Federal Benefits Claims Representative
il y a 3 semaines
**Duties**:
This is the expert level for Federal Benefits Claims Representatives responsible for developing and processing the full range of the most difficult, complex, and responsible federal benefits related claims work which frequently requires comprehensive investigations to determine initial and continuing benefit eligibility. The incumbent prepares and submits complete and authoritative final adjudication packages to the Social Security Administration (SSA) for final action. Although the most extensive federal benefits program involves SSA benefits and services, the incumbent is also responsible for any claims work involving the benefit programs of the Department of Veterans Affairs (DVA), the Office of Personnel Management (OPM), the Railroad Retirement Board (RRB), and the Department of Labor (DOL).
**Major Duties and Responsibilities**
**A. Claims Development and Processing - 90%**
Develops, analyzes, and processes the wide spectrum of claims covering the full range of federal benefits, including a substantial number of the most complex claims involving the most difficult technical issues. Interviews applicants, advises inquirers of the type(s) of benefits for which they are eligible, including DOL Black Lung. Obtains requisite information and supporting documentation. Interprets applicable laws, regulations, policies, and procedures. Assists applicants in securing evidence and examines and evaluates presented evidence to evaluate its validity and acceptability in establishing entitlement to benefits. Provides expert analytical opinions in resolution of evidentiary discrepancies.
Develops and prepares the full range of federal benefits claims to the point of final adjudication. This requires researching and documenting conclusions on all issues that could affect the type and amount of benefits
entitlements. In the development of disability claims, safeguards the integrity of the disability process by selecting appropriate qualified medical sources, evaluating medical reports and re-contacting sources for clarification or additional information, and recommending consultative exams where appropriate. Schedules special consultative medical examinations, evaluates the amounts billed for consultative examinations, and negotiates with physicians, clinics, and/or hospitals to obtain reasonable fees.
Independently develops and thoroughly documents cases involving fraud and/or complex points of law. Conducts interviews, and if necessary, extensive off-site field investigations. Drafts detailed reports with authoritative recommendations for final adjudication by the appropriate federal agency.
Advises potential claimants of the provision of the law regarding special complications such as reduced retirement benefits versus reduced disability/survivor benefits.
Provides information to claimants regarding reconsideration and subsequent administrative appeals rights as defined under applicable law. Assists claimants in filing for reconsideration or an appeal. Prepares the case and routes it to the appropriate Federal agency.
Develops and resolves the most complex post entitlement issues resulting from suspension, resumption, continuation, or termination of payments, and re-entitlement in erroneous termination cases. Analyzes and
evaluates bank records to resolve payment discrepancies. Works with local banks on complex cases to recall, reclaim, or interpret benefits that are not payable. If necessary, contacts the estate or relatives of deceased
beneficiaries to reclaim such benefits.
Responds to a variety of verbal and written inquiries that frequently involve complex and/or contentious issues. For example, explains alien taxation and alien non-payment provisions, computations such as the windfall elimination provision and a variety of benefit offsets such as the government pension offset, worker's compensation offset, and public disability offset.
Conducts investigations involving the most difficult, sensitive, and complex disability claims and program integrity work. Exercises a considerable degree of independence when conducting out-of-the office investigations through on-site visits and complicated inquiries. Develops claims from applicants who due to the nature of their disability, e.g., blindness, hearing loss, etc. are prevented from filing an in-person or tele-claim. Performs representative payee audits and overpayment collections. Verifies questionable vital statistics documents by comparison to official
records. Writes detailed reports for submission to the appropriate agency on results of investigations. Establishes and maintains cooperative relationships with a wide range of working level contacts within the host country local community, e.g., educational, banking, and medical institutions, churches, government agencies, etc.
**Qualifications and Evaluations**:
- Requirements:
**WORK EXPERIENCE**
Two (2) years of this experience must be acquired in the performance as a federal benefit claims re
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