CLAIMS ADJUDICATOR SUPPORT SPECIALIST 1

Definition

Under the direction of a Supervisor or Manager, Division of Disability Determination Services, Department of Labor, conducts field and telephone investigations to obtain medical and other data to assist in the adjudication of claims filed under the Social Security Disability Program; provides information to claimants and other interested parties about rights and responsibilities under the law; may act as a lead worker over lower level non-professional staff; does related work as required.

Examples of work

• May be required to take the lead in the work of a unit and/or perform the more complex phase of work.
• May provide guidance and instruction to level 2 Support Specialist and other individuals and groups engaged in the work of the unit.
• May compile medical and other evidence for adjudication of claims.
• Conducts telephone and/or field investigations.
• Investigates improper or incomplete reporting of information.
• Records applicant information for claims or benefits.
• Reviews information on claims documents for completeness.
• Proofreads material for accuracy.
• Interviews claimants, relatives, friends, neighbors, advocates, and other individuals to obtain pertinent information related to disability claims.
• Develops information sources to facilitate the prompt adjudication of claims.
• Explains agency programs and services.
• Records (logs) notification of lack of insured status, death of wage earner, and other pertinent claimant data.
• Prepares referrals for claimants for vocational rehabilitation services or other public or private benefit services.
• Obtains written permission for release of medical information.
• Prepares clear, sound, accurate, and informative reports containing findings, conclusions, and recommendations.
• Will be required to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.

Education

Successful completion of sixty (60) semester credit hours in an accredited college or university.

Experience

Two (2) years of experience in the collection and verification of information and data for eligibility determination for benefits or services.

License

Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform the essential duties of the position.

Knowledge, skills and abilities

Knowledge of basic interviewing techniques. Knowledge of appropriate sources for verification of claimant information. Ability to interpret and apply pertinent laws, regulations, procedures, and policies applicable to the Social Security Disability Act. Ability to interpret and apply pertinent laws, regulations, procedures, and policies applicable to information privacy and confidentiality. Ability to synthesize facts to reach logical conclusions. Ability to interpret and apply pertinent laws, regulations, procedures, and policies applicable to claims for benefits or services. Ability to interpret and apply pertinent laws, regulations, procedures, and policies governing vocational rehabilitation programs. Ability to interpret and apply guidelines governing benefit eligibility. Ability to interpret medical reports. Ability to read and understand information regarding human anatomy, physiology, pathology, psychiatry, and childhood diseases. Ability to collect data through questioning. Ability to interact with various people who are in differing situations. Ability to communicate effectively. Ability to provide assignments/instructions to subordinates and supervise the performance of their work. Ability to follow oral and written directions. Ability to maintain essential records and files. Ability to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units. Ability to read, write, speak, understand, or communicate in English sufficiently to perform the duties of this position. American Sign Language or Braille may also be considered as acceptable forms of communication. Persons with mental or physical disabilities are eligible as long as they can perform the essential functions of the job after reasonable accommodation is made to their known limitations. If the accommodation cannot be made because it would cause the employer undue hardship, such persons may not be eligible. This job specification is applicable to the following title code(s) which are different work week or work month and/or variants of the job class title: Job Spec Code State, Local or Common Class of Service Work Week State Class Code Local Class Code Salary Range

Note

The examples of work for this title are for illustrative purposes only. A particular position using this title may not perform all duties listed in this job specification. Conversely, all duties performed on the job may not be listed. NOTE: Appointments may be made to positions requiring bilingual skills. - Bilingual in Spanish and English SPECIAL SKILL Applicants must be able to read, write, speak, understand, or communicate in Spanish and English sufficiently to perform the duties of this position. Applicants who do not possess the required education may substitute additional experience as indicated above on a year- for-year basis (30 semester credit hours is equal to one year of experience.) SC3517N/AA16-Bilingual In Spanish And EnglishSC3517N/AA16- This job specification is for government use only. Salary range is only applicable to state government. Local salaries are established by individual local jurisdictions. 9/11/1999