- Claims Processing Specialist
- Virginia Beach, VA
IntellecTechs is looking for qualified candidates to fill the Claims Processing Specialist position in support of the Department of Veterans Affairs Pilot Program – Decision Ready Claim (DRC) Initiative Modernization Support Services Virginia Beach, VA. These positions will support the VA’s efforts to expedite Veterans Benefits Administration’s decision-making process for disability compensation and dependency and indemnity compensation claims (DIC) processing. The areas of responsibilities are detailed below:
Veterans DRC Processing Duties:
- Work as part of a team to process 335,000 Veteran DIC claims
- Review VA Form 21-4138 and 21-0985 to determine if additional information is needed for the claimed condition.
- Request records from the Veterans Service Organizations (VSO) and Veteran.
- Communicate the status of record requests with the VSO and VA.
- Use a rules-based system to determine if the conditions identified on the exam request form warrant an exam based on the laws defined in Title 38 of the US Code of Federal Regulations
- Using VA’s internal guidance established in the M21-1 Adjudication Procedures Manual, Identify which conditions warrant an examination or medical opinion.
- Identify criteria met or not met in making a determination.
- Identify the type of medical exam that should be completed for each condition warranting an exam.
- Provide data and feedback to the various VSOs on errors with submitted examinations or medical opinion request packages that require clarification from VSO or the Veteran.
- Utilize the VA’s Veterans Benefits Claims processing system which incorporates an Internet authorization application, document processing functionality, optical character recognition (OCR) scanning capability and DRC claims processing software to submit approved examination requests and communicate such with the VSO and/or Veteran.
- Input and validate medical claims data into the DRC application.
- Communicate to VSO and/or Veteran that claimed condition(s) does not qualify for DRC
- Securely provide status updates throughout the process specifically pertaining to Exams or Medical Opinions requests submitted via the DRC exam request system to the appropriate Contract Exam Vendor (CEV).
- Field and Maintain records associated with calls from VSO and/or Veterans.
- Troubleshoot exam or medical opinion request issues with CEVs.
- Provide customer service communication to Veterans and VSOs on exam or medical opinion issues (such as what documentation is missing or needed to complete the request package).
- Respond to written and oral VSOs, Veterans, and CEV inquiries.
Veterans Benefits Examination:
- Examine claims and other DRC requests for Veterans Claims. Documents must be accurate, provide adequate documentation or citations, and comply with laws and regulations. Justification submitted must be in compliance with VA’s guidance and Federal Laws.
- Review claims for completeness and accuracy.
- Complete procedural processing of Veterans Benefits claims.
- Determine sufficiency of package documentation.
- Possess knowledge of electronic claims editing and submission capabilities, including on-line claims processing and query systems.
- Respond to written and oral vendor inquiries.
- Must be able to obtain a favorable National Agency Check (no criminal record)
- Requires a high school diploma or its equivalent with 2+ years of experience in the field or in a related area.
- Must have working knowledge of Microsoft Office Access and Excel.
- Must have experience working with web-based applications
- Experience processing Veterans Benefits claims and have strong customer service skills
- Demonstrated success working in a team environment focused on meeting organizational goals and objectives required.
- Familiar with standard concepts, practices, and procedures within a particular field. Relies on experience and judgment to plan and accomplish goals.
- Scheduled Shifts: Monday- Friday 8AM- 4:00PM; 4:00PM – 12:00Midnight. Saturdays may be required.
MUST BE ABLE TO OBTAIN AND MAINTAIN REQUIRED CLEARANCE
IntellecTechs, Inc. is a premier provider of Information Technology (IT), Training and Professional Technical and Administrative Services to federal and commercial customers. IntellecTechs' government customers include Department Navy Chief Information Office (DONCIO), U.S. Navy (USN), U.S. Marine Corps (USMC), National Education and Training Command (NETC), Program Executive Office (PEO) Enterprise Information Systems (EIS), National Aeronautics and Space Administration (NASA) and Space and Naval Warfare command (SPAWAR). Our project management experience and commitment to client relationship enables us to provide creative and cost-effective solutions regardless to the size of the mission. By eliminating boundaries, collaborating in new ways, and continually seeking improvement, IntellecTechs is helping clients at all levels to connect, protect, and serve citizens better than ever. Our headquarters is located in Virginia Beach, VA and is also a certified testing center authorized to administer Prometric and Pearson VUE exams. IntellecTechs is an 8(a) company, certified by the SBA, Economically Disadvantaged Women Owned Small Business (EDWOSB), Service-Disabled Veteran-Owned Small Business (SDVOSB), Small Disadvantaged Business (SDB) and Small Women and Minority Owned (SWaM).
IntellecTechs, Inc. is a private corporation established in the Commonwealth of Virginia, is an Equal Employment Opportunity and Affirmative Action employer. This commitment affirms IntellecTechs, Inc.'s policy to provide equal employment opportunity in accordance with all applicable Equal Employment Opportunity/Affirmative Action laws, directives and regulations to all employees and qualified applicants without regard to race, ethnicity, color, religion, national origin, sex, age, disability status, pregnancy, sexual orientation, gender identity, genetic information, protected veteran status, or any other protected status under Federal, State or Local laws.
IntellecTechs, Inc. will not tolerate discrimination or sexual harassment in its workplace and will take all reasonable steps necessary to ensure nondiscriminatory treatment throughout its programs and business practices to include, but not limited to the following: recruiting/posting/advertising, selection and hiring; disciplinary actions; involuntary and voluntary terminations and layoffs; position upgrades and promotions; rates of pay and other compensation; training programs and participation/selection criteria; and apprenticeships. Also, IntellecTechs, Inc. will provide reasonable accommodations to applicants and employees with disabilities in accordance with Federal, State or Local regulations and laws.
We value our diversified team and work diligently to provide and promote a culture free from discrimination and harassment.