This position is in the Financial Health Care Service, Systems Management and Configuration. Incumbent serves as the subject matter expert on the processing systems for medical claims. The position will include planning, designing, analyzing, testing, implementing, and configuring automated systems as well as providing analysis and advice related to legacy and new claims processing systems.
To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 09/12/2025. 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-12 position you must have served 52 weeks at the GS-11. 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. Provide a copy of your last or most recent SF-50, "Notification of Personnel Action" to indicate your current federal status. You must also submit additional SF-50(s) to clearly demonstrate one year time-in-grade as required in the announcement. If the most recent SF-50 has an effective within the past year, it may not clearly demonstrate that you possess one year time-in-grade. In this instance, you must provide an additional SF-50 that clearly demonstrates one year time-in-grade. AND Selective Placement Factor: This position includes a skill, knowledge, ability or other worker characteristic basic to -and essential for- satisfactory performance of the job. Selective Placement Factors are a prerequisite to appointment and represent minimum requirements for a position. Applicants who do not meet it are ineligible for further consideration. Evidence of the Selective Placement Factor must be reflected in your resume. The Selective Placement Factor for this position is: Do you have experience in medical claims processing, along with a strong understanding of industry standard practices and systems management? AND 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-11 in the normal line of progression for the occupation in the organization. Specialized experience includes, but is not limited to: Applying knowledge of industry-standard medical claims processing to review, analyze, and resolve complex claims issues in compliance with agency regulations and procedures Analyzing and improving medical claims systems and procedures by interpreting and applying technical rules, regulations, and guidelines to enhance operational efficiency Evaluating procedural effectiveness and recommending improvements based on system performance data and regulatory updates Utilizing a working knowledge of medical claims system operations to ensure compliance with organizational objectives, policies, and priorities Interpreting and applying the underlying objectives and policies that govern medical claims processing systems to align operations with broader organizational goals You will be rated on the following Competencies for this position: Financial Analysis Budget Administration Analysis and Problem Solving Communication Per Office of Personnel Management General Schedule Qualification Policies, federal employees are assumed to have gained experience by performing duties and responsibilities appropriate for their official series and grade level as described in their position description. Experience that would not normally be part of the employee's position is creditable when documented by satisfactory evidence (e.g., a memorandum from the manager, human resources director, or official documentation such as SF-52, SF-50 documenting an official detail/assignments, or other comparable documentation). The documentation must indicate whether the employee performed the duties full time or, if part-time, the percentage of times the employee performed the additional duties. To receive credit for experience in your resume that is not within the official series and grade level of your position, you must provide official documentation of such experience as indicated above. 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 OPM's web site at http://www.opm.gov/qualifications/standards/indexes/alph-ndx.asp.
This job announcement will remain open for 5 business days. This is a non-bargaining unit position. VA offers a comprehensive total rewards package: VA Total Rewards Work Schedule: Monday-Friday 8:00am- 4:30pm Compressed/Flexible Schedule: Available, may be available with supervisor's approval Telework: Available, upon supervisory approval Duty Location Status: To be determined - This is a virtual position that will be required to work in the nearest VA facility if office space is available. Position Description Title/PD#: Systems and Procedures Analyst/ PD14204A Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not Authorized Physical Demands: The work is sedentary, although some light physical effort may be required. Major Duties: Plans, designs, analyzes, configures, tests, and integrates automated systems for processing medical claims Provides direction in the implementation and maintenance of the processing systems for medical claims and works directly on projects related to the improvement of such systems Analyzes and evaluates current medical claims processing policies, practices, procedures and recommends changes to practices covering the core medical claims processing system and its interfaces Analyzes and evaluates the impact of new policy and procedures on current financial systems, policies and procedures; and recommends implementation plans to senior leadership Assists customers with medical claims systems, acquisitions, consulting inquiries, reconciling reports, taking corrective action on medical claims processing systems issues or reporting errors, and providing training to VA field station staff