Claims Examiner

Veterans Health Administration; Lakewood (CO); On-site; USD 65,000 - 78,000; Full time

Job summary

Veterans Health Administration seeks a qualified candidate to ensure timely access to healthcare for thousands of beneficiaries and to support prompt claim reimbursement to healthcare providers worldwide.

Ideal applicants will meet time-in-grade requirements, possess specialized experience in evaluating medical documentation for eligibility, and interpret clinical information to support accurate reimbursement decisions.

Qualifications

• Evaluate medical documentation to determine benefit eligibility and appropriate payment decisions.
• Review and interprets healthcare information including diagnoses, procedures, treatment notes, and medical terminology.
• Use industry standard coding systems and software to translate medical descriptions into standardized codes for claims processing and reimbursement.
• Experience with health insurance policy and plan types to include commercial, federal, and state plans.
• Manage high volume or fast paced customer interactions with patience and empathy while maintaining accuracy, professionalism, and a strong commitment to service.

Responsibilities

• Ensure timely access to healthcare for thousands of beneficiaries.
• Process claims and reimburse providers accurately and promptly.

Job description

The purpose of this position is to ensure timely access to healthcare for thousands of beneficiaries domestically and more than six million eligible service-connected Veterans around the world. The position supports beneficiary and Veteran well-being through prompt claim reimbursement to thousands of domestic and international healthcare providers.

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 09/22/2026.

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-08 position you must have served 52 weeks at the GS-07. 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.

Specialized Experience

Have one year of specialized experience equivalent to at least the next lower grade GS-07 in the normal line of progression for the occupation in the organization. NOTE: To be minimally qualified for this position, you must meet the following examples of specialized experience. Examples of specialized experience would typically include, but are not limited to:

• Evaluate medical documentation to determine benefit eligibility and appropriate payment decisions.
• Review and interprets healthcare information including diagnoses, procedures, treatment notes, and medical terminology.
• Use industry standard coding systems and software to translate medical descriptions into standardized codes for claims processing and reimbursement.
• Experience with health insurance policy and plan types to include commercial, federal, and state plans.
• Manage high volume or fast paced customer interactions with patience and empathy while maintaining accuracy, professionalism, and a strong commitment to service.

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/.