC) or Certified Workers' Compensation Professional (CWCP)
Working experience in, and have a comprehensive knowledge of, Commercial Property claims adjudication (Building, Contents and Business Interruption)
Working experience in, and have a comprehensive knowledge of, Property insurance, coverages, and claims administration
Working experience in, and have a comprehensive knowledge of, Tort/Casualty insurance, coverages, and claims administration
Working experience with examining a workers' compensation claim and breaking it down to its constituent parts to identify whether claim compensability was based on appropriate investigation and valid evidence
Working experience with understanding the complex and controversial issues of contested claims and how to work towards amicable resolutions
Education is not required for this position unless you are using education to meet the minimum qualifications. If you are using education to meet the minimum qualifications or highly qualifying criteria, you must upload transcripts. Additionally, if you would like for your education to be considered by the hiring panel as part of your overall accomplishments, you must attach copies of transcripts (online transcripts will be accepted).
Only education from accredited and pre-accredited institutions will be accepted. Foreign education must be evaluated for equivalency in the United States. For more information, please click here.
You will be evaluated for this job based on how well you meet the qualifications above.
Your experience is subject to evaluation and verification against the information in your resume. The numeric rating you receive is a self-assessment only and is based on your responses to the questionnaire. Do not overstate or understate your level of experience and capability. If a determination is made that you rated yourself higher than is supported by your resume, or if your resume lacks sufficient information, you will be rated accordingly or you may be considered ineligible.
The following documents must be submitted with your application:
Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
Electronically https://www.usajobs.gov/ and search for announcement number NENAFCC2512718928. All documentation required in the vacancy must be submitted by 11:59 p.m., Eastern Standard Time, on the closing date of the announcement.
It is the applicant's responsibility to ensure they allow an acceptable amount of time prior to the close of a vacancy to create a USA Jobs account and complete the application process. All times displayed in this vacancy are based upon Eastern Standard Time (EST).
If you encounter technical difficulties which prevent you from applying, you must send an email to the agency contact listed on this vacancy, including screen shots which clearly display the error and time it occurred. Late applications are accepted on a case-by-case basis under limited circumstances.
Referred applicants will be evaluated by a rating panel to determine the quality and extent of total accomplishments, experience, education, and/or certification. The top candidates will be forwarded to the hiring official for selection consideration and may undergo an interview and reference checks.
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