Insurance Specialist

Veterans Benefits Administration•Philadelphia, PA

About The Position

This position serves as an Insurance Specialist within the Policy Maintenance Center of the Veterans Benefits Administration's Insurance Service, Department of Veterans Affairs. The Insurance Service & Operations Center provides insurance products and services to Veterans, Service members, and military families, helping policyholders secure peace of mind and beneficiaries financial security. The Insurance Specialist reviews work items, suspense payment actions, and out-of-balance policies; assesses policy billing, transaction history, liabilities, and funds in suspense; and conducts complex policy and loan audits. The role calculates refund actions and interest, completes system actions, and processes payments, liens, and fund recovery actions as appropriate. It also researches returned and missing government checks, determines the status and availability of funds, investigates potential fraud or payee errors, and coordinates with Veterans and Treasury personnel. The position prepares customer correspondence explaining policy actions and amounts due or owed, and works with peers and supervisors to resolve complex policy issues and complete priority workload on time. Additional work includes processing loan and cash surrender actions, underwriting applications such as reinstatements and conversions, overdue dividend payments, and control listings and suspended accounts. The Insurance Specialist reviews and adjusts policies involving allotment and deduction from benefit billing, corrects policy balances and payee information, disburses dividends held on account, reinstates lapsed insurance, calculates reinstatement requirements, audits premium and loan activity, and processes missing-check inquiries. The position is primarily in an office setting. Some travel may be necessary for training, meetings, or customer interactions.

Requirements

For GS-07, one year of specialized experience equivalent to GS-05, including applying established laws, regulations, policies, procedures, and guidelines; reviewing records to identify issues and determine actions; providing customer service and responding to routine inquiries; communicating with internal and external stakeholders; and using judgment to resolve routine problems or refer complex matters.
For GS-07, qualifying education may substitute for experience: one full year of graduate-level education demonstrating the competencies necessary for the work, or superior academic achievement (including a GPA of 3.0 or higher under the stated criteria). Education and experience may be combined.
For GS-09, one year of specialized experience equivalent to GS-07, including knowledge of the legal and regulatory basis of VA Insurance laws, programs, practices, methods, and technologies sufficient to work independently on conventional assignments, and knowledge of Insurance Service organization, operations, and coordinating organizations' work processes.
For GS-09, qualifying education may substitute for experience: a master's or equivalent graduate degree, two full years of progressively higher-level graduate education leading to such a degree, or a related LL.B. or J.D. Graduate education must demonstrate competencies necessary for the work. Education and experience may be combined.
Current Federal employees who held a GS grade in the past 52 weeks must meet time-in-grade requirements by the announcement closing date: 52 weeks at GS-05 for GS-07, or 52 weeks at GS-07 for GS-09. The requirement also applies to former Federal employees applying for reinstatement and current employees applying under VEOA.
U.S. citizenship is required. Selective Service registration is required for males born after December 31, 1959.
A one-year probationary period is required, and continued employment is subject to written certification that it advances the public interest. A probationary or trial period may also be required.
The position is subject to a background/security investigation and online onboarding. Acceptable identification is required for I-9 and pre-employment requirements; from May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be used as acceptable employment identification.
Applicants relying on education for qualification must submit a transcript. Education must be from an appropriately accredited institution; foreign education requires a Certificate of Foreign Equivalency with the transcript.
Part-time experience is credited on a prorated basis; applicants seeking credit must identify duties, responsibilities, and weekly hours.

Responsibilities

Review work items, suspense payment actions, out-of-balance policies, control listings, suspense payment lists, suspended account lists, and billing-alter policies; audit and correct records as needed.
Assess policy billing, transaction history, liabilities, and funds in suspense.
Conduct complex policy and loan audits and calculate refund actions to allocate funds, bring accounts current, and resolve or establish indebtedness.
Complete system actions and, when applicable, calculate interest before releasing a payment, establishing a lien, or developing action to recoup funds.
Process returned payments and research and develop information to locate payees and properly apply funds.
Prepare and release customer correspondence explaining policy actions and money due or owed.
Research missing government checks initiated by the VA Insurance program, including inquiries to the Treasury Department.
Initiate check-status inquiries through the Treasury Check Information System (TCIS), determine the status and availability of funds, and refund available funds.
When funds are unavailable, determine whether fraudulent activity or an incorrect payee was involved; communicate with Veterans and Treasury's Check Claims Department and initiate recovery when an incorrect payee is identified.
Coordinate with peers and supervisors to resolve complex policy issues and complete priority workload in a timely manner.
Process loan and cash surrender actions, underwriting applications such as reinstatements and conversions, and overdue dividend payments.
Review and adjust policies involving allotment and deduction from benefit billing, correcting policy balances and payee information.
Disburse dividends held on account, reinstate lapsed insurance, calculate monetary requirements for reinstatement of lapsed or automatically surrendered insurance, audit premium and loan activity, and process missing checks.