Summary The Lead Legal Administrative Specialist GS-11 serves on matters pertaining to the development, evaluation, and disposition of appealed issues for the Veterans and Family Member Programs (VFMP) Directorate's administered programs. Responsibilities Major Duties Include (but are not limited to): Independently develops action and/or recommendations to address appeal policy, legal issues, and procedural issues; Develops responses to correspondences from other Federal agencies, providers, professional organizations, and Congressional offices; Performs research, problem solving analysis, interpretation, and evaluation of laws, regulations, and policies associated with Community Care Operations; Determines the specific information needed for an appeals request and formulates a comprehensive approach to obtain and analyze data, facts, and references needed; Determines the most efficient way to handle multiple tasks and projects concurrently and effectively within the established guidelines; Documents all contacts with providers and beneficiaries and keeps the appellant apprised of the status of the Decision Review; Assimilates complex and fragmented information through the application of analytical skills, conducts comprehensive reviews, identifies relevant facts, and formulate sound conclusions and recommendations based on findings; Provides Decision Review determinations that are supported by thorough review, facts, supporting additional factual or medical documentation, and clear understanding of background information; and develops and implements necessary changes and process improvements within the area of responsibility. Work Schedule: 6:00 am - 5:00 pm Telework: This position may be authorized for telework. Telework eligibility will be discussed during the interview process. Position Description/PD#: Lead Legal Administrative Specialist/PD56415A Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized Requirements Conditions of Employment You must be a U.S. Citizen to apply for this job Selective Service Registration is required for males born after 12/31/1959 You may be required to serve a probationary/trial period 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 dentification 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) Qualifications To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 09/26/2025. 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-11 position you must have served 52 weeks at the GS-09. 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 Specialized Experience and/or Education as described below. Specialized Experience (GS-11): You must have one year of specialized experience equivalent to at least the next lower grade (GS-9) in the normal line of progression for the occupation in the organization. Examples of Specialized Experience includes (but are not limited to): Experience leading a team providing problem solving methods and techniques and identifying viable solutions Experience in determining the most efficient way to handle multiple tasks and projects concurrently and effectively within the established guidelines Experience performing research and applying regulations, and/or policies and/or desk procedures to develop medical case determinations Experience independently developing action(s) and/or recommendations to address appeal policy, legal issues, and procedural issues. Experience with medical and or billing claims OR, Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher level graduate education leading to such a degree or LL.M., (if related) OR, Combination: Applicants may also combine education and experience to qualify at this level. You must have a combination of specialized experience and education beyond a master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree Or LL.B. or J.D., (if related). You will be rated on the following Competencies for this position: Critical Thinking Communication Problem Solving Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Note: A full year of work is considered to be 35-40 hours of work per week. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. Physical Requirements: The work is primarily sedentary, although some slight physical effort may be required. Use of a computer and keyboard is extensive. 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/. Education A transcript must be submitted with your application if you are basing all or part of your qualifications on education. Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/. Additional Information Receiving Service Credit or Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed. This job opportunity announcement may be used to fill additional vacancies. If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement. Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act.
