JOB TITLE: DISABILITY CLAIMS ADJUDICATOR TRAINEE

JOB CODE: 45070

SERIES NATURE OF WORK: The Disability Claims Adjudicator job series describes work determining eligiblity for federal disability benefits.

DEFINITION: This is a 12 month structured training program to develop the knowledge and skills needed to adjudicate disability claims.

An employee in this job receives classroom and on-the-job training designed to develop technical skills and knowledges in the development, evaluation, and adjudication of claims for disability benefits. Employees obtain and evaluate evidence in claims for disability benefits in consultation with supervisors, psychologists, and physicians. As an employee gains experience, work assignments become progressively more difficult and are performed with increasing independence. Work is performed in accordance with Social Security laws, regulations, and departmental policies and procedures. Work is performed under close supervision by an administrative supervisor who assigns claims, gives preliminary instructions, and closely reviews work in process and upon completion for quality and adherence to established federal and departmental standards.

EXAMPLES OF WORK: (NOTE: The examples of work are representative of the work, but every position classified to this job may not perform all examples of work listed. Conversely, this is not an all-inclusive list of work examples.)

• Participates in a formal classroom and on-the-job training program to learn disability claims adjudication procedures and techniques.

• Discusses and learns the laws, regulations, rules, policies, and procedures concerning the Social Security Disability Insurance program and the Supplemental Security Income Disability program, the use of federal vocational resources, medical terminology and diagnoses including anatomy and physiology, and documentation requirements.

• Assembles and maintains up-to-date references for the applicable laws, regulations, rulings, and standards governing the disability insurance program

• Reads, studies, and becomes familiar with Social Security laws, regulations, rules and standards, operational policies and procedures of disability claims adjudications, disability claim development techniques, vocational rehabilitation referral systems, and assorted resource documents in order to adjudicate disability claims in accordance with federal policy.

• Attends lectures and reads assignments on disability adjudication materials; responds to questions and studies; and takes quizzes and tests on disability program rules, regulations, laws, operational policies and procedures, and developmental techniques to aid in understanding and retention of material presented in training sessions.

• Prepares questions for physician and claimant conversations and documents procedures to develop disability claims in a timely manner.

• Conducts conferences with the claimant and claimant's representative or attorney to provide information regarding the basis for the pending decision, acquire additional evidence, and discuss steps to complete consideration of the claim as required by due process.

• Identifies sources and requests medical data concerning an applicant's physical or mental condition to ascertain the onset, duration, and severity of alleged impairments.

• Arranges for medical, psychiatric, psychological, and laboratory studies or other examinations to obtain necessary and specific medical data.

• Identifies sources and requests data concerning the applicant's work experience and educational background.

• Evaluates or assists an administrative supervisor in evaluating the sufficiency, relevancy, and probative value of data obtained.

• Evaluates or assists a physician or psychologist in evaluating medical data obtained and its effect on a claimant’s ability to perform work-related functions.

• Determines disability or assists in determining disability of applicants by applying appropriate Social Security laws, regulations, and standards.

• Cooperates and maintains effective working relationships with claimants, staff members, the medical community, and private agencies to secure information for the adjudication of disability claims and to refer claimants for other services.

• Communicates with claimants, claimants’ representatives, attorneys, physicians, hospital personnel, and other medical sources to secure evidence necessary for the proper development of disability claims.

• Refers applicants for rehabilitation services.

• Prepares reports of work performed as well as reports and summaries of medical and vocational information received.

• Prepares or assists in preparing official written disability decisions that include rationale to support the decision, such as data documenting the claimant's condition and the Social Security regulations, and determines if the case should be indexed for review at a later date.

• Performs related work as required.

ENTRY LEVEL KNOWLEDGES, SKILLS, AND ABILITIES:

• Knowledge of the principles and practices of data research, collection, and analysis.

• Knowledge of the use and functionality of Microsoft Office Suite software.

• Ability to read and understand Social Security laws, rules and regulations, medical terminology and diagnoses, federal vocational resources, and other reference materials.

• Ability to analyze medical and vocational data to determine if it is complete, appropriate, and accurate as required by SSA disability guidelines.

• Ability to analyze and evaluate allegations and evidence of impairments to determine their effect on the ability to perform work-related activities.

• Ability to recognize important facts in medical reports, vocational data, claimants' allegations, and disability reports and make sound technical conclustions based on the evidence.

• Ability to organize work and set priorities in order to meet program goals and objectives.

• Ability to write clear and concise reports of findings, statements of problems, and conclusions of facts concerning disability claims.

• Ability to communicate effectively in writing.

• Ability to communicate effectively orally.

• Ability to establish and maintain effective working relationships.

MINIMUM EXPERIENCE AND TRAINING: (NOTE: Based on the Entry Level Knowledges, Skills, and Abilities)

• A bachelor’s degree;

or

• Four years of paraprofessional experience researching and analyzing data, writing detailed reports, and presenting conclusions;

or

• An equivalent combination of experience and training.