Class Series Concept

In the Division of Disability Determination Services, the DDS Adjudicator Series is a professional series that performs medical and vocational analysis and determinations for the Social Security Administration disability claims and State Non-Grant Medical Assistance.

Definition

Adjudicates initial Social Security Disability and Supplemental Security Income claims. Determines the sufficiency of the medical evidence, credibility of allegations, symptoms and medical opinions, and remaining functional capacity for work.

Distinguishing Characteristics

This is an in-training level designed to provide guidelines, training opportunities, and direct work experience through a structured in-training program.  Incumbents are required to attend and complete an extensive on-the-job classroom structured training program. Weigh objective medical findings, claimant and third party statements, age, education and previous work. Prepares residual functional capacity assessments and assesses vocational skills, abilities, and capacities to determine if individuals applying for Social Security disability benefits are able to work.

Typical Work

Reviews initial claims for Social Security and Supplemental Security Income Disability to obtain supporting evidence from medical and non-medical sources; 

Prepares written correspondence to these providers of information and conducts investigative telephone interviews with these sources when necessary; 

Determines the need for additional documentation and authorizes the purchase of specialized medical examinations or other evidentiary requirements necessary to evaluate the claim; reviews medical reports, and other purchased evidence for completeness to ensure that authorized services were rendered; 

Identifies discrepancies, such as conflicting evidence, and addresses opinions of disability; 

Determines the ­consistency of the claimant’s statements ­and learns how to identify and resolve fraud and similar fault issues;

Consults with staff physician on signs, symptoms and diagnostic findings and residual functional capacity assessment and evaluates the applicant's physical and mental capacity for work; 

Identifies the existence of drug and/or alcohol conditions; 

Determines when claims, which are awarded benefits, are received for confirming eligibility. Establishes the date for review based upon the current finding of disability and the potential for medical improvement; 

Completes the disability determination document allowing or denying benefits; Makes referrals to Vocational Rehabilitation and/or Services for the Blind; 

Advises the claimant of due process and appeal rights via a personalized denial notice;

Performs other work as required.

Knowledge and Abilities

Knowledge of:  medical terms, human anatomy and physiology, psychiatric terms, common drugs; common occupations and their general requirements; ethics and procedures of medical profession; State and Federal statutes; research and assessment of information. 

Ability to:  interpret and apply laws, rules, regulations and court decisions; communicate effectively, orally and in writing; write analyses of medical evidence; write non-technical reports describing medical issues to lay persons; analyze complex medical, vocational and programmatic data; discuss medical requirements with staff physicians; prepare and defend a timely, quality decision and to organize and coordinate evidence of record; execute equitable and lawful adjudication; establish and 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.

Class Specification History

Revised June 10, 1971 Revises minimum qualifications
Revised May 21, 1973 Title change (formerly OASI Adjudicator 1)
Revised August 26, 1977 Revises definition
Revised March 9, 1990 Revises definition and minimum qualifications, adds distinguishing characteristics, title change (formerly OASDHI Adjudicator 1)
Revised November 13, 2000: Revises salary, title change (formerly ODI Adjudicator 1), definition and minimum qualifications
New class code: (formerly 47780) effective July 1, 2007

Revised class series concept, definition and distinguishing characteristics; adopted June 30, 2017; effective July 1, 2017.