DISABILITY CLAIMS EXAMINER 1* - 05052026-77330

Job Information

LOCATION OF (4) POSITION(S) TO BE FILLED: DEPARTMENT OF HUMAN SERVICES, DAVIDSON COUNTY

For more information, visit the link below:

https://www.tn.gov/content/dam/tn/human-services/documents/HRC0019759_DISABILITY_CLAIMS_EXAMR1_Davidson_51826.pdf

This is a remote position

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Qualifications

Education and Experience: Graduation from an accredited college or university with a bachelor's degree.

Substitution of Experience for Education: Full-time professional disability claims examination work may be substituted for the required education on a year-for-year basis.

Necessary Special Qualifications:

1. Complete a federal background check in accordance with the Homeland Security Presidential Directive 12 (HSPD-12) for issuance of an HSPD-12 compliant Personal Identity Verification (PIV) credential card.
2. After appointment, successfully complete (as indicated by an assessment at completion) a prescribed course of training offered by the Tennessee Department of Human Services.

Overview

This classification learns to perform disability determination work of average difficulty. An employee in this class is responsible for learning to determine adult medical eligibility for Social Security Disability, Supplemental Security Income or Medicaid benefits for initial claims in accordance with federal Social Security Administration guidelines. This classification performs responsibilities under direct supervision at the learning level. This class differs from the Disability Claims Examiner 2 in that an incumbent of the latter functions at the working level.

*An applicant appointed to this classification will be reclassified to a Disability Claims Examiner 2 after successful completion of a mandatory two-year training period; 'unacceptable' or 'needs improvement' performance ratings during the training period will result in automatic demotion or termination.

Responsibilities

ALL LISTED RESPONSIBILITIES WILL BE PERFORMED AT THE LEARNING LEVEL:

1. Determines adult medical eligibility for Social Security Disability, Supplemental Security Income or Medicaid benefits using medical, psychiatric, vocational, and educational data for initial claims in accordance with federal Social Security Administration guidelines.
2. Routinely conducts telephone interviews with claimants and others to obtain and/or clarify information on applications. Determines jurisdiction and proper timeframe for requests of claimant records and obtains records from relevant treatment sources.
3. Reviews and analyzes applications, medical assessments, medical records, and vocational assessments as needed for initial claims. Reviews prior decisions for accuracy and development of evidence and examines new allegations or evidence, redetermines medical eligibility, and issues reconsideration decisions.
4. Documents case notes, appointments, and general correspondence for review and adjudication. Organizes and enters claimant documentary evidence and claim decisions into an electronic case management folder.
5. Assesses claimant's medical conditions to identify impairments, onset issues, and limitations by reviewing medical records, statements, and other pertinent information to prepare a medical assessment.
6. Confers with internal medical consultants and various other subject matter experts to ensure all aspects of disability claims are in accordance with federal guidelines. Selects, composes, and sends proper federal disability determination notices to claimants explaining medical and vocational decision issues to claimants and authorized representatives.
7. Schedules/reschedules consultative examination appointments for claimants and notify claimants, third parties, attorneys of appointment time and date, and documents reasons for missed exams. Authorizes payments for examinations and claimant travel.
8. Reviews claimant's work history to determine if claimant's past work description is adequate and contacts claimant by phone if additional work history is needed. Identifies and analyzes claimant's past relevant work by researching jobs and earnings reported to SSA and compare the claimant's residual capacity with the functional requirements of the claimant's past and other work.

Competencies (KSA's)

Competencies:

1. Customer Focus
2. Resourcefulness
3. Communicates Effectively
4. Instills Trust
5. Situational Adaptability

Knowledges:

1. Customer and Personal Service

Skills:

1. Active Learning and Listening
2. Service Orientation
3. Critical Thinking
4. Judgment and Decision Making
5. Time Management

Abilities:

1. Deductive Reasoning
2. Inductive Reasoning
3. Problem Sensitivity
4. Written Comprehension

Tools & Equipment

1. General Office Equipment
2. Computer/Laptop/Tablet
3. Multifunction Printer (Print/Copy/Scan/Fax)
4. Cell Phone