Summary The Customer Service Specialist position is in the Care in the Community and reports to the Assistant Chief of HAS. The Specialist conducts reviews in the areas of community care coordination and payment of claims related to Care in the Community to attempt to resolve concerns from Veterans and community providers. Conducts reviews as required by their direct supervisor and Medical Center leadership. Responsibilities Major Duties include, but are not limited to: Serves as the liaison between the patient/family, vendor, Veterans Board of Appeals, Congressional Liaisons, District Counsel, Veteran's Affairs Medical Centers, and the Office of Community Care and provides a channel through which the unit can respond to patients' needs and concerns. Provides consultative services to Veterans, vendors, congressional offices, Veteran Service Organizations, staff, and other stakeholders to facilitate performance improvement by providing training with regards to business and financial processes as well as internal controls. Communicates with the patient and their family and with clinical and administrative staff, Veteran's Affairs (VA), and private sector, to enhance responsiveness in meeting the health care needs of Veterans. Performs a variety of support service functions and related work in dispersing information to the public on rights, benefits, privileges, or obligations, explaining pertinent legal provision, regulation on related administrate practices, and their applications to specific cases, and assisting individuals in developing needed evidence and preparing required documents, or in resolving errors, delays, or other problems in obtaining benefits or fulfilling obligations. Answers questions regarding claims status, relays Medicare pricing messages provided by FBCS (fee-based claim system) or other claim processing software/databases, total amount paid, check information, and timeliness of processing. Takes inquiries from Veterans, their family members, and/or representatives and to research all appropriate documentation for the indicated issue (i.e., consults, referrals, vendor contracts etc.) and assesses, interprets, and documents results to support the response. Provides updates on progress of work to supervisor, service line leadership, Office of Patient Advocates (OPA), Congressional Offices, VISN and medical facility leadership regarding completed investigations resulting in confirmation of issue resolution. Investigates complaints, initiates action/appeals or change to rectify the situation and reports corrective measures taken to parties involved, when warranted. Monitors and evaluates corrective measures taken. Participates in the establishment of administrative qualitative standards intended to improve programs, facilities, and operations. Maintains a close working relationship with various program officials. Identifies, analyzes, and makes recommendations on process improvement based on research analyses. Organizes, compiles, summarizes, and analyzes the data collected and develops reports which reflect the scope of activities and identifies trends and opportunities for process improvement. Performs other related duties as assigned. Work Schedule: 8:00am-4:30pm, Monday- Friday. Telework: Adhoc Only - As determined by the agency policy. Position Description/PD#: Customer Service Specialist/PD101300 Requirements Conditions of Employment 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. Physical Requirements: Work is mostly sedentary; however, standing during presentations or training, bending, and carrying light items is required. The work is performed in a typical office setting with adequate light, heat, and ventilation. Some travel is 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 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) As a condition of employment for accepting this position, you will be required to serve a 1-year probationary period 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. Upon completion of your probationary period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest. Qualifications To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 05/26/2026. 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-9 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 and/or education 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: experience where you were responsible for performing reviews by examining medical records, authorizations, community payment records, and historical tracking of submitted health care claims. Conduct performance reviews to determine the economy, efficiency, and effectiveness of program operations and to determine whether the entity has complied with laws and regulations applicable to the program. Provides consultative services to customers, staff, and other stakeholders to facilitate performance improvement by providing training with regards to business and financial processes as well as internal controls. Perform a variety of support service functions and related work in dispersing information to the public on rights, benefits, privileges, or obligations; explaining pertinent legal provision, regulation, and related administrate practices, and their application to specific cases; and assisting individuals in developing needed evidence and preparing required documents, or in resolving errors, delays, or other problems in obtain benefits or fulfilling obligations. OR, Education:. Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have 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. OR, Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education beyond 1 full year of graduate level education or superior academic achievement. 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. 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 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. The John J Pershing VA & its CBOC's are committed to hiring a diverse workforce from various backgrounds and individuals who demonstrate a diversity, equity and inclusion-related mindset and behaviors. We are strongly seeking candidates who represent the full range of cultural and identity factors including but not limited to race, ethnicity, sex, sexual orientation/identity, gender identity and expression, age, language, abilities/disabilities, socioeconomic status, religion, spiritual practices, geographic region, and other characteristics. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments. Receiving Service Credit for 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. VA may offer newly-appointed Federal employee's credit for their job-related non-federal experience or active duty uniformed military service. 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. The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced VA competitive service employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit appropriate documentation (a copy of the agency notice, your most recent performance rating, and your most recent SF-50 noting current position, grade level, and duty location) and be found well-qualified for this vacancy. To be well-qualified: applicants must possess experience that exceeds the minimum qualifications of the position including all selective factors, and who are proficient in most of the required competencies of the job. Information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/.
