About the role
Duties
Social Insurance Specialist (Claims Specialist) conduct in-depth interviews and help claimants develop their claims for retirement, survivors and disability benefits and/or supplemental security income. They work with claimants to establish their continuing eligibility for payment, assist claimants in filing for administrative appeals, adjudicate high-level claims and authorize them for payment, provide referral services, and identify and investigate potential program abuse.
Qualifications
Qualifications Requirement:
GS-5: Three years of general experience, one year which is equivalent to the GS-4, that demonstrates the ability to 1) analyze problems to identify significant factors, gather pertinent data, and recognize solutions; 2) plan and organize work; and 3) communicate effectively orally and in writing. Examples of general experience include providing information and assistance to the general public, analyzing, explaining, applying or interpreting laws, rules, regulation or policies.
GS-7: Fifty-two weeks of specialized experience equivalent to the GS-5 grade level. Examples of specialized experience include assisting individuals in filing applications for financial assistance, unemployment, Veterans benefits, insurance benefits, health benefits and/or social service programs; developing, processing, or authorizing claims; explaining benefit related programs to the general public; or evaluating benefit program policies, procedures and guidelines.
GS-9: Fifty-two weeks of specialized experience equivalent to the GS-7 grade level. Examples of specialized experience include assisting individuals in establishing their entitlement to receive benefits; adjudicating or investigating claims; or evaluating benefit programs to assess the integrity and quality of operations.
GS-11: Fifty-two weeks of specialized experience equivalent to the GS-9 grade level. Examples of specialized experience include developing, examining, investigating, adjudicating or authorizing of claims under a program for SSA benefits, health insurance, pension plan, income maintenance or related programs.
SUBSTITUTION OF EDUCATION: Substitution of education for general or specialized experience will be made in accordance with the OPM Operating Manual, Qualification Standards for General Schedule Positions. Employees who are substituting education for experience must upload a copy of unofficial or official transcripts prior to the announcement closing. Selectees will be required to provide official transcripts upon selection.
GS-5: Completion of a full 4-year course of study in any field leading to a bachelor's degree OR a combination of post-high school education and the general experience described above. One year of study is defined as 30 earned semester hours or 45 earned quarter hours.
Education
GS-7: One full year of graduate level education in any field. One year of full-time graduate study is defined as 18 earned semester hours or 27 earned quarter hours ORa combination of graduate level education and the specialized experience as described above OR a Bachelor's degree and superior academic achievement in any field can be applied as a substitution. Superior academic achievement is based on:
- Graduated in the upper third of the graduating class in the college, university, or major subdivision; OR
- Graduated with a cumulative 3.0 GPA or higher out of 4.0 based on 4 years of education, or based on courses completed during the final 2 years of the curriculum; OR
- Graduated with a 3.5 GPA or higher based on the average of all the required courses completed in the major field or the required courses in the major field completed during the final 2 years of the curriculum; OR
- Election to membership in a national scholastic honor society that meets the minimum requirements of the Association of College Honor Societies (except for freshman honor societies).
GS-9: 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.
For GS-11: 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.
IF YOU WERE NEVER A FEDERAL EMPLOYEE , YOU ARE NOT ELIGIBLE FOR THIS POSITION. THIS POSITION IS OPEN TO FEDERAL EMPLOYEES WHO HAVE UNDERGONE A REDUCTION IN FORCE (RIF).
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