Claims Processing Director jobs in Norfolk, VA

Claims Processing Director plans and directs one or more departments responsible for administration of health insurance claims, payment processing, billing research, and responding to inquiries. Establishes and implements organizational policies and procedures; may offer guidance on the appropriate handling of complex or high-value claims. Being a Claims Processing Director develops and executes strategic business plans for the department. Coordinates operations with other areas of the organization. Additionally, Claims Processing Director requires a bachelor's degree. Typically reports to top management. The Claims Processing Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Processing Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)

U
CLAIMS EXAMINER
  • US Immediate Office of the Chief of Naval...
  • Norfolk, VA FULL_TIME
  • Duties

    • You will analyze and evaluate all documentation and supporting evidence surrounding a claimed loss to ensure that all necessary information, evidence and forms needed for prompt and just disposition.
    • You will analyze Government Bills of Lading, tenders of service, tariffs and other contractual liability in accordance with applicable regulations and directives.
    • You will use an internal claims database to track and manage assigned claims.
    • You will review offers of settlement and compromise from carriers as dictated by governing regulations and prudent judgement.
    • You will annotate files to reflect decision-making and prepare summaries of evidence when necessary to refer the file to the Supervisory Claims Examiner.
    • You will independently examine assigned claims and reconsideration requests.
    • You will negotiate carrier recovery settlements with contractors.

    Requirements

    Conditions of Employment

    • Must be a US Citizen.
    • Must be determined suitable for federal employment.
    • Must participate in the direct deposit pay program.
    • New employees to the Department of the Navy will be required to successfully pass the E-Verify employment verification check. To learn more about E-Verify, including your rights and responsibilities, visit e-verify.gov
    • Within the Department of Defense (DoD), the appointment of retired military members within 180 days immediately following retirement date to a civilian position is subject to the provisions of 5 United States Code 3326.
    • Males born after 12-31-59 must be registered for Selective Service.
    • You will be required to obtain and maintain an interim and/or final security clearance prior to entrance on duty. Failure to obtain and maintain the required level of clearance may result in the withdrawal of a job offer or removal

    Qualifications

    This position has a selective placement factor that will be used to screen out ineligible candidates. The selective placement factor is: Do you have experience in the private or public sector handling personal property claims OR experience in processing and negotiating claims and liaising with various entities? If so, please document this clearly within your resume.

    In addition to the selective placement factor, your resume must demonstrate at least one year of specialized experience at or equivalent to the GS-07 grade level or pay band in the Federal service or equivalent experience in the private or public sector performing most or all of the following duties: (1) Examining assigned claims and reconsideration requests; (2) Analyzing and evaluating all documentation and supporting evidence surrounding a claimed loss to ensure that all necessary information, evidence and forms needed for disposition of claims is provided; (3) Requesting substantiating information from all claimants; (4) Calculating monies owed to claimants; and (5) Negotiating with claimant to deny or settle claims

    Additional qualification information can be found from the following Office of Personnel Management website:
    https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/#url=List-by-Occupational-Series

    Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., professional, philanthropic, religious, 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.

    Education

    There is no educational substitution for experience in this series at this grade level.

    Additional information

    This position is covered by the Department of Defense Priority Placement Program.

    Additional vacancies may be filled by this announcement.

    Term appointments may be extended up to 8 years at the discretion of management and in accordance with applicable regulations. Additionally, you may be noncompetitively converted to a permanent career-conditional or career appointment under specific conditions.

    This position is eligible for part time, full time or ad-hoc telework at the discretion of management.

    Certain incentives (such as Recruitment, Relocation or Student Loan Repayment) may be authorized to eligible selectees.

    A tentative offer of employment will be rescinded if the selectee fails to meet the pre-employment requirements, including failure to report to any of the scheduled appointments.

    Federal annuitant information: The selection of an annuitant is subject to the Department of Defense and Department of the Navy policy on the employment of annuitants. Policy information may be found at: http://www.secnav.navy.mil/donhr/Documents/CivilianJobs/FedCivAnnuitants.pdf

    ICTAP Applicants: To be considered well-qualified and exercise selection priority as an ICTAP candidate for this vacancy, displaced Federal employees must satisfy all qualification requirements for the position and receive a rating in the highly qualified category or higher. For more information about ICTAP eligibility please review the following link: https://www.usajobs.gov/Help/working-in-government/unique-hiring-paths/federal-employees/career-transition/

    Military Spouse Preference applicants will be placed at the highest grade for which they have applied and are determined Best Qualified (BQ). A BQ military spouse possesses knowledge, skills, abilities, and competencies comparable to others who meet the competitive referral criteria for the specific position.


    • Benefits

      A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

      Review our benefits

      Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

    How You Will Be Evaluated

    You will be evaluated for this job based on how well you meet the qualifications above.

    In order to qualify for this position, your resume must provide sufficient experience and/or education, knowledge, skills, and abilities to perform the duties of the specific position for which you are being considered. Your resume is the key means we have for evaluating your skills, knowledge, and abilities as they relate to this position. Therefore, we encourage you to be clear and specific when describing your experience.

    When the application process is complete, we will review your resume to ensure you meet the hiring eligibility and qualification requirements listed in this announcement. You will be rated based on the information provided in your resume and responses to the Occupational Questionnaire, along with your supporting documentation to determine your ability to demonstrate the following competencies:

    • COMPUTER LITERACY
    • EXAMINING CLAIMS ASSISTANCE
    • INFORMATION MANAGEMENT
    • ORAL COMMUNICATION
    • WRITTEN COMMUNICATION


    You will be evaluated and rated under Category Rating selection procedures. Additional points are not added for veterans' preference; however, preference is still applied. Applicants eligible for veteran's preference will receive selection priority over non-veterans.

    If you meet the qualification requirements, your application will be placed in one of three categories:

    Best Qualified- Candidates in this category possess exceptional skills and experience to exceed well above the minimum requirements for announced position.
    Highly Qualified-Candidates in this category possess good skills and experience above the minimum requirements for announced position.
    Qualified- Candidates in this category meet the minimum experience requirements for announced position.

    If selected, you may be required to provide supporting documentation.

    If after reviewing your resume and supporting documentation, a determination is made that you inflated your qualifications and/or experience, your score may be adjusted to more accurately reflect your abilities or you may be found ineligible/not qualified.

    Please follow all instructions carefully. Errors or omissions may affect your rating or consideration for employment.

    All qualifications requirements must be met by the closing date of this announcement.

    • Benefits

      A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

      Review our benefits

      Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

    • Required Documents

      As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have - whether you're a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you're eligible under their policies.

      You are required to provide documentation that supports the eligibility and qualification claims made in your resume and assessment questionnaire. You must submit the applicable documents listed here and those listed with the eligibilities you select in the announcement questionnaire with your application package. Applicants who do not provide supporting documentation that fully support their claims will not be referred to the hiring manager. Cover letter is optional.

      A complete resume is required. Your resume must show relevant experience, job title, duties and accomplishments. Your resume must show complete information for each job entry to support minimum qualifications. The following information should be provided in your resume, but it is acceptable to provide elsewhere in your application package: employer's name, starting and end dates (Mo/Yr), hours per week, and pay plan, series and grade level (e.g. GS-0201-09) for relevant federal experience.TIP: A good way to ensure you include all essential information is to use the Resume Builder in USAJOBS to create your resume.

      Are you claiming membership in any professional organizations, or possession of a license, certificate or credentials? Check the Conditions of Employment section above to see if any are required. If you claim membership, license, certification, or credentials, you must submit a copy of said document in your application package.

      Are you using education as a substitute for some or all of the experience requirement? Is there a basic education requirement for this position? Check the Education section above to see what is allowed and what is required. Any claims you make in your resume or assessment questionnaire regarding education or degrees MUST be supported by submitting with your application official or unofficial transcripts or a list of courses, grades earned, completion dates, and quarter and semester hours earned issued from your school. While unofficial transcripts are acceptable for initial application, an official transcript will ultimately be required if you are selected for the position. You may submit a copy your degree(s) if specific coursework does not have to be verified.

      Are you a veteran claiming 5-point veterans' preference or claiming sole survivorship preference? You must submit a copy of your latest DD-214 Certificate of Release or Discharge from Active Duty (any copy that shows all dates of service, as well as character of service [Honorable, General, etc.] is acceptable) OR a VA letter that shows dates of service or service connected disability AND character of service. If you have more than one DD-214 for multiple periods of active duty service, submit a copy for each period of service. If you were issued a DD-215 to amend aforementioned information on the DD-214 you must submit that too. If you are not sure of your preference eligibility, visit the Department of Labor's website: Veterans' Preference Advisor

      Are you a disabled veteran or claiming 10-point veterans' preference?
      If you are eligible to claim 10 point veterans preference you must submit a DD-214 Certificate of Release or Discharge from Active Duty as described above for 5-point preference.

      You must also provide the applicable supporting documentation of your disability (e.g. disability letter from the VA) as described on Standard Form-15 (SF-15). http://www.opm.gov/forms/pdf_fill/SF15.pdf.

      Are you an active duty service member? Active Duty Service Members are required to submit a statement of service printed on command letterhead and signed by the command. The statement of service must provide the branch of service, rate/rank, all dates of service, the expected date of discharge and anticipated character of service (Honorable, General, etc.).

      Documents submitted as part of the application package, to include supplemental documents, may be shared beyond the Human Resources Office. Some supplemental documents contain personal information such as SSN and DOB and some documents such as military orders and marriage certificates may contain personal information for someone other than you. You may sanitize these documents to remove said personal information before you submit your application. You must provide an un-sanitized version of the documents if you are selected.

      If you are relying on your education to meet qualification requirements:

      Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

      Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

    • How to Apply

      Click the Apply Online button to create an account or log in to your existing USAJOBS account.

      To apply for this position, you must provide a complete Application Package which includes:
      1. Complete resume with relevant experience, job title, duties and accomplishments. Your resume must show complete information for each job entry to support minimum qualifications. The following information should be provided in your resume, but it is acceptable to provide elsewhere in your application package: employer's name, starting and end dates (Mo/Yr), hours per week, and pay plan, series and grade level (e.g. GS-0201-09) for relevant federal experience. TIP: A good way to ensure you include all essential information is to use the Resume Builder in USAJOBS to create your resume.
      2. Complete assessment questionnaire. For a quick preview of the assessment questionnaire click here: https://apply.usastaffing.gov/ViewQuestionnaire/12366557
      3. Supporting documentation

      Failure to submit a complete application package will result in an ineligible rating and loss of consideration.

      Your complete application (resume, assessment questionnaire, and all supporting documents) must be received by 11:59 pm Eastern Standard Time (EST) on 04/15/2024. Applications received after 04/15/2024 will generally result in an ineligible rating and loss of consideration. If more than one resume is received, only the last resume received and processed will be reviewed.

      Note: To check the status of your application or return to a previous or incomplete application, log into your USAJOBS account: https://mydon.usajobs.gov/Account/Login select Application Status, and click on the more information link under the application status for this position. Your uploaded documents may take several hours to clear the virus scan process so please plan appropriately.

      You are encouraged to apply online. Applying online will allow you to review and track the status of your application.

      Do not email or send hard copy resumes/applications to the Contact Information or Agency Information listed in this vacancy announcement. All resumes/applications received at the addresses listed in the Contact Information or Agency Information will be destroyed and will not be considered for this vacancy announcement.

      It is the applicant's responsibility to verify that all information in their resume and documents are legible and accurate. HR will not modify answers/documents submitted by an applicant.

      Agency contact information

      Department of Navy EIC

      Email

      doneic@us.navy.mil

      Address

      NLSC
      1322 Patterson Ave
      Suite 3000
      Washington Navy Yard, DC 20374
      US

      Next steps

      When the application process is complete, your complete application (resume, assessment questionnaire, and all supporting documents) will be reviewed to determine if you meet the hiring eligibility and qualification requirements for which you requested consideration. You will be rated based on the information provided in your resume and responses to the questionnaire, along with your supporting documentation to determine your level of knowledge, skill, and ability related to the job requirements.

      Generally, only best qualified candidates will be referred to the hiring manager. Sometimes well qualified andminimally qualified candidates are referred. Occasionally, candidates eligible for priority consideration are referred, and no other candidates are referred.

      The hiring manager may choose to conduct interviews.

      You will be notified of our rating and referral decision. If you are referred, you will be notified when a hiring decision is made.

      NOTE: If you have any questions or need assistance, please email the DON Employment Information Center at DONEIC@us.navy.mil

    • Fair and Transparent

      The Federal hiring process is set up to be fair and transparent. Please read the following guidance.

      • Equal Employment Opportunity (EEO) Policy
      • Reasonable accommodation policy
      • Financial suitability
      • Selective Service
      • New employee probationary period
      • Signature and false statements
      • Privacy Act
      • Social security number request

    Required Documents

    You are required to provide documentation that supports the eligibility and qualification claims made in your resume and assessment questionnaire. You must submit the applicable documents listed here and those listed with the eligibilities you select in the announcement questionnaire with your application package. Applicants who do not provide supporting documentation that fully support their claims will not be referred to the hiring manager. Cover letter is optional.

    A complete resume is required. Your resume must show relevant experience, job title, duties and accomplishments. Your resume must show complete information for each job entry to support minimum qualifications. The following information should be provided in your resume, but it is acceptable to provide elsewhere in your application package: employer's name, starting and end dates (Mo/Yr), hours per week, and pay plan, series and grade level (e.g. GS-0201-09) for relevant federal experience.TIP: A good way to ensure you include all essential information is to use the Resume Builder in USAJOBS to create your resume.

    Are you claiming membership in any professional organizations, or possession of a license, certificate or credentials? Check the Conditions of Employment section above to see if any are required. If you claim membership, license, certification, or credentials, you must submit a copy of said document in your application package.

    Are you using education as a substitute for some or all of the experience requirement? Is there a basic education requirement for this position? Check the Education section above to see what is allowed and what is required. Any claims you make in your resume or assessment questionnaire regarding education or degrees MUST be supported by submitting with your application official or unofficial transcripts or a list of courses, grades earned, completion dates, and quarter and semester hours earned issued from your school. While unofficial transcripts are acceptable for initial application, an official transcript will ultimately be required if you are selected for the position. You may submit a copy your degree(s) if specific coursework does not have to be verified.

    Are you a veteran claiming 5-point veterans' preference or claiming sole survivorship preference? You must submit a copy of your latest DD-214 Certificate of Release or Discharge from Active Duty (any copy that shows all dates of service, as well as character of service [Honorable, General, etc.] is acceptable) OR a VA letter that shows dates of service or service connected disability AND character of service. If you have more than one DD-214 for multiple periods of active duty service, submit a copy for each period of service. If you were issued a DD-215 to amend aforementioned information on the DD-214 you must submit that too. If you are not sure of your preference eligibility, visit the Department of Labor's website: Veterans' Preference Advisor

    Are you a disabled veteran or claiming 10-point veterans' preference?
    If you are eligible to claim 10 point veterans preference you must submit a DD-214 Certificate of Release or Discharge from Active Duty as described above for 5-point preference.

    You must also provide the applicable supporting documentation of your disability (e.g. disability letter from the VA) as described on Standard Form-15 (SF-15). http://www.opm.gov/forms/pdf_fill/SF15.pdf.

    Are you an active duty service member? Active Duty Service Members are required to submit a statement of service printed on command letterhead and signed by the command. The statement of service must provide the branch of service, rate/rank, all dates of service, the expected date of discharge and anticipated character of service (Honorable, General, etc.).

    Documents submitted as part of the application package, to include supplemental documents, may be shared beyond the Human Resources Office. Some supplemental documents contain personal information such as SSN and DOB and some documents such as military orders and marriage certificates may contain personal information for someone other than you. You may sanitize these documents to remove said personal information before you submit your application. You must provide an un-sanitized version of the documents if you are selected.

    If you are relying on your education to meet qualification requirements:

    Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

    Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.


    Help

    This job is open to

    • The public

      U.S. Citizens, Nationals or those who owe allegiance to the U.S.

    Clarification from the agency

    U.S. CITIZENS

  • 14 Days Ago

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Processing Technician
  • Default Board
  • Norfolk, VA FULL_TIME
  • GENERAL DONOR CENTER — ENTRY-LEVEL Want to Expand your career-development potential, your ability to help donors and patients, and your access to professional opportunities? We’re growing fast. [You c...
  • 12 Days Ago

O
Processing Technician
  • Octapharma Plasma, Inc.
  • Chesapeake, VA FULL_TIME
  • Requisition Number20-1239Post Date3/7/2020TitleProcessing TechnicianCityChesapeakeStateVAPosition Typepart-timeDescriptionWant to Expandyour career-development potential,your ability to help donors an...
  • 1 Month Ago

O
Processing Technician
  • Octapharma Plasma, Inc.
  • Portsmouth, VA FULL_TIME
  • Requisition Number20-2653Post Date6/17/2020TitleProcessing TechnicianCityPortsmouthStateVAPosition Typepart-timeDescriptionWant to Expandyour career-development potential,your ability to help donors a...
  • 1 Month Ago

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Rating/Claims System Analyst
  • Elevance Health
  • Norfolk, VA FULL_TIME
  • Job Family: IFT > IT Bus Systems Solutions Planning Type: Full time Date Posted: Apr 22, 2024 Anticipated End Date: May 06, 2024 Reference: JR111007 Description Rating/Claims System Analyst Location: ...
  • Just Posted

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Auto Claims Supervisor
  • Chubb INA Holdings Inc.
  • Chesapeake, VA FULL_TIME
  • Chubb is the world’s largest publicly traded property and casualty insurer. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident a...
  • 2 Days Ago

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0 Claims Processing Director jobs found in Norfolk, VA area

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Physician (Rheumatology) GP-602-14
  • Civilian Corps
  • Portsmouth, VA
  • Overview This position is located at the Navy Medicine Readiness and Training Command (NMRTC) in Portsmouth, VA, within ...
  • 4/24/2024 12:00:00 AM

A
Data Warehouse Architect
  • American Auto Shield, Inc
  • Virginia Beach, VA
  • ** Data Warehouse Architect** **Job Category****:** Data Governance **Requisition Number****:** DATAW001917 Showing 1 lo...
  • 4/24/2024 12:00:00 AM

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Ambulatory Pharmacist, Part-Time (Onsite- Norfolk, VA)
  • Cencora, Inc.
  • Norfolk, VA
  • Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthi...
  • 4/23/2024 12:00:00 AM

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Regional Talent Manager
  • Clayton Homes
  • Norfolk, VA
  • Anticipated End Date:2024-06-30Position Title:LTSS Service Coordinator-RN ClinicianJob Description:This is a field posit...
  • 4/23/2024 12:00:00 AM

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LTSS Service Coordinator-RN Clinician
  • Elevance Health
  • Norfolk, VA
  • Anticipated End Date: 2024-07-31 Position Title: LTSS Service Coordinator-RN Clinician Job Description: Location: This i...
  • 4/22/2024 12:00:00 AM

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Pharmacy Quality Assurance Specialist
  • Elevance Health
  • Norfolk, VA
  • Description Pharmacy Quality Assurance Specialist Location: This position will work a hybrid model (remote and office). ...
  • 4/21/2024 12:00:00 AM

C
SUPERVISOR
  • Commander, Naval Information Warfare Systems Command (NAVWARSYSCOM)
  • Norfolk, VA
  • Summary This is a public notice flyer to notify interested applicants of anticipated vacancies. Applications will not be...
  • 4/21/2024 12:00:00 AM

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Ambulatory Pharmacist, Part-Time (Onsite- Norfolk, VA)
  • Cencora
  • Norfolk, VA
  • Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthi...
  • 3/27/2024 12:00:00 AM

According to the United States Census Bureau, the city has a total area of 96 square miles (250 km2), of which 54 square miles (140 km2) is land and 42 square miles (110 km2) (43.9%) is water. Norfolk is located at 36°55′N 76°12′W / 36.917°N 76.200°W / 36.917; -76.200 (36.8857° N, 76.2599° W) The city is located at the southeastern corner of Virginia at the junction of the Elizabeth River and the Chesapeake Bay. The Hampton Roads Metropolitan Statistical Area (officially known as the Virginia Beach-Norfolk-Newport News, VA-NC MSA) is the 37th largest in the United States, with an estimated...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Processing Director jobs
$149,411 to $200,779
Norfolk, Virginia area prices
were up 1.2% from a year ago

Claims Processing Director in Portsmouth, NH
Insurance claims and processing clerks work closely with insurance brokers and agents, handling the administrative duties behind insurance policy renewals, claims processing and new policies.
December 28, 2019
Claims Processing Director in Santa Barbara, CA
Complete with new dashboards, reporting functionality, business intelligence tools, and improved security, FileHandler Enterprise is the new benchmark for Claims Management Software.
February 08, 2020
Claims Processing Director in San Diego, CA
Pulpstream makes it possible for you to have one system for tracking all claims.
January 07, 2020