CLAIMS ADJUDICATOR DISABILITY DETERMINATIONS
New Jersey treats Claims Adjudicator Disability Determinations as a competitive-class job, so the gate is an examination and the ranked list it produces rather than a direct offer.
The spec names a bachelor's degree, but it leaves the door open to substitute experience for the degree. The FY 2027 range lands between $63,663 and $92,953, and state payroll currently lists about 94 people in the title, most of them at Labor.
How to apply
This title is filled by competitive examination.
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See where to apply for this title →Who employs this title
Claims Adjudicator Disability Determinations appears on the State payroll at one department, Department of Labor.
State departments
| Employer | Employees |
|---|---|
| Department of Labor | 94 |
State payroll and independent authority payroll are separate systems and are never merged. See data sources.
Who employs this title
State payroll records show 94 people working under this title. The median actual salary is $67,170. The agencies employing the most are:
- Labor (94)
Counts from NJ YourMoney agency payroll. See statewide workforce analytics.
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 the direction of a Claims Adjudicator Supervisor, analyzes initial disability applications; develops medical, vocational, and other non-medical data; evaluates all evidence compiled and makes an appropriate determination of entitlement to disability benefits; does related work as required.
Examples of work
Reviews, analyzes, and evaluates medical, vocational and other non-medical data to determine appropriate action and adjudicate the claim. Prepares clear and accurate determinations containing findings, conclusions, and recommendations in all initial claims. Evaluates data and reexamines data based on medical documentation. Determines presumptive disability in Title XVI initial claims. Authorizes District Offices to initiate advance benefits to claimants. Reviews information to determine if claimants can functionally perform their relevant work or if additional information is necessary and takes appropriate action. Communicates with treating physicians, hospitals, and other medical sources to elicit the required medical data. Communicates with claimant to obtain any required additional information and all vocational data prior to onset of disability. Notifies claimant of delays incurred in obtaining evidence from treating sources. Recommends and schedules medical examinations with consulting physicians. Gives consulting physician pertinent background medical data. Authorizes payments for consultative examinations, medical reports, and claimant's travel expenses. Provides assistance to higher level adjudicative staff in the development and adjudication of cases in appeal or in continuing review. Prepares and/or confers on cases for review and consultation by State Agency review physicians. Organizes and identifies relevant medical evidence. Proposes recommendation for residual functional capacity based upon the medical findings in the file. Analyzes and evaluates vocational information to determine if a claimant could functionally perform his or her customary or other past relevant work. Obtains statement of claimant's physical capability from medical sources. May recommend payee and/or notify Federal District Office to initiate payee development prior to closure. Affords "Due Process" to those claimants whose claims are to be unfavorably revised. Identifies and refers claims for rehabilitation services to the appropriate agency. Queries Social Security and State databases to obtain and analyze necessary data on claims. Maintains and updates policy manuals and implements new program changes. Responds to status requests from District Office. Maintains accurate records, reports, and files and prepares weekly statistical data. Will be required to learn to utilize various types of electronic and/or manual recording and computerized 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 legal aspects, procedures, ramifications, or "Due Process" issues when benefits cease or claims are unfavorably reversed. Knowledge of the in-person and telephone interviewing techniques. Knowledge of the theories of disability and other social insurance. Knowledge of the methods of case processing. Ability to interpret and apply rules and regulations governing the disability provisions of the Social Security Act and the Supplemental Security Income program and their amendments, international agreements, and operational procedures and policies. Ability to interpret and apply laws, rules and regulations of the Federal Privacy Act. Ability to interpret statistical data contained in reports. Ability to make clear, concise and convincing presentations of study findings, conclusions, and recommendations at conferences and staff meetings. Ability to deal effectively with all situations with claimants, attorneys and other claimant representatives. Ability to organize assigned work, analyze complex claims problems, and evaluate all pertinent evidence obtained, and maintain accurate claims files and records. Ability to obtain medical documentation necessary to case adjudication. Ability to handle and resolve complaints from claimants and/or their representatives. Ability to plan and effectively conduct orientation and in- service training programs. Ability to effectively communicate policies, procedures, rules, and regulations both orally and in writing. 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. America 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 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. Five (5) years of professional experience in work involving the review of medical documentation and investigation of medical claims for eligibility determination of benefits or services. OR Possession of a bachelor's degree from an accredited college or university; and one (1) year of the above-mentioned professional experience. "Professional experience" refers to work that is analytical, evaluative, and interpretive; requires a range of basic knowledge of the profession's concepts and practices; and is performed with the authority to act and make accurate and informed decisions. SC3521N/AP20-Bilingual In Spanish And EnglishSC3521N/AP20- 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