These positions are located in VHA Office of Integrated Veteran Care (IVC), Integrated External Networks, Customer Experience, Customer Service. The primary function of the Contact Representative (CS) is responding to customer inquiries received via telephone interactions regarding program benefits administered by IVC.
To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 10/30/2025. Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-8 position you must have served 52 weeks at the GS-7. The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment. You may qualify based on your experience as described below: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-7 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Providing advisory services to Veterans, beneficiaries, and the public regarding health benefit programs administered by the Office of Integrated Veteran Care (IVC), including CHAMPVA, Spina Bifida, CWVV, Caregiver, and Foreign Medical Programs. Explaining complex benefit options, eligibility requirements, and administrative procedures to a diverse customer base through telephone, written, and electronic communication. Researching and interpreting VA regulations, policies, and procedures to respond to inquiries and resolve issues related to IVC health benefit programs. Composing written responses to inquiries using standard or customized formats, ensuring clarity and compliance with VA correspondence standards. Utilizing knowledge of medical terminology and office automation (e.g, databases, email) to support customer service functions. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.
Duties include, but are not limited to: Answer incoming telephone calls from customers regarding program benefits administered by IVC. Redeveloping claims for reprocessing, ensuring that all required information and documents are present and complete to facilitate payment of claims. Explaining payment methodologies used in adjudicating medical claims. Utilizing policies and regulations to resolve inquiries. Recording new and/or updated information in computerized databases. Gaining and maintaining expertise in all IVC benefits programs to include CHAMPVA, Spina Bifida, the Foreign Medical Program (FMP), Children of Women Vietnam Veterans (CWVV), CHAMPVA In-House Treatment Initiative (CITI), Caregiver, Camp Lejeune, VA Dental Insurance Program (VADIP). Developing, examining, adjusting, reconsidering, recommending settlement of various types of claims, receives and processes requests for authorization of healthcare services, supplies and benefits. Assisting in the preparation and development of claims and giving advice and assistance in obtaining evidence and supporting documents that may be necessary. Explaining and advising the basis for payment decisions and reasons for dis-allowance. Informing claimants and applicants of the reasons for approval, denial, rejection, or partial acceptance of their claims and/or applications for benefits. Work Schedule: 8 hour tour Monday - Friday between 6am and 5pm MT, based on business needs Telework: This position may be authorized for telework. Telework eligibility will be discussed during the interview process. Virtual/Remote: This is not a remote position. The selectee will be required to report to a VA facility, Agency/VA approved leased space, or any Federal building designated by VA. Position Description/PD#: Contact Representative/PD04785A Relocation/Recruitment Incentives: Not authorized Critical Skills Incentive (CSI): Not approved Permanent Change of Station (PCS): Not authorized