Class Series Concept

See DDS Adjudicator 1.

Definition

This is the fully qualified, journey level of the series. As a single decision- maker with independent authority; adjudicates disability claims to include, but are not limited to Initial, reconsideration, childhood disability, Continued Disability Review, Military Causality/Wounded Warrior and Quick Disability Determinations.

Distinguishing Characteristics

Performs the full scope of direct services analysis (Activities of Daily Living assessments, arranging medical consultations, assessing medical and vocational capacity) and applies extensive medical and policy knowledge gained in determining a claimant’s capacity to work. These positions also have the sole responsibility for determining residual functional capacity and vocational analysis with little or no medical oversight. Work assignments include independent analysis and making final determinations on a full range of Social Security disability claims, including specialized and high profile priority workloads.

Typical Work

Performs the duties of a DDS Adjudicator 2;

Evaluates the data contained in medical, vocational and legal reports which may contain extensive medical records, physician’s opinion statements, laboratory and medical testing results, and vocational workshop evaluations; 

Obtains information from medical providers, claimants, or other sources as needed;
Determines when Social Security Administrative documentation standards have been met and makes appropriate decision of disability; 

Determines the need for additional documentation and authorizes the purchase of specialized medical examination or other evidentiary requirements necessary to evaluate the claim.

Identifies discrepancies, conflicting evidence or opinions of disability and resolves issues by obtaining additional evidence or through reasoned judgment.

Prepares and completes the residual capacity assessments; Consults with contracted staff physicians and psychologists as needed on medical findings;

Identifies and resolves fraud and similar fault issues; 

Identifies the existence of drug and/or alcohol conditions and determines if it is material to the finding of disability;

Conducts Continuing Disability Reviews;

Performs analysis of claims previously awarded benefits by Administrative Law Judge(s);

Reviews, analyzes and makes final determinations for specialized, complex and high profile claims such as Wounded Warrior/Military Causality and Compassionate Allowances;

Completes the disability determination document allowing, denying, continuing, or ceasing benefits; identifies the evidence used, analyzes the medical and vocational facts of the case and writes the decision showing how these facts comply with the Social Security policy; 

Makes referral to Vocational Rehabilitation and/or Services for the Blind; 

Performs other duties as assigned.

Knowledge and Abilities

Knowledge of:  the Social Security/SSI disability program; policy and procedures and common case law; proficiency in relating functional physical and mental limitations to Social Security/SSI disability program policy; medical terms, human anatomy and physiology, psychiatric terms, common drugs; ethics and procedures of medical profession; common jobs and their requirements and how to use job information sources (such as Dictionary of Occupational titles and OccuBrowse federal administrative policy and procedures, including in depth knowledge of common Social Security administrative policy procedures. 

Ability to:  interpret and apply laws, rules, regulations and court decisions; communicate complex issues effectively, orally and in writing; 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; determine when to complete cases without benefit to medical staff consultation; prepare and defend a timely and accurate decision that is equitable and in accordance with the law. Maintain effective working relationships with claimants, physicians, attorneys, advocates, facilitators, other public agencies, 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

Two years of successful experience as an adjudicator of Social Security Disability claims within the last 3 years.

Class Specification History

Adopted: November 13, 2000
New class code: (formerly 47791) effective July 1, 2007
(08/25/2009) Removed OR Equivalent education/experience language from desirable qualifications.
Revised salary range, definition, distinguishing characteristics, typical work and desirable qualifications; adopted June 30, 2017; effective July 1, 2017.