Class Series Concept

See DDS Adjudicator 1.

Definition

Adjudicates initial, reconsiderations and disabled children claims; with a greater focus on caseload management. Evaluates the data contained in medical, non-medical, vocational, and legal reports; determines most effective  and efficient way to procure information; obtains information about functional limitations; Obtains information from medical providers, claimants, or other sources; determines when Social Security Administration documentation standards have been met and makes appropriate decision of disability.

Distinguishing Characteristics

In a training capacity, under close supervision, incumbents receive extensive medical, mental and vocational training.  This level requires the ability to learn and apply different sets of federal regulatory rules, laws, policies, procedures and processes necessary to adjudicate Social Security Disability and Supplemental Security Income disability claims.  Performs routine direct services analysis (Activities of Daily Living assessments, arranging medical consultations, assessing medical and vocational capacity) and applies extensive medical knowledge gained in determining a claimant’s capacity to work.

Typical Work

Performs the duties of a DDS Adjudicator 1;

Analyzes and reviews initial, reconsideration and child disability claims and evaluates the data contained in medical, vocational and legal reports; 

Develops case documents through the applicant, medical and non-medical sources; determines most effective way to procure information; obtains information about functional limitations through collateral contacts and interviews; determines when Social Security Administrative documentation standards have been met and makes appropriate decision of disability; 

Authorizes the purchase of specialized medical examination or other evidentiary requirements necessary to evaluate the claims; reviews medical reports and other evidence purchased for completeness to ensure that authorized services were rendered; assures that payment vouchers are correct and authorizes payment according to established accounting procedures; 

Prepares or participates in the completion of the residual capacity assessment; 

Consults with staff physicians as needed on medical findings; 

Evaluates the applicant's physical and mental capacity for work; 

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; 

Determines future reviews dates on all approved or continued claims; 

Conducts first level of appeal of unfavorable or partially favorable decisions of initial claims; 

Completes the disability determination document allowing, denying, continuing, or ceasing benefits; makes referral to Vocational Rehabilitation and/or Services for the Blind; 

Advises claimants of due process and appeal rights of Social Security disability program law; 

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; federal administrative policy and 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; 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

One year of successful experience as an adjudicator of Social Security Disability claims within the last two years.

Class Specification History

Effective May 1, 1963
Adopted June 26, 1964
Revised May 21, 1973 Revises definition and minimum qualifications, adds distinguishing characteristics, and title change (formerly OASI Adjudicator 2)
Revised April 18, 1974 Revises minimum qualifications
Revised August 26, 1977 Revises distinguishing characteristics
Revised September 28, 1977 Revises definition and distinguishing characteristics
Revised May 12, 1978 Revises definition and distinguishing characteristics
Revised March 9, 1990 Revises definition and minimum qualifications, deletes distinguishing characteristics, and title change (formerly OASDHI Adjudicator 2)
Revised November 13, 2000: Revises salary, title change (formerly ODI Adjudicator 2), definition and minimum qualifications
New class code: (formerly 47790) effective July 1, 2007
(08/25/2009) Removed OR Equivalent education/experience language from desirable qualifications.
Revised definition, distinguishing characteristics, typical work and desirable qualifications; adopted June 30, 2017; effective July 1, 2017.