Insurance Specialist

Veterans Benefits Administration • Philadelphia, PA

19d • Onsite

About The Position

The incumbent serves as an Insurance Specialist on the Quality Assurance staff, which oversees the Insurance Quality Assurance program. The position conducts in-depth reviews of work inputs from the Insurance Policyholders Services and Insurance Claims divisions to ensure accurate operations processing and disbursements. It evaluates insurance transactions for potential fraud or inappropriate processing, reviews supporting histories and documents, and recommends improvements to quality assurance, disbursement, and policy procedures. Recommendations may have significant effects across the Insurance program and may depart substantially from established work practices.

The specialist also provides formal and refresher training to Quality Assurance and Operations personnel, advises lower-grade Insurance Specialists on difficult cases, and assists the supervisor with feedback on employee performance. The position involves independent work, judgment, completion of assignments, and preparation of reports and recommendations for the Assistant Director and/or Staff Chief(s). The position has a GS-9/11 grade progression; promotion to the full performance level may be possible without further competition when regulatory, qualification, and performance requirements are met, but selection at a lower grade does not guarantee promotion.

The schedule is full time, Monday through Friday. Compressed or flexible scheduling is available between 6:00 a.m. and 6:00 p.m. The position is eligible only for situational (ad hoc) telework with supervisory approval; the employee must report to the official duty station on each scheduled workday, and routine or recurring telework is not authorized. This is not a virtual position. The work is basically sedentary.

Requirements

• For GS-09, at least 52 weeks of specialized experience equivalent to GS-07 involving analysis of procedural or factual issues, research and application of standardized analytical methods, and evaluation of task inputs for accuracy; or qualifying graduate education or an equivalent combination of experience and education.
• For GS-11, at least 52 weeks of specialized experience equivalent to GS-09 involving technical assignments and casework applying laws, rules, regulations, or procedures related to the Life Insurance program, and maintenance of VA Life Insurance Accounts or examination, investigation, authorization, and verification of VA life insurance claims or related programs; or qualifying doctoral-level education or an equivalent combination of experience and education.
• Current Federal GS employees must meet time-in-grade requirements by the announcement closing date: 52 weeks at GS-07 for GS-09 consideration or 52 weeks at GS-09 for GS-11 consideration.
• Must be a U.S. citizen.
• Selective Service registration is required for males born after December 31, 1959.
• Must serve a one-year probationary period and may be subject to a probationary or trial period.
• Subject to a background/security investigation.
• Selected applicants must complete online onboarding and provide acceptable identification for employment verification; effective May 7, 2025, non-REAL ID-compliant driver's licenses or state identification cards are not acceptable for this purpose.
• A transcript must be submitted if education is used to qualify; foreign education requires a Certificate of Foreign Equivalency with the transcript.
• The work is basically sedentary.

Responsibilities

• Conduct in-depth reviews of task inputs from Insurance Policyholders Services and Insurance Claims to ensure accurate operations processing and disbursements.
• Recommend improvements to the Insurance Quality Assurance program, disbursement practices, and policy procedures.
• Analyze computer-generated insurance transaction listings for possible fraudulent activity.
• Monitor computer-generated listings to verify the appropriateness of account transactions.
• Analyze transaction histories, source documents, and other documentation when fraud or inappropriate insurance transaction processing is suspected.
• Conduct formal training for newly assigned personnel and training on new procedures for Quality Assurance staff, as well as refresher training for Operations staff.
• Advise and assist lower-grade Insurance Specialists in Operations on difficult cases and provide refresher training as needed.
• Assist the supervisor by providing feedback on performance reviews for lower-grade and/or new employees.
• Provide input to the supervisor for performance appraisals and supervisory evaluations.
• Independently complete assignments and prepare reports and recommendations for the Assistant Director and/or Staff Chief(s).

Benefits

• Federal employees and their families have access to a comprehensive benefits package; specific benefits depend on position type and should be confirmed with the hiring agency.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level