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State of Washington Classified Job Specification

DDS ADJUDICATOR 4

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DDS ADJUDICATOR 4
168M
Category: Financial Services

Class Series Concept

See DDS Adjudicator 1.

Definition

Leads professional staff engaged in the compilation, review and analysis of the medical and vocational aspects of disability claims adjudication.

Distinguishing Characteristics

This is a senior and lead level of the class series, working independently as a lead worker assisting the supervisor with work assignments, monitoring, mentoring and providing technical assistance to lower level staff.
Positions carry a partial caseload of disability claims and independently mentor and coach lower level staff on Social Security disability program, policy, and technical aspects of claims adjudication.

Typical Work

Monitors performance of staff assigned to the unit and assists supervisor in order to determine training needs;

Provide technical assistance concerning interpretation of medical and program policy;

Maintains a partial caseload of disability claims to keep current on program, policy, caseload management and technology changes;

Develops and coordinates caseload management plans for lower level staff;

Provides desk coverage for adjudicators on leave;

Provides consultative examination order review and recommendation;

Acts in supervisor’s absence, attending supervisor meetings, reporting to management, leading unit meetings;

Advises adjudicators on appropriate medical and vocational development and decision policy;

Keeps current with policy changes and relays information to unit;

Mentors and assists trainees through steps of the in-training plan;

May be responsible for participating in pilots, special studies or adjudicating special workloads;

Develops and carries out specialized studies, analyses and reports;

Prepares summary and status reports;

Participates in developing and maintaining appropriate and consistent statewide policies, procedures and standards;

Performs other work as required.

Knowledge and Abilities

Knowledge of: the Social Security/SSI disability program statues, regulations, policies and common use law pertaining to disability evaluation; medical terms, human anatomy and physiology, psychiatric terms, common drugs, common treatment modalities and their implications; common occupations and their physical and mental skill requirements; effective supervisory and management principles and techniques; review methods and statistical analysis techniques.

Ability to: coach, mentor and train; rapidly review and analyze Social Security/SSI cases for sufficiency of documentation and correctness of decision; speak effectively in a public setting; establish and maintain effective working relationships with peers, colleagues, supervisors, claimants, physicians and the general public.

Legal Requirement(s)

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Desirable Qualifications

A Bachelor's degree 

OR

Professional experience working with disability, medical or insurance claims adjudication or investigation, health care, unemployment, workers compensation, social services, or related field will substitute, year for year, for education.

AND

Three years of recent experience as an adjudicator of Social Security Disability Insurance. Must have successful experience adjudicating all claim types.

Note: Recent years of experience must be gained within four years of application.

Class Specification History

New class; adopted June 13, 2019; effective July 1, 2019.

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