Disability Determination Specialist II

Job Code: 32000353
Salary Grade: NC11

Class Concept

Employees in this class serve in a specialized role within the organization. The work utilizes comprehensive knowledge of Social Security Administration disability policies and procedures, related court decisions and administrative rulings.

The Quality Assurance Specialist role involves reviewing cases for decision accuracy and preparing studies of agency functions and operation. The Quality Assurance Specialist may also provide consultation and training on vocational issues for more complicated cases. The QA Specialist is knowledgeable in physical and mental demands of an extensive array of job types and provides consultation and guidance to other DD Specialists about transferability of claimant skill sets to other jobs.

The Professional Relations Specialist role has responsibility for the recruitment and maintenance of a qualified medical panel. Employees perform a variety of functions such as consulting in specialized areas, participate in training, review cases for quality assurance, gather/analyze information on the agency operations, develop/present claims after initial review, among other duties.

The Assistant Unit Manager is responsible for training and developing unit staff. Employees in this role serve in lieu of the Unit Supervisor by providing daily oversight of all employees in a specified unit, resolving problems, ensuring productivity goals are met, and performing related administrative tasks (such as approving employee leave, input into performance evaluations).

The Claims Review Specialist role is assigned to an Operations unit. Employees in this role review complex claims and specialty workloads. In this capacity, they process cases that are unassigned due to absences and separations.

The Trainer role implements the training program established by the training manager. This role may provide input into the design and delivery of training, instruct employees in the administrative and medical adjudication criteria to determine disability, technical aspects of processing claims, basic anatomy and physiology of body systems, and case processing skills. They may also provide in-service training on various types of disability claims, levels of claims adjudication, claims processing procedures, evaluation criterial and/or other specialized training to all staff.

Recruitment Requirements

Knowledge, Skills, and Abilities

• Working knowledge of a wide variety of disabilities and their impact.
• Considerable knowledge of medical and non-medical regulations, policies, and procedures of the Federal Social Security Act and the Medicaid program.
• Considerable knowledge of the principles and theories of instruction including technology use.
• Thorough knowledge of medical terminology, CPT coding, injuries, illnesses, and diseases and their impact on functional abilities.
• Skill in applying relevant laws, regulations, policies, and procedures in complex case situations.
• Ability to analyze data and make accurate decisions in a production-oriented setting.
• Ability to formulate ideas and communicate them in written and oral form including written summaries of findings and the rationale for decisions.
• Ability to compose course and lesson plans, including course objectives, instructional strategies, examinations, and course syllabi.
• Ability to establish and maintain effective working relationships with the general public, state, Federal, and local agencies; and a variety of professional disciplines and co-workers.
• Ability to express oneself clearly and concisely in oral and written form.

Minimum Education and Experience

Bachelor's degree from an appropriately accredited institution and three years of progressive experience as Disability Determination Specialist; or an equivalent combination of education and experience.