Class Concept
Employees in this class determine the eligibility of initial applications for medical disability as required by the Federal social security laws. Employees review the claims and evaluate evidence to determine if a medical disability is evident or if additional information is needed to develop the case before analyzing the evidence based on medical and vocational factors. Work entails the collection and review of extensive medical and personal histories and the application of laws, rules, regulations and policy directives in the determination process. Employees may process Social Security disability and State Medicaid claims.
After demonstrating knowledge and skill in evaluating initial claims and successfully completing the internal advancement process, the Disability Determination Specialists evaluate claims at the reconsideration level of the appeals process, determine continuing entitlement, including specialty cases. Work in this class may involve performing post-adjudicative reviews on cases where medical evidence is received after the case has been closed, or arranging for medical examinations and securing additional evidence. Employees ensure all pertinent allegations have been properly documented and verified, additional evidence is secured if needed, evaluate conflicting or susceptible diagnoses or information, evaluate case data, and determine if a disability exists or continues to exist and prepares rationale to support the decision. This work requires considerable interpretation of data and rules to determine the appropriate course of action.
