2/1/89 B

This is the second class in the Disability Determination Series for positions that evaluate medical, vocational, and other relevant evidence to process and adjudicate disability claims in accordance with federal guidelines under the Social Security Act. Positions in this class conduct formal quality reviews of disability claims for proper determinations, completeness of documentation and research, and resolutions of any problems or conflicts. May function primarily as a lead worker in a disability determination unit that processes and adjudicates disability claims or as a quality review specialist in a unit that conducts post-closure reviews. Incumbents routinely rotate between functions to assure cross training and uniform quality assurance. This class is distinguished from the Disability Determination Analyst class by the responsibilities for reviewing the work of the Disability Determination Analysts, performing special studies and/or training and assisting staff.

Complexity of Work: Performs work of considerable difficulty by assuring that adjudicated disability claims meet federal and state regulatory requirements with regard to the substantive decision, technical accuracy and uniformity. Assists the unit supervisor in maintaining proper workflow in the unit by providing casework assistance to Disability Determination Analysts. Conducts a review of a random sample of claims; analyzes research for completeness, accuracy and quality; provides a written explanation of any deficiency cited; and provides technical assistance to Disability Determination Analysts by answering policy questions and directing caseload development activities. Identifies case development problem areas; recommends and conducts training sessions on such areas as federal policy and program criteria; explains policy positions on complex medical, vocational, and other case related issues to medical consultants, line supervisors, case consultants and Disability Determination Analysts; prepares written decisions regarding notices to the claimants; evaluates and approves or disapproves requests for purchases of consultative examinations after considering all evidence in case files; and conducts special work assignments involving court

cases or particularly unusual or difficult decisions, special studies, special task forces or projects.

Supervision Given: Supervision is typically not a factor. Position may serve as lead workers on disability determination units by providing technical assistance, policy explanations and direction of caseload development activities.

Supervision Received: Receives directions from a Disability Determination Unit Supervisor in the form of general assignments and periodic review. Independently develops work sequence and methods within established policies and procedures while adhering to established time frames.

Scope: Work affects the efficiency and integrity of the disability insurance program that impacts claimants' economic condition and lifestyle.

Impact of Actions: Effective job performance ensures the appropriate and consistent processing of claims. A significant loss in time, money, services and public goodwill may be incurred through errors in judgment or inappropriate decisions. Actions may also influence the documentation and development of claims which will determine the final legal decisions.

Personal Contacts: Frequent internal and external contacts are made with doctors, psychologists, mental health agencies, and hospitals to obtain medical evidence; with claimants to verify and clarify allegations of disability and work history; with agency personnel to obtain medical records; with lawyers and congressmen to respond to requests fun information or provide status reports on claims; with employers to verify ability to perform a job; and with family, friends, and neighbors of claimants to obtain supplemental information for claims processing.

Knowledge: Considerable knowledge of the statutes, rules, and regulations applicable to the Disability Determination program; of techniques for gathering, reviewing, and evaluating medical vocational information; of disability and medical terminology; and of interview techniques.

Skills: None identified for this class.

Abilities: Demonstrated ability to learn, interpret, and apply statutes, rules and regulations governing the administration of the disability determination programs; to communicate effectively both

orally and in writing; to clearly express reasons for adjudication decisions; to manage a large, complex caseload; to analyze medical and vocational information; and to prepare and facilitate training sessions.

OUALIFICATIONS GUIDE*

Licenses or Certification: None.

Education or Training: Graduation from an accredited college or university, with course work in a social science, a medically-disciplined, or a related field.

Level and Type of Experience: Experience in adjudication and review of disability benefit claims; caseload management, human services or medically related work with emphasis in disability determination.

Any equivalent combination of training and experience indicating possession of the preceding knowledge and abilities may substitute for this education and experience.

This class specification was revised in January 1989 as a result of the Classification Review/Specification Update Program.