Disability determination specialist

basic purpose:

 

Positions in this job family perform complex professional level work, interpreting and implementing provisions of the Federal Social Security Act to determine eligibility for disability benefits for applicants throughout the state of Oklahoma.  Incumbents obtain, evaluate and analyze all pertinent information to prepare a legally defensible disability determination to approve or deny benefits.

 

Typical functions:

 

The functions within this job family will vary by level, but may include the following:

 

·       Reviews and analyzes evidence of  illness, injury, disease or other medical condition s and vocational factors  which prevent an individual from working or gaining employment, and prepares a determination  to approve or deny disability benefits.  Prepares a detailed written analysis explaining the facts of the case and the basis for the decision and provides written notice to the claimant and the Social Security Administration.

·       Maintains a complex and diverse caseload of Social Security Disability claims and claims for Supplemental Security Income at various stages of development, and exercises judgment to insure resolution of all issues.

·       Protects and safeguards confidential and sensitive personal, medical and vocational information in accordance with federal and state mandates.

·       Completes case reviews on a variety of difficult or complex disability cases, at different stages of development, in order to assure compliance with internal office procedures, Social Security laws and regulations and legal statutes.

·       Determines the medical and vocational information needed to substantiate the claim, analyzes medical, vocational, educational and other collateral information received and integrates those findings with Social Security regulations concerning disability and with facts of that particular claim.

·       Determines the need for additional medical tests, evaluations or consultative examinations in the fields of medicine, psychology, psychiatry or other specialties and arranges for expenditure of funds for medical evidence.

·       Prepares a written residual functional capacity assessment based on the severity of the medical condition and the nature of the impairment.

·       Consults with internal and external professionals, or contract providers, including physicians, psychologists, and vocational experts to address highly complex issues.

·       Interviews or corresponds with claimants, family members, legal representatives, employers, community resources and others as needed to obtain additional information or collateral evidence concerning an individual’s functional abilities.

 

lEVEL DESCRIPTORS:

 

This job family consists of four levels of work which are distinguished by the level of complexity and diversity of the specific job assignments, the level of expertise required for the completion of duties assigned and the responsibility assigned for assisting, training and supervising others.

 

Level I:                                                  Code:  K11A                                        Salary Band:        I

This is the basic level, where incumbents, under direct supervision, receive mandatory classroom training in case processing, medical evaluation and terminology, vocational evaluation, internal procedures for case development and in the provisions of the Social Security Act, concerning eligibility for disability benefits. Incumbents perform entry level professional work in managing a progressive caseload of Title II and Title XVI disability claims and  learn to process disability cases using various secure software applications with Federal and State operating systems.  Incumbents learn to evaluate disability applications for benefits in order to resolve jurisdictional issues and to resolve conflicts in evidence through contact with claimants, representatives, employers, medical providers and others.  Incumbents analyze and evaluate multiple case issues simultaneously; analyze medical source opinions and effects of medication or pain on the claimant’s ability to function in a work environment; assess credibility of claimant’s statements regarding their ability to work and prepare vocational assessments for adults based on a variety of vocational factors.

 

Knowledge, Skills and Abilities required at this level include knowledge of the provisions of the Social Security Administration concerning eligibility for disability benefits;  of program policies and procedures; of various types of injuries, illnesses and diseases and their effects on  functional abilities; of medical terminology;  procedures for collecting and analyzing information; of interviewing techniques; of Federal and State laws  regarding confidentiality of personal information and procedures for obtaining and disclosing information; of the various systems software applications that interface with Social Security Act national systems and of the electronic disability process system.  Ability is required to analyze medical information concerning various types of illnesses, injuries or diseases and related treatments; to collect information concerning an individual’s functional abilities, employment, education and other factors; to develop and manage case files; to evaluate various physical and mental impairments; to organize and prioritize a disability caseload; to communicate effectively; and to establish and maintain effective working relationships.


Education and Experience requirements at this level consist of a bachelor's degree; or an equivalent combination of education and experience, substituting one year of professional-level experience in adjudicating Social Security disability claims in a designated state agency for each year of the required education.

 

Level II:                                                 Code:  K11B                                        Salary Band:   J

 

This is the career level where employees have responsibility for a full range of activities involved in independently developing, reviewing, analyzing and adjudicating disability claims at different degrees of complexity.  Incumbents independently plan and carry out assignments, interpret policy and determine methods and contacts. In addition to tasks performed at Level I, employees at this level will manage a full caseload of disability claims and prepare legally defensible disability determinations for review at the appellate levels, assess unusual circumstances, incomplete or conflicting data and interpret and implement methodology resulting from such elements as continuous changes in the disability program and advancements.

 

Knowledge, Skills and Abilities required at this level include those identified in Level I plus knowledge of Federal and State statutes and regulations related to the Social Security Act; Social Security rulings and pertinent court rulings; of the disability claims process including appeals and the legal principles of Res Judicata, Collateral Estoppel and Administrative Finality.  Ability is required to analyze and review diverse and highly complex claims.

 

Education and Experience requirements at this level consist of a bachelor's degree and one year of professional level experience in adjudicating disability determinations for the Social Security Administration in a designated state agency; or an equivalent combination of education and experience, substituting one additional year of qualifying experience for each year of the required bachelor’s degree.

 

Level III:                                                Code:  K11C                                        Salary Band:    K

 

This is the specialist level where  the employees perform advanced level professional work  and provide expertise in the disability claims adjudication process by advising other staff, as well as analyzing and evaluating unusually complex and difficult cases which encompass sensitive, controversial and technical issues; evaluate the total effect of multiple interrelated issues; perform a complete and independent evaluation of all facts and evidence defining legal and factual issues; research pertinent decisions and other reference materials; apply laws, regulations, policies and procedures to determine appropriate action; and apply guidelines and  precedents in non-routine situations.  Duties at this level may also include training and mentoring staff.  At this level employees are given wide latitude for exercising independent judgment.

 

Knowledge, Skills, and Abilities required at this level include those identified at Level II plus knowledge of judicial processes; ability is required to apply judgment and creativity to resolve complex program related issues.  This level requires the ability to perform a complete and independent analysis of all facts and evidence; to define legal and factual issues; to research precedent decisions and other reference materials; and to apply relevant laws, regulations, policies and procedures.

 

Education and Experience requirements at this level consist of those identified at Level II plus two additional years of professional level experience in adjudicating disability determinations for the Social Security Administration in a designated state agency.

 

Level IV:                                                Code:  K11D                                        Salary Band:        L

 

This is the advanced level where employees are subject matter experts with responsibility for providing authoritative advice and expert consultative services related to Disability policy.  Incumbents must be able to effectively communicate program knowledge of a complex, broad and diversified nature to contacts both internal and external to SSA and make recommendations for program improvements.    Duties may include direct supervision of staff and assisting in the supervision of a designated unit or team.  Incumbents develop and present initial and ongoing training to staff; perform quality assurance functions in insuring the timeliness and accuracy of staff decisions and actions; function as vocational experts at all levels of disability claims; develop and implement recruitment and monitoring for independent medical providers and resolve complaints regarding services provided by consultative medical providers.

 

Knowledge, Skills, and Abilities required at this level include those identified at Level III plus knowledge of analytical and evaluation methods and techniques.  Ability is required to provide consultation to others in the application of various policies and guidelines; to perform special studies and program analysis; and to develop and implement training; to identify different learning styles and training needs.

 

Education and Experience requirements at this level consist of those identified at Level III plus one additional year of professional level experience in adjudicating disability determinations for the Social Security Administration in a designated state agency.

 

NOTE:  Experience which was incidental or not reflective of a major responsibility of the position shall not be accepted as qualifying.