CLAIMS ADJUDICATOR SUPERVISOR DISABILITY DETERMINATIONS

Official job specification

The text below is the official specification published by the New Jersey Civil Service Commission. The plain-language summary and analysis above are derived from it by NJ Civil Service Navigator. Source: the official specification page at NJ CSC.

Definition

Under direction of a Manager in the Department of Labor, supervises and coordinates activities of adjudicators and other staff of lower grade involved in disability determinations at all levels according to the provisions of Title II and Title XVI of the Federal Social Security Act; serves as consultant on difficult vocational decisions and program issues; conducts field investigations and management evaluation studies; does other related duties as required.

Examples of work

Supervises adjudicators responsible for the review and/or adjudication of disability cases at the initial, reconsideration, continuing, hearing, or any assigned special project levels; conducts face-to-face interviews or evidentiary hearings for claimants who have applied for reconsideration of disability determinations; and/or, conducts face-to-face or telephone interviews to provide due process notice or rebuttals to claimants facing cessation of benefits for failure to meet continuing eligibility standards. Supervises staff who perform nonadjudicatory staff assignments including quality assurance review, medical relations, or training. Conducts sample case review of all level of DDS case assignments to determine validity of decisions. Examines, analyzes, interprets, and evaluates medical vocational evidence in a claimant's file to determine validity of decision and eligibility for disability benefits. Provides guidance to staff determining cases involving complex medical, vocational, residual functional capacity, and legal issues. Conducts meetings for the dissemination of information or training of staff. Prepares clear, concise, accurate, and informative reports. Conducts reviews of staff work to ensure that program and fiscal requirements are being met; reviews deficient claims returned from any SSA quality assurance component, and may prepare rebuttals to QA errors. May supervise an On the Job/Skills Assessment unit involved in conducting adjudicator orientation, training, and customized skills assessment for adjudicators, specialists, physicians, and other claims staff. Plans, organizes, and assigns work of the organizational unit and evaluates employee performance and conduct, enabling the effective recommendation of the hiring, fining, promoting, and disciplining of subordinates. Establishes and maintains cooperative working relationships between the unit, local Social Security Offices, medical relations staff, and other support areas to resolve problems and promote effective communications. Oversees and participles in the design of special studies to evaluate the effectiveness of existing work practices. Conducts comprehensive reviews of the medical consultative examination procedure to ensure that purchases are within established procedural and fiscal limitations. Establishes work priorities to meet mandatory quality, processing time, productivity, and aged case federal goals. Reviews and evaluates deficiency rates of adjudicators to determine performance weakness; develops and implements improvement plans. Reviews and analyzes case deficiency reports to determine training needs. Prepares clear, concise, and accurate written instruction and reports for claims requiring corrective action. Collects and tabulates data to determine accuracy and developmental and workload trends to improve overall agency operation. Reviews and analyzes due process determinations and hearings at any level to ensure that cessation of benefits or unfavorable benefit actions are determined within the boundaries of the law. Reviews beneficiary account status for relevant case information. Supervises work activity of staff involved in the analysis of requests from other SSA components including requests from the Federal Bureau of Hearing and Appeals, out-of-state requests, and cases informally remanded to the agency. Oversees the handling of claims filed under SSA international agreements with European countries. Oversees the handling of requests pursuant to the Federal Freedom of Information and Privacy Acts. Interprets and applies legislation, regulations, and operational policies and procedures. Designs training modules for new and existing adjudicator staff. Coordinates office-training initiatives with different agency components, parent agency initiatives, and varying SSA components. Oversees the maintenance and update of training materials and logs. Determines validity of referrals from Vocational Rehabilitation and Commission for the Blind. Maintains and updates program and policy manuals. 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.

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 the methods used to collect and analyze data. Knowledge of the methods used to conduct interviews and investigations. Knowledge of the factors involved in the processing of claims. Knowledge of the methods used to determine eligibility for benefits or claims. Knowledge of medical terms, medical evaluations and testing procedures associated with disability claims. Knowledge of the factors considered in the determination of eligibility claims. Knowledge of legal aspects and ramifications when affording due process to claimants whose benefits are to be ceased. Ability to interpret and evaluate medical information for disability determinations. Ability to interpret and analyze court rulings to determine the impact on the evaluation of disability claims. Ability to arrive at disability determinations within the parameters of law. Ability to interpret and evaluate evidence in disability cases. Ability to collect and analyze data Ability to interpret laws, rules and regulations and apply them to specific situations.. Ability to assess significance of residual functional capacity, age, education, and work experience on a claimant's ability to engage in work activity. Ability to supervise and prepare training outlines, manuals and other related materials. Ability to review and analyze complex cases to determine validity of determinations. Ability to prepare reports and correspondence. Ability to supervise the maintenance of records, files, and reference materials. Ability to supervise and evaluate individual and group performance. Ability to interpret statistical data. Ability to complete technical forms. Ability to work cooperatively with members of the medial community to obtain needed case information for disability determinations or problem resolutions. Ability to develop, initiates, and executes performance improvement plans for subordinates to meet unit goals. Ability 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, and communicate in English sufficiently to perform 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 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. CODES: 27/R27 - MCK 6/24/02

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. Applicants must meet one of the following or a combination of both experience and education. Thirty (30) semester hour credits are equal to one (1) year of relevant experience. Seven (7) years of professional experience gathering and reviewing medical and/or vocational documentation and the investigation and analysis of claims to determine the eligibility or ineligibility for disability benefits, or closely related disability, medical, health insurance or adjusting agency experience, two (2) years of which shall have involved evaluation and adjudication of claims. OR Possession of a bachelor's degree from an accredited college or university; and three (3) years of the above-mentioned professional experience, two (2) years of which shall have invlolved evaluation and adjudication of claims. "Professional experience" refers to work that is creative, analytical, evaluative, and interpretive; requires a range and depth of specialized knowledge of the profession's principles, concepts, theories, and practices; and is performed with the authority to act according to one's own judgment and make accurate and informed decisions.