Job Information
State of Tennessee Job Information
Opening Date/Time
Thur 06/29/2023 12:00AM Central Time
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Closing Date/Time
Wed 07/05/2023 11:59PM Central Time
Salary (Monthly)
$3,958.00 - $4,958.00
Salary (Annually)
$47,496.00 - $59,496.00
Job Type
Full-Time
City, State Location
Nashville, TN
Department
Human Services
LOCATION OF (6) POSITIONS TO BE FILLED: DEPARTMENT OF HUMAN SERVICES, REHABILITATION SERVICES - DISABILITY DETERMINATION DIVISION, DAVIDSON COUNTY
For more information, visit the link below:
Disability Claims QA Reviewer_Davidson_071223.pdf (tn.gov)
Hybrid
Qualifications
Education and Experience: Graduation from an accredited college or university with a bachelor's degree AND experience equivalent to three years of professional disability claims examination work, one year of which must include work involved in the examination of continuing disability review and one year of which must include work involved in the examination of childhood disability claims for social security.
Necessary Special Qualifications: A valid vehicle operator's license may be required for employment in some positions.
Positions within the Disability Determinations Section of the Division of Rehabilitation Services within the Department of Human Services will be required to 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.
Summary
Summary: Under general supervision, is responsible for Social Security Disability quality review of casework at all levels of difficulty; and performs related work as required.
Distinguishing Features: An employee in this class is responsible for reviewing the entire scope of disability claims for accuracy and adherence to established policies and procedures in all phases of the adjudication process. These employees train, troubleshoot for, and advise other members of the sub-series, including management, and serve as the main source of consultation in the agency for the highly complex and difficult cases. This class differs from that of Disability Claims Examiner 3 in that an incumbent of the latter is responsible for performing highly complex casework requiring advanced expertise in disability case examinations for continuing eligibility and special court ordered or administratively ordered cases. This class differs from that of Disability Claims Supervisor 1 in that incumbents of the latter are responsible for supervising the work of a moderate sized unit of examiners and may supervise employees of this class.
Responsibilities
Analyzing Data or Information:
- Evaluates the accuracy of disability decisions for compliance with established policies and procedures; determines completeness of case development; assesses validity of medical and vocational analyses; develops cases and conducts physical and mental analyses of claims as necessary.
- Receives and analyzes disability claims for technical issues in order to ensure or take proper action.
Updating and Using Relevant Knowledge:
- Receives and analyzes policy and procedure updates in order to apply knowledge and utilize up to date information.
Coaching and Developing Others:
- Explains the significance of regulations and requirements and how those apply to case processing.
- Coaches and advises disability claims examiners, physicians, and others; provides one-on-one consultation on the topics of caseload management and disability claims computer techniques; provides advanced guidance on technical issues for experienced examiners; provides training, coaching, and/or advice for physicians and others on Social Security policy and procedure; acts as a resource for examiners, physicians, and others regarding the development of complex or unusual cases.
- Coaches examiners in sensitivity techniques to work effectively with mentally ill, terminally ill, and chronically ill claimants; guides examiners in review of medical evidence and preparation of physical and mental residual functional capacity assessments.
Processing Information:
- Compiles data and prepares formal assessments as needed regarding technical issues in disability claims.
- Conducts case sampling and individual case reviews.
- Ensures coding is correct according to medical and psychological consultant exam fee schedule.
Judging the Qualities of Things, Services, or People:
- Assesses the qualifications of consultative examination panelists to ensure they meet the requirements for an acceptable medical source.
Staffing Organizational Units:
- Recruits, interviews, selects, and trains new consultative panelists.
Provide Consultation and Advice to Others:
- Provides staff and/or management with recommendations for future actions based upon completed case reviews and identified trends and deficiencies.
Evaluating Information to Determine Compliance with Standards:
- Reviews the quality of case work through each stage of processing.
- Monitors the disability examiner's workload and makes recommendations for action to ensure Social Security disability claims are moving forward.
- Ensures that the disability examiner is completing business processes in order to adjudicate cases in a timely manner according to established guidelines.
Developing and Building Teams:
- Coordinates a working relationship between consultative panelists, DDS transcription services and translators.
- Provides consultative panelists with policy and procedure updates to maintain a consistent scheduling and flow of reports to DDS.
- Works with hospitals, clinics, schools and other organizations to provide a consistent flow of records and information into the agency.
Communicating with Supervisors, Peers, or Subordinates:
- Monitors project development; performs quality checks on existing or special projects; determines percentages of cases to sample for review for projects; provides feedback for internal monitoring; reports quality trends to management; recommends actions in compliance with federal and state agency goals and objectives to management; directs special projects.
- Provides clear and understandable information in a professional manner to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
Communicating with Persons Outside Organization:
- Maintains professional contact in communication with the public; explains or solicits information from claimants, attorneys, lay persons, and/or associates; resolves problems with cases and/or assists claimants by phone; coordinates and enforces Social Security policies, procedures, rules and regulations as they pertain to the adjudication process; attends meetings, training, and conferences or seminars at the local, state, and federal level.
Resolving Conflicts and Negotiating with Others:
- Listens to parties, addresses concerns, and resolves complaints and disputes in a respectful manner.
Organizing, Planning, and Prioritizing Work:
- Prioritizes consultative exam provider annual reviews, quality assessment reviews, and on-site assessments.
- Reviews consultative exam panel providers and areas for services to ensure adequate coverage.
- Flags and prioritizes disability claims according to Social Security standards and policy.
- Prioritizes and balances individual workload to ensure individual and agency goals and guidelines are met.
Establishing and Maintaining Interpersonal Relationships:
- Develops and maintains cooperative working relationships with staff and others, building rapport and interacting in a respectful and constructive manner.
- Recognizes communication and learning styles, strengths, and deficiencies among peers.
Getting Information:
- Receives and reviews paper and electronic case files, medical records, and other items as needed throughout the life of the case.
- Receives and processes information from the claimant, claimant's relatives, medical providers, Social Security Administration, congressional offices, attorney and non-attorney claimant representatives, supervisors, and others across the agency.
- Initiates contact with a variety of professional and non-professional sources in order to obtain necessary information.
Documenting/Recording Information:
- Prepares and maintains records and reports; prepares site visit observation reports, complaint letter responses, and written responses to unusual case issues; documents missing or inadequate reports; prepares reports documenting the adjudication of disability claims.
Interacting With Computers:
- Accesses, enters and reviews data utilizing agency operation systems, MS Office, and other systems as required.
Competencies
Competencies:
- Decision Quality
- Functional/Technical Competency
- Problem Solving
- Technical Learning, Informing
- Time Management
- Conflict Management
- Written Communications
Knowledge:
- Clerical Procedures
- Customer Service Techniques
- DDS Operating Systems, MS Office, and Other Systems
- Medical, Psychological, and Therapeutic Concepts
- Personnel and Human Resources Concepts
- SSA Claim Production, Processing, and Quality
- SSA Laws and Regulations
- Training in SSA Disability Program Requirements
Skills:
- Active Learning
- Active Listening
- Actively Provide Internal and External Customer Service
- Adaptively Respond to Changing Situations and Information
- Basic Mathematics
- Complex Problem Solving
- Critical Thinking
- Instructing
- Judgment and Decision Making
- Management of Personnel Resources
- Monitoring Self, Others, and Work Processes
- Negotiation
- Persuasion
- Quality Control Analysis for SSA Disability Claims
- Reading Comprehension
- Recognizing and Applying Learning Strategies or Styles
- Social Perceptiveness
- Systems Evaluation
- Time Management
- Troubleshooting
- Writing
Abilities:
- Concentrate Amid Distractions
- Deductive Reasoning
- Identify Problems
- Inductive Reasoning
- Learn and Apply Different Sets of Rules
- Memorization
- Multitask
- Oral Comprehension and Expression
- Quickly and Accurately Recognize and Analyze Information and Patterns
- Understand, Interact, and Communicate with Others Effectively
- Written Comprehension and Expression
Tools & Equipment
- Personal Computer
- Multi-Function Printer/Copier/Scanner
- Telephone
- Fax Machine
- TDD Assistive Telephone System
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