Clarification from the agency

This vacancy is open to current Office of Medicare Hearings and Appeals (OMHA) federal employees in Central Operations who are serving under a competitive career or career-conditional appointment or an excepted service appointment based on Schedule A (people with disabilities) or VRA hiring authority.

The Legal Administrative Specialist performs the following duties:

• Reviewing, organizing, and managing complex Medicare appeals cases prior to adjudication assignments.
• Gathering, sorting, classifying and interpreting data to provide recommendations for process improvement.
• Identifying and resolving processing issues with Medicare appeals cases.
• Communicating with appellants and their representatives regarding the status of pending appeals.
• Explaining pertinent regulations and administrative practices to coworkers and stakeholders.

Conditions of employment

1. Security and Background Requirements: If not previously completed, a background security investigation will be required for all appointees. Appointment will be subject to the applicant's successful completion of a background security investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a background security reinvestigation or supplemental investigation may be required at a later time. Applicants are also advised that all information concerning qualifications is subject to investigation. False representation may be grounds for non-consideration, non-selection and/or appropriate disciplinary action.
2. E-Verify: If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the DHS "E-Verify" System. Federal law requires DHS to use the E-Verify System to verify employment eligibility of all new hires and as a condition of continued employment obligates the new hire to take affirmative steps to resolve any discrepancies identified by the system. The U.S. Department of Health and Human Services is an E-Verify participant.
3. Direct Deposit: All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choice.
4. All qualification requirements must be met by the date the announcement closes.
5. Financial disclosure statement may be required: No
6. One-year probationary period may be required.
7. Travel, transportation, and relocation expenses may be paid: No
8. Bargaining Unit Position: No
9. Drug Screening Required: No
10. Recruitment incentives may be authorized: No
11. Student loan repayment incentive may be authorized: No
12. Annual leave for non-federal service may be authorized: No
13. U.S. Citizenship Required: Yes
14. Males born after December 31, 1959 must be registered or exempt from Selective Service - http://www.sss.gov

Qualifications

Please limit your resume to 2 pages.

Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.

Specialized Experience: To be eligible at the GS-9 position, you must have one year of specialized experience that is equivalent to at least the GS-7 grade level performing duties such as: completing quality control of case records and evaluating completeness of case records; using reports to identify and elevate priority workflow processing; researching legal case filing anomalies and recommending appropriate action; explaining case processing procedures to internal and external stakeholders; and researching and responding to appellants or their representatives' inquiries.

OR

Have successfully completed a 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., if related, in a field which demonstrates the knowledge, skills, and abilities necessary to perform the work of the positions.

OR

Have the specialized experience described above, but less than one year; and have at least one year of graduate education as described above, but less than the required two years. (To compute the percentages, divide your total months of qualifying experience by 12. Then, divide your semester hours of graduate education beyond the first year (total graduate semester hours minus 18) by 18. Add the two percentages. The total percentages must equal at least 100% to qualify.) (Note: You must attach a copy of your transcripts.)

Time-in-grade: Current General Schedule (GS) federal employees, and those that have served in GS positions within the last 52 weeks, must have served 52 weeks at the next lower grade, or a combination of the next lower grade level and an equivalent band in the federal service. 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 date 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.

Documenting experience: In accordance with Office of Personnel Management policy, 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, however, when documented by satisfactory evidence, such as a signed memorandum from the employee's supervisor or an SF-50 or SF-52 documenting an official detail or other official assignment. The documentation must indicate whether the duties were performed full time or, if part time, the "percentage of times" the other duties were performed. It is expected that this documentation is included in the employee's official personnel record. In order to receive credit for experience in your resume that is not within the official series and grade level of your official position, you must provide a copy of the appropriate 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; religious; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to gain employment. You will receive credit for all qualifying experience, including volunteer experience. If such experience is on a part-time basis, you must provide the average number of hours worked per week as well as the beginning and ending dates of the experience so it can be fully credited.

How you will be evaluated

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

Once the application process is complete, a review of the resume and supporting documentation will be made and compared against your responses to the assessment questionnaire to determine if you are qualified for this job. If, after reviewing your resume and or supporting documentation, a determination is made that you have inflated your qualifications and/or experience, you may lose consideration for this position. Please follow all instructions carefully. Errors or omissions may affect your eligibility.

You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, most recent performance appraisal), the responses you provide on the application questionnaire, and the result of the additional assessments required for this position, as applicable. If you are found tentatively eligible after a HR review, you may be further evaluated based on a subject matter review of your resume, a job knowledge test, a writing sample, or interview. Failure to comply with any of the additional assessment requirements will result in removal from further consideration.

Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):

• • Legal, Government and Jurisprudence
  • Manages and Organizes Information
  • Oral Communication
  • Quality Assurance
  • Written Communication

In order to be considered for this position, you must complete all required steps in the process. In addition to the application and application questionnaire, this position requires successful completion of additional assessments, including a structured resume review. This assessment measures the critical competencies listed above that are required to successfully perform the job.

Structured Resume Review: Subject matter experts (SMEs) will review your resume to determine your qualifications for this position based on the required specialized experience. Your resume should demonstrate how you meet all aspects of the specialized experience statement. SMEs will not review additional information beyond the first 2 pages of your resume (e.g., links embedded in your resume will not be opened).

To preview the assessment questionnaire, click the following link: https://apply.usastaffing.gov/ViewQuestionnaire/12885885

Submission of a resume alone IS NOT a complete application. You must provide a complete online Application Package which includes:

• Your Resume must clearly articulate how your skills and experiences align to the criteria defined in the qualifications section of this announcement and it must support your responses to the assessment questionnaire. For each position you must describe your duties, accomplishments, related skills, and responsibilities. Your resume must also include the month and year that you began and ended for each position held. Full-time employment will be assumed unless otherwise stated on your resume. Part-time employment will be prorated in crediting experience. Not providing this information may result in the lowering of your assessment score or an ineligible rating. Please limit your resume to 2 pages. For resume writing guidance, please visit the USAJobs Resource Center.
• SF-50 "Notification of Personnel Action" - you must submit an SF-50 to clearly demonstrate one year time-in-grade as required in the announcement. If the most recent SF-50 has an effective date 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.
• A copy of your 2025 final performance appraisal, with numerical rating. Given that the USAJobs file upload size is limited to 5MB, please print your 2025 PMAP using "file, print, Adobe PDF", which should shrink the size of the file to well under that limit.
• A complete Assessment Questionnaire (https://apply.usastaffing.gov/ViewQuestionnaire/12885885)

Other Supporting Documents: (Only Submit if applicable to you)

• Transcripts (if qualifying based on education). A transcript is required to substantiate possession of the required and claimed education. Unofficial transcripts (including screen-prints from your school's web portal) are acceptable for initial application; however the unofficial transcript must show your name, the name of the educational institution, the degree awarded, and the conferred/awarded date. Self-prepared transcripts will not be accepted. Official transcripts are required prior to appointment.
• CTAP documentation: you must submit the following documents at the time of application: (1) Proof of Eligibility (Reduction-in-Force separation notice, Notice of proposed removal for failure to relocate, notice of injury compensation termination, OR notice of disability annuity termination); (2) Your latest performance rating showing a rating of at least "fully successful" (level 3); AND (3) Your most recent Notification of Personnel Action, Standard Form 50 (SF-50), or equivalent personnel action, showing your tenure, position occupied, and duty station.

You are not required to submit official documents at this time; copies are sufficient.

Next steps