Job Listing
Claims Examiner
Veterans Health Administration · Posted today
Hybrid Lakewood, CO $62K – $81K Apply by Sep 22, 2026 Claims Assistance And Examining ESFJINFJISFJISTJ Healthcare
Apply for this job → About the Role
The purpose of this position is to ensure timely access to healthcare for thousands of beneficiaries domestically and more than six million eligible service-connected Veterans around the world. The position supports beneficiary and Veteran well-being through prompt claim reimbursement to thousands of domestic and international healthcare providers.
What You'll Do
- →This job announcement will remain open for 8 business days.
- →The initial application review cut-off for this job announcement is 50 applications.
- →Applications received up to 11:59pm EST on the date in which 50 applications is reached will receive first consideration (initial cutoff).
- →Applications received after 11:59pm EST on the date in which 50 applications are received may not receive consideration unless otherwise requested by management.
- →Additional applications will be reviewed in one-day increments at management request.
- →Note: Submitting multiple applications will change the order in which your application is reviewed.
- →Examine claims to consider whether the condition treated is service-connected or associated with and aggravating a service-connected condition.
- →Review accuracy and completeness of submitted documentation; analyzes the diagnostic and procedure codes (reasons for medical care and procedures performed); considers FDA indications and unlabeled indications for medications; and completes the conversion of foreign currency to U.S. dollars in accordance with FMP 38 U.S.C. §1724.
- →Identify and resolve other issues associated with the request for payment prior to adjudication.
- →Develops and evaluates relevant documentation related to Veteran/beneficiary claims submitted for payment; the incumbent examines expenditures for accuracy, adequacy of documentation, citations, compliance with regulations, and justifications for Specialty Program payment.
- →Evaluate and process provider health care claims that are being corrected or reconsidered for payment; this requires extensive research via systems including Customer Relations Manager (CRM), claim adjudication software, document management systems that contain claim attachments, and National Provider Identification (NPI) online.
- →Handles escalated claims referenced in high-level government inquiries (Congressional, White House, Secretary of VA), reporting findings, analysis, and recommendations for corrective action in professional correspondence.
- →Collect and store vendor data so that the foreign banking information can be used to pay foreign providers by Electronic Funds Transfer (EFT).
- →Ensure foreign vendors are paid into foreign financial institutions where their company is located to improve payment integrity, address fraud risk concerns brought up by the GAO and SVAC, ensure regulatory compliance with the U.S.
Requirements
- ✓You must be a U.S.
- ✓Citizen to apply for this job To be considered for this position, you must complete all required steps in the process.
- ✓In addition to the application and questionnaire, this position requires an online assessment.
- ✓The online assessment measures critical general competencies required to perform the job.
- ✓Selective Service Registration is required for males born after 12/31/1959 Physical Requirements: The work is primarily sedentary with occasional requirements to walk around in an office building to meet with employees.
- ✓Most work requirements involve using a computer and standard office automation equipment.
- ✓The incumbent may need to stoop, bend, reach, or occasionally carry loads weighing up to 20 pounds.
- ✓The work required does not inherently include any physical requirements essential for successful job performance that could not otherwise be performed with accommodation or workplace adjustment.
- ✓A pre-placement physical examination is not required.
- ✓Subject to background/security investigation Selected applicants will be required to complete an online onboarding process.
- ✓Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents).
- ✓Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
- ✓Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP) As a condition of employment for accepting this position, you will be required to serve a 1-year probationary period or 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest.
- ✓In determining if your employment advances the public interest, we may consider: your performance and conduct; the needs and interests of the agency; whether your continued employment would advance organizational goals of the agency or the Government; and whether your continued employment would advance the efficiency of the Federal service.
Personality Fit
Job ID: f2dd561f-48b0-4ee0-88a7-439030aa809a
Posted via USAJobs