Medical Claims Examiner

We need to output HTML fragment with sections: About the role? Actually we have "Who We Are", "Who You Are", "How You Will Make An Impact", "Responsibilities", "The Team", "Here’s What You Need", "Work Environment", "Position Type/Expected Hours of Work", "Benefits", "Salary". We need to map to allowed headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We must not repeat job title. Use

for section headings. Use

• for any list of duties/requirements/benefits, and

  for prose. Include a section only when posting has real, specific content. No filler. We need to preserve all substantive information, but we can condense into sections. We need to decide which sections to include: About the role (maybe from "Who We Are" and "How You Will Make An Impact"? Actually "About the role" could be description of role. We have "Who You Are" (candidate profile) and "How You Will Make An Impact" (impact). Could combine into About the role. Responsibilities: we have a long list of responsibilities. Use

  • . Requirements: maybe from "Here’s What You Need" (experience, education). Could be Requirements. Qualifications: maybe overlapping with Requirements; but we can combine. Skills: maybe from "Experience safeguarding..." etc. Benefits: we have Benefits section with bullet list. Pay: we have Salary Dependent on Experience (DOE). That's not specific; it's vague. According to rule: never create Pay/Schedule/Benefits sections unless posting actually states them. It states "Salary Dependent on Experience (DOE). Compensation will be based on qualifications, relevant experience, and internal equity." That's still vague but it's stating something about salary. It's not a specific number or range, but it's still stating that salary is DOE. The rule says: never emit a heading followed by filler/placeholder text (e.g., "commensurate with experience", "not specified", "N/A", "varies", "TBD") and never create Pay/Schedule/Benefits sections unless the posting actually states them. "Dependent on Experience (DOE)" is similar to "commensurate with experience". That's placeholder. So we should NOT create a Pay section because it's just DOE. So omit Pay. Schedule: we have Position Type/Expected Hours of Work: full-time hybrid, typical days Monday-Friday 6:00 a.m.–6:00 p.m. Central Time, may require overtime, evening/weekend as needed, reside within local commuting area of San Antonio, Texas, rotating schedule on-site/telework. That's specific schedule info. So we can create a Schedule section. Benefits: we have specific benefits list: competitive compensation package, comprehensive health and wellness benefits including medical, dental, vision, access to company-provided retirement savings options with matching contributions, opportunities for professional growth and continued learning, additional perks such as discounts. That's specific enough. So include Benefits. Now we need to avoid boilerplate like EEO etc. Not present. We need to ensure we don't repeat job title. We need to output only HTML fragment. Let's craft sections:

    About the role

    maybe combine Who We Are, Who You Are, How You Will Make An Impact? But "About the role" should describe the role, not the company. Could include "Who You Are" and "How You Will Make An Impact". Also maybe include "Who We Are" as context but that's about company. Might be okay to include in About the role? The instruction: use

    for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we can have About the role containing description of role and impact. We'll keep it concise but preserve all substantive info. We need to preserve ALL substantive information; do not invent or summarize away detail. So we cannot omit details like specific tasks, systems, etc. But we can put them in appropriate sections (Responsibilities, Requirements, etc). For About the role we can include a brief paragraph summarizing role purpose and impact, but we must not lose details that are elsewhere. Since details are captured in Responsibilities and Requirements, we can summarize in About the role without losing info? The instruction says preserve ALL substantive information; do NOT invent or summarize away detail. Summarizing might be considered summarizing away detail. Safer to keep details in their respective sections and maybe About the role just a short intro that doesn't omit details that are elsewhere. But we need to ensure we don't lose any info that is only in About the role section. If we put all details in Responsibilities and Requirements, we can have About the role just a short statement like "The Medical Claims Examiner supports medical claims and healthcare cost recovery activities for a federal healthcare customer." That's a summary but it's not losing info because the details are elsewhere. However the instruction says do NOT summarize away detail. Does summarizing the role purpose count as summarizing away detail? Possibly they want us to not omit any detail; summarizing is okay as long as we still have the details elsewhere. The details are in Responsibilities etc. So it's okay. Thus we can have About the role with a paragraph from "How You Will Make An Impact" maybe plus "Who You Are"? But that might duplicate. Better to keep About the role short. Now Requirements: from "Here’s What You Need": list of experience, education, etc. We'll put as

    • . Qualifications: maybe overlapping; but we could split: Requirements = experience and education; Qualifications = specific skills like familiarity with systems, HIPAA, etc. But we can also combine. However we need to avoid thin sections. Let's make Requirements include experience and education; Qualifications include technical skills and abilities; Skills maybe include communication, Microsoft Office, etc. But we might have overlapping. Better to follow typical sections: Requirements (experience/education), Qualifications (specific systems knowledge, clearances), Skills (soft skills, software proficiency). But we need to ensure we don't create thin sections with little content. Let's extract: Experience: One or more years of experience in medical or insurance claims, healthcare administration, billing, collections, case management, records management, legal support, or related field. Education: Associate or bachelor’s degree in healthcare administration, business administration, paralegal studies, finance, insurance, or related field is preferred. Experience reviewing and processing medical records, billing statements, insurance documentation, claims correspondence, payment records, or similar documents. Familiarity with healthcare billing, third-party collections, insurance denials, appeals, payment verification, or healthcare cost-recovery activities. Experience supporting a federal healthcare program, Department of Defense organization, federal agency, or government contractor is preferred. Strong attention to detail and ability to accurately manage multiple electronic case files, deadlines, correspondence, and financial information. Experience working under established productivity, accuracy, timeliness, and quality-control requirements. Familiarity with ACMP, ABACUS, DEERS, GFEBS, JLV, MHS GENESIS, PEPR, SharePoint, or comparable healthcare and claims-management systems. Experience safeguarding HIPAA-protected records, PII, PHI, CUI, or other sensitive government information. Professional written and verbal communication skills and proficiency with Microsoft Word, Excel, Outlook, Teams, and SharePoint. Ability to work independently, follow detailed procedures, and learn multiple government claims, medical-record, eligibility, and financial systems. Public Trust or ability to successfully complete a government background investigation. Must be a US Citizen. We can split: Requirements: experience and education (maybe also citizenship). Qualifications: technical systems familiarity, safeguarding info, Public Trust, citizenship? Skills: communication, Microsoft Office, ability to work independently, attention to detail, etc. But attention to detail appears also in requirements. Might duplicate. Better to have: Requirements: experience, education, citizenship. Qualifications: familiarity with systems, safeguarding info, Public Trust, ability to work under productivity/accuracy requirements, experience supporting federal healthcare, attention to detail, ability to manage multiple files. Skills: communication, Microsoft Office proficiency, ability to work independently, learn systems. But there is overlap; risk of thin sections. Given instruction: Prefer a few substantive sections over many thin ones. So maybe combine Requirements and Qualifications into one section called Requirements (or Qualifications). But we have both headings allowed. We could have Requirements (experience/education) and Qualifications (systems, security, etc). Skills maybe not needed if we incorporate into Qualifications. But we need to include Benefits and Schedule sections. Thus sections: About the role, Responsibilities, Requirements, Qualifications, Benefits, Schedule. Check if any content left for Skills: we have communication and Microsoft Office proficiency; we could put those in Qualifications. Now ensure we don't create sections with filler. Now craft HTML. We'll need to escape any special characters? Not needed. Let's write:

      About the role

      The Medical Claims Examiner supports medical claims and healthcare cost‑recovery activities for a federal healthcare customer, identifying responsible third parties, processing claims, tracking payments, maintaining case files, and recovering costs owed to the government while adhering to government procedures.

      That's a summary; we keep details elsewhere. Now Responsibilities: we have a long list. We'll put each as
    • . We must ensure we preserve all responsibilities exactly as given, but we can rephrase slightly? The instruction: preserve ALL substantive information; do NOT invent or summarize away detail. So we should keep the wording close to original. We can copy each responsibility sentence as is, maybe split into list items. Let's list them: - Monitor shared organizational email inboxes and physical mail for incoming claims, correspondence, and inquiries. - Process new referrals and establish Medical Affirmative Claims and Third-Party Collection case files. - Enter claims and case information into ACMP and other required government systems. - Maintain accurate electronic case files, tracking logs, correspondence, and supporting documentation. - Research and collect authorized patient, beneficiary, treatment, billing, insurance, eligibility, and case-related information. - Access medical, administrative, eligibility, and financial systems to obtain records, treatment timelines, billing statements, patient demographics, and related information. - Verify patient and claim information and identify missing, inaccurate, or inconsistent data. - Gather and organize medical records, accident reports, insurance information, billing data, and supporting documents for review. - Properly name, index, upload, and maintain documents in SharePoint and government case-management systems. - Record Third-Party Collection denial codes and payer responses. - Complete standardized appeal templates and assemble appeal packages for higher-level review. - Research potentially liable parties, insurance carriers, civilian attorneys, and other relevant entities. - Prepare notices of claim using government-approved templates. - Draft standard demand letters, settlement memoranda, and other routine correspondence for review and signature by authorized government personnel. - Prepare and mail claims forms and supporting documentation when electronic submission is unavailable. - Respond professionally to routine inquiries from insurance carriers, attorneys’ offices, healthcare organizations, government personnel, and other authorized parties. - Provide approved, non-sensitive documentation in accordance with government direction. - Update case status information within required timeframes. - Track case milestones, correspondence, follow-up actions, payment activity, and statute-of-limitations deadlines. - Perform data cleanup and first-level quality reviews of claims, reports, case files, and supporting documentation. - Process cash collection vouchers and support the routing of recovered funds to the appropriate line of accounting. - Verify payments, settlements, unpaid balances, and case status using authorized financial systems. - Assist with collecting productivity, claims-processing, payment, and financial-recovery metrics for monthly reporting. - Follow established standard operating procedures, quality control requirements, and supervisory direction. - Perform other duties as assigned. Now Requirements: we need to list experience and education and citizenship maybe. Let's list: - One or more years of experience in medical or insurance claims, healthcare administration, billing, collections, case management, records management, legal support, or a related field. - Associate or