DISABILITY CLAIMS EXAMINER 2* - 12162025-73606

Job Information

LOCATION OF (1) POSITION(S) TO BE FILLED: DEPARTMENT OF HUMAN SERVICES, REHABILITATION SERVICES - DISABILITY DETERMINATION DIVISION, DAVIDSON COUNTY

For more information, visit the link below:
https://www.tn.gov/content/dam/tn/human-services/documents/HRC0017071_Disability_Claims_Examr2_Davidson_1526.pdf

This is a remote position

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Qualifications

Education and Experience: Bachelor's degree and two years of full-time professional disability claims examination work.

Substitution of Experience for Education: Additional full-time professional disability claims examination work may be substituted for the required education on a year-for-year basis.

Necessary Special Qualifications:

1. Complete a federal background check in accordance with the Homeland Security Presidential Directive 12 (HSPD-12) for issuance of an HSPD-12 compliant Personal Identity Verification (PIV) credential card.

Overview

This classification performs disability determination work of average difficulty. An employee in this class is responsible for determining adult and child medical eligibility for Social Security Disability, Supplemental Security Income or Medicaid benefits for initial claims in accordance with federal Social Security Administration (SSA) guidelines. This classification performs responsibilities at the working level under general supervision. This class differs from the Sr Disability Claims Examiner in that an incumbent of the latter are responsible adjudication of continuing disability cases and special court ordered or administratively ordered reviews and reviewing claims for compliance with pertinent laws, rules, and regulations.

Responsibilities

1. Determines adult and child medical eligibility for Social Security Disability, Supplemental Security Income or Medicaid benefits using medical, psychiatric, vocational, and educational data for initial and reconsideration claims in accordance with federal Social Security Administration (SSA) guidelines.
2. Routinely conducts telephone interviews with claimants and others to obtain and/or clarify information on applications. Determines jurisdiction and proper timeframe for requests of claimant records and obtains records from relevant treatment sources.
3. Independently reviews and analyzes applications, medical assessments, medical records, and vocational assessments as needed for initial and reconsideration claims. Reviews prior decisions for accuracy and development of evidence and examines new allegations or evidence, redetermines medical eligibility, and issues reconsideration decisions.
4. Documents case notes, appointments, and general correspondence for review and adjudication. Organizes and enters claimant documentary evidence and claim decisions into an electronic case management folder.
5. Assesses claimant's medical conditions to identify impairments, onset issues, and limitations by reviewing medical records, statements, and other pertinent information to prepare a medical assessment.
6. Routinely confers with internal medical consultants and various other subject matter experts to ensure all aspects of disability claims are in accordance with federal guidelines. Selects, composes, and sends proper federal disability determination notices to claimants explaining medical and vocational decision issues to claimants and authorized representatives.
7. Schedules/reschedules consultative examination appointments for claimants and notifies claimants, third parties, attorneys of appointment time and date, and documents reasons for any missed exams. Authorizes payments for examinations and claimant travel.
8. Reviews claimant's work history to determine if claimant's past work description is adequate and contacts claimant by phone if additional work history is needed. Identifies and analyzes claimant's past relevant work by researching jobs and earnings reported to SSA and compares the claimant's residual capacity with the functional requirements of the claimant's past and other work.

Competencies (KSA's)

Competencies:

1. Customer Focus
2. Resourcefulness
3. Communicates Effectively
4. Instills Trust
5. Situational Adaptability

Knowledges:

1. Customer and Personal Service
2. Medicine and Dentistry

Skills:

1. Active Learning and Listening
2. Service Orientation
3. Critical Thinking
4. Judgment and Decision Making
5. Time Management

Abilities:

1. Deductive Reasoning
2. Inductive Reasoning
3. Problem Sensitivity
4. Written Comprehension

Tools & Equipment

1. General Office Equipment
2. Computer/Laptop/Tablet
3. Multifunction Printer (Print/Copy/Scan/Fax)
4. Cell Phone