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State of Washington Classified Job Specification

DDS ADJUDICATOR 4

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DDS ADJUDICATOR 4
168L
Category: Financial Services

Class Series Concept

See DDS Adjudicator 1.

Definition

This is the supervisory or expert level of the series.  Positions have shared Statewide or Regional responsibility in ­at least one of the following areas: 

  • Supervision­: Supervises a unit of DDS Adjudicators;
  • Quality assurance: Reviews decisions made by the DDS Adjudicator to ensure accurate and policy compliant decisions;
  • Disability Hearings: Conducts case review and hearings for claimants whose benefits have been ceased after a Continuing Disability Review;
  • Professional Relations: Provides education to the Medical and Professional community about the disability program requirements and has oversight of contracted Consultative Examiners;
  • Training: Provides introductory and ongoing training for DDS Adjudicators and contracted medical consultants;
  • Cooperative Disability Investigations:  Reviews and writes decisions for fraud and similar fault.

Distinguishing Characteristics

Positions in this class are considered experts and have advanced knowledge, skills and abilities in all aspects of disability claims adjudication, medical, vocational, and program/policy.

Typical Work

Supervises a unit of disability adjudicators and support personnel; 

Evaluates the performance of subordinates or, as a specialist, may assist supervisor with information to help evaluate employee performance; 

Responsible for maintaining and coordinating liaison activities with the Social Security field offices and community service offices in assigned geographical areas; 

May provide medical and policy review and signatory authority on case decisions by DDS adjudicator 1’s and 2’s; 

Reviews cases for appropriate documentation, processing procedures and decision policy; samples cases to assure that quality standards are met; 

Audits the quality of case development; 

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

Develops and carries out specialized studies, analyses and reports; 

Reviews and implements Social Security/SSI federal laws and regulations; 

Prepares summary and status reports; 

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

Recruits physicians to provide medical exams and ancillary services; 

Coordinates and maintains effective relationships with the medical community and other outside resources; responds to inquiries and complaints from the medical community and clients; 

Plans and develops seminars, publications and training for providers; 

Investigates and resolves problems between the DDS and consultative examination providers; 

Coordinates the participation of beneficiaries, attorneys, other representatives and witnesses involved in the hearing process; 

Conducts face to face evidentiary hearings and acts as a sole decision-maker on specialized categories of appeal level claims; 

Represents the DDDS at DSHS Fair Hearings; 

Makes determinations on cases involving sensitive legal issues; 

Plans, organizes and presents introductory and ongoing training for all professional adjudicators and medical consultants; 

Trains new adjudicative staff; 

Develops training manuals and trains on program policies and procedures and systems software; 

Reviews and prepares decisions on claims for possible fraud and similar fault; 

Works closely with Office of Inspector General and Washington State Patrol in investigations process and decision-making;

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:  Review and analyze Social Security/SSI cases for sufficiency of documentation and correctness of decision; speak effectively in a public setting; write analysis of complex medical evidence and provide reasoned conclusions; write non-technical reports describing medical issues to lay persons; analyze complex medical, vocational and programmatic data and provide reasoned conclusions; discuss medical requirements with staff physicians; prepare and defend a timely and accurate decision that is equitable and in accordance with the law; establish and maintain effective working relationships with subordinates, 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 successful experience as an adjudicator of Social Security Disability claims within the last 3 years.

Class Specification History

Effective May 1, 1963
Adopted June 26, 1964
Revised March 13, 1972 Revises definition and minimum qualifications
Revised May 21, 1973 Revises definition, adds distinguishing characteristics, and title change (formerly OASI Adjudicator 3)
Revised April 18, 1974 Revises minimum qualifications
Revised August 26, 1977 Revises distinguishing characteristics
Revised September 28, 1977 Revises distinguishing characteristics
Revised May 12, 1978 Revises distinguishing characteristics
Revised March 9, 1990 Revises definition and minimum qualifications, deletes distinguishing characteristics, and title change (formerly OASDHI Adjudicator 3)
Revised November 13, 2000: Revises salary, title change (formerly ODI Adjudication Supervisor/Specialist), definition and minimum qualifications
New class code: (formerly 47800) effective July 1, 2007
(08/25/2009) Removed OR Equivalent education/experience language from desirable qualifications.
Revised salary range, definition, distinguishing characteristics, typical work, knowledge and abilities and desirable qualifications; adopted June 30, 2017; effective July 1, 2017.

 

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