Disability Claims Examiner 1
$31,644 a year
Full Job Description
State of Tennessee Job Information
Wed 06/09/2021 12:00AM Central Time
Tue 06/22/2021 11:59PM Central Time
City, State Location
LOCATION OF (32) POSITIONS TO BE FILLED: DEPARTMENT OF HUMAN SERVICES, REHABILITATION SERVICES - DISABILITY DETERMINATION DIVISION, DAVIDSON COUNTY
Education and Experience: Graduation from an accredited college or university with a bachelor's degree.
Necessary Special Qualifications: None.
Examination Method: Education and Experience, 100%, for Preferred Service positions.
Summary: Under immediate supervision, is responsible for professional disability claims examination work of routine difficulty; and performs related work as required.
Distinguishing Features: This is the entry level class in the Disability Claims Examiner sub-series. An employee in this class is responsible for learning to adjudicate initial disability claims. This class differs from that of Disability Claims Examiner 2 in that an incumbent of the latter is responsible for working-level disability claims examination duties.
- An applicant appointed to this flexibly staffed class will be reclassified to the next higher class in the series after successful completion of a mandatory one-year training period; inadequate or marginal performance during the training period will result in automatic demotion or termination.
Analyzing Data or Information
1. Learns to assess claimant's medical condition and identify impairments; determines degree and duration of impairments; determines exertional and non-exertional limitations; assesses the effects and impact of pain and fatigue on claimant's abilities; determines the combined effects of impairments on claimant; establishes the onset and duration of adult residual functional capacity.
2. Learns to determine claimant's medical eligibility for Social Security Disability, Supplemental Security Income or Medicaid benefits using medical, psychiatric, vocational, and educational data; may write technical rationale for determinations; may determine and make recommendations regarding the claimant's ability to handle income. <
3. Learns to assess records to ensure that evidence presented is sufficient and relevant; verifies accuracy and reliability of evidence provided by claimant and other sources; assesses credibility and weight of evidence provided by claimant for consideration in disability determinations.
4. Learns to assess claimant's vocational status; identifies and examines claimant's past relevant work; compares work and earnings claimed to those reported as earnings by the Social Security Administration; determines time required for skill acquisition for job options; compares functional requirements of work with claimants' disabilities and capabilities.
Evaluating Information to Determine Compliance with Standards:
1. Learns to interpret test results and examination results according to Social Security policy and procedures; compares claimant physical and mental condition to Social Security Administration list of impairments; learns to assess need for additional medical examinations for claimant.
2. Learns to determine jurisdiction, relevant treatment sources and proper time period for requests of claimant records; learns to determine requirements for medical and psychological tests and findings needed for application processing; determines recency and relevance of evidence.
3. Learns to read and analyze medical records for initial adult disability determinations to ensure the key information is available and noted for medical review.
4. Learns to determine if claimant's past work description is adequate and meets the definition of substantial gainful activity using income tables; learns to determine claimants' ability to do work using vocational tables based on age, education, transferability of skill and level of functional capacity.
5. Learns to review initial adult disability applications for the purposes of determining accuracy and relevance of information included in accordance with Social Security Administration policy.
Making Decisions and Solving Problems:
1. Learns to analyze information and evaluate options to choose the best actions and solve problems throughout the disability claim process.
Organizing, Planning, and Prioritizing Work:
1. Learns to develop and/or adhere to specific goals by appropriately planning, prioritizing, and organizing work to meet performance standards in a timely manner.
2. Learns to manage and prioritize workload using available resources to ensure activities are completed within established timeframes.
Communicating with Persons Outside Organization:
1. Learns to compose decision letters to claimants; learns to select and send proper federal disability determination notices to claimants; learns to explain medical and vocational decision issues to claimants and authorized representatives verbally or in writing as needed.
2. Learns to conduct telephone interviews with claimants and others to clarify information on applications or to obtain additional information as necessary.
3. Learns to communicate with medical and other sources to request appropriate records, evidence, and any needed clarifications.
4. Learns to reschedule and/or approve additional needed medical examinations and/or tests for claimants with providers.
1. Learns to gather information from medical and non-medical sources, claimants, and authorized representatives through written and verbal communication.
2. Learns to review initial adult disability applications and other claim related records for the purposes of requesting information in accordance with established program policy.
3. Learns to review received records and additional information to ensure items are placed with the appropriate claim and information is maintained accurately.
Interacting With Computers:
1. Learns to operate federal and/or state computer systems and programs to enter case documentation, diaries, and complete reports as needed.
2. Learns to use federal and/or state electronic equipment and other available resources to research and gather needed information for disability claims processing.
3. Learns to utilize federal and/or state electronic communication systems to appropriately communicate with needed parties.
4. Learns to operate the designated system to enter timesheet, leave, and additional personnel information independently and accurately.
Updating and Using Relevant Knowledge:
1. Reads, organizes, and applies new information relevant to agency specific policy and procedures.
2. Remains up to date on new policies and procedures as they are implemented in order to ensure accurate disability decisions.
3. Attends all required trainings and remains up to date on any new or updated technical requirements.
1. Learns to code and enter decisions into claim records following Social Security Administration policies and procedures.
2. Learns to enter treatment dates chronologically into claim records while annotating and summarizing all claim related information.
3. Learns to appropriately document all phone conversations in narrative format using agency computer system.
Establishing and Maintaining Interpersonal Relationships:
1. Develops and maintains healthy working relationships with co-workers and vendors to promote productivity and effectively serve client needs.
2. Develops constructive and cooperative working relationships with partnering agencies, co-workers, supervisors, other employees, and local governmental agencies through meetings and other positive interactions to ensure quality and timely services.
Communicating with Supervisors, Peers, or Subordinates:
1. Learns to communicate with supervisors, staff, and co-workers by telephone, in written form, email, or in person to ensure effective claims processing.
2. Learns to authorize payments accurately for medical records and/or examinations and claimant travel in accordance with agency guidelines in a timely manner.
1. Problem Solving
3. Priority Setting
5. Timely Decision Making
7. Written Communications
8. Customer Focus
2. Customer and Personal Service
3. Basic Computer Knowledge
1. Active Learning
2. Active Listening
3. Critical Thinking
5. Reading Comprehension
8. Service Orientation
9. Social Perceptiveness
10. Complex Problem Solving
11. Judgment and Decision Making
12. Time Management
1. Category Flexibility - The ability to generate or use different sets of rules for combining or grouping things in different ways.
2. Deductive Reasoning
3. Inductive Reasoning
4. Information Ordering
6. Oral Comprehension
7. Oral Expression
8. Problem Sensitivity
9. Selective Attention
10. Speed of Closure - The ability to quickly make sense of, combine, and organize information into meaningful patterns.
11. Task Flexibility - The ability to shift back and forth between two or more activities or sources of information.
12. Written Comprehension
13. Written Expression
Tools and Equipment Used
- Personal Computer
- Fax Machine
- Agency Designated Systems and Software
State of Tennessee