Disability Determination Specialist
Basic Purpose:
Positions in this job family perform complex professional level work, interpreting and implementing provisions of the Federal Social Security Act to determine eligibility for disability benefits for applicants throughout the state of Oklahoma. Incumbents obtain, evaluate and analyze all pertinent information to prepare a legally defensible disability determination to approve or deny benefits.
Typical functions:
The functions within this job family will vary by level, but may include the following:
- Reviews and analyzes evidence of illness, injury, disease or other medical condition and vocational factors which prevent an individual from working or gaining employment, and prepares a determination to approve or deny disability benefits. Prepares a detailed written analysis explaining the facts of the case and the basis for the decision and provides written notice to the claimant and the Social Security Administration.
- Maintains a complex and diverse caseload of Social Security Disability claims and claims for Supplemental Security Income at various stages of development, and exercises judgment to insure resolution of all issues.
- Protects and safeguards confidential and sensitive personal, medical and vocational information in accordance with federal and state mandates.
- Completes case reviews on a variety of difficult or complex disability cases, at different stages of development, in order to assure compliance with internal office procedures, Social Security laws and regulations and legal statutes.
- Determines the medical and vocational information needed to substantiate the claim, analyzes medical, vocational, educational and other collateral information received and integrates those findings with Social Security regulations concerning disability and with facts of that particular claim.
- Determines the need for additional medical tests, evaluations or consultative examinations in the fields of medicine, psychology, psychiatry or other specialties and arranges for expenditure of funds for medical evidence.
- Prepares a written residual functional capacity assessment based on the severity of the medical condition and the nature of the impairment.
- Consults with internal and external professionals, or contract providers, including physicians, psychologists, and vocational experts to address highly complex issues.
- Interviews or corresponds with claimants, family members, legal representatives, employers, community resources and others as needed to obtain additional information or collateral evidence concerning an individual’s functional abilities.
Level Descriptors:
This job family consists of four levels of work which are distinguished by the level of complexity and diversity of the specific job assignments, the level of expertise required for the completion of duties assigned and the responsibility assigned for assisting, training and supervising others.
Level I: Code: K11A Salary Band: I
This is the basic level, where incumbents, under direct supervision, receive
mandatory classroom training in case processing, medical evaluation and
terminology, vocational evaluation, internal procedures for case development and
in the provisions of the Social Security Act, concerning eligibility for
disability benefits. Incumbents perform entry level professional work in
managing a progressive caseload of Title II and Title XVI disability claims and
learn to process disability cases using various secure software applications
with Federal and State operating systems. Incumbents learn to evaluate
disability applications for benefits in order to resolve jurisdictional issues
and to resolve conflicts in evidence through contact with claimants,
representatives, employers, medical providers and others. Incumbents analyze and
evaluate multiple case issues simultaneously; analyze medical source opinions
and effects of medication or pain on the claimant’s ability to function in a
work environment; assess credibility of claimant’s statements regarding their
ability to work and prepare vocational assessments for adults based on a variety
of vocational factors.
Knowledge, Skills and Abilities required at this level include knowledge of the
provisions of the Social Security Administration concerning eligibility for
disability benefits; of program policies and procedures; of various types of
injuries, illnesses and diseases and their effects on functional abilities; of
medical terminology; procedures for collecting and analyzing information; of
interviewing techniques; of Federal and State laws regarding confidentiality of
personal information and procedures for obtaining and disclosing information; of
the various systems software applications that interface with Social Security
Act national systems and of the electronic disability process system. Ability is
required to analyze medical information concerning various types of illnesses,
injuries or diseases and related treatments; to collect information concerning
an individual’s functional abilities, employment, education and other factors;
to develop and manage case files; to evaluate various physical and mental
impairments; to organize and prioritize a disability caseload; to communicate
effectively; and to establish and maintain effective working relationships.
Education and Experience requirements at this level consist of a bachelor's
degree; or an equivalent combination of education and experience, substituting
one year of professional-level experience in adjudicating Social Security
disability claims in a designated state agency for each year of the required
education.
Level II: Code: K11B Salary Band: J
This is the career level where employees have responsibility for a full range
of activities involved in independently developing, reviewing, analyzing and
adjudicating disability claims at different degrees of complexity. Incumbents
independently plan and carry out assignments, interpret policy and determine
methods and contacts. In addition to tasks performed at Level I, employees at
this level will manage a full caseload of disability claims and prepare legally
defensible disability determinations for review at the appellate levels, assess
unusual circumstances, incomplete or conflicting data and interpret and
implement methodology resulting from such elements as continuous changes in the
disability program and advancements.
Knowledge, Skills and Abilities required at this level include those identified
in Level I plus knowledge of Federal and State statutes and regulations related
to the Social Security Act; Social Security rulings and pertinent court rulings;
of the disability claims process including appeals and the legal principles of
Res Judicata, Collateral Estoppel and Administrative Finality. Ability is
required to analyze and review diverse and highly complex claims.
Education and Experience requirements at this level consist of a bachelor's
degree and one year of professional level experience in adjudicating disability
determinations for the Social Security Administration in a designated state
agency; or an equivalent combination of education and experience, substituting
one additional year of qualifying experience for each year of the required
bachelor’s degree.
Level III: Code: K11C Salary Band: K
This is the specialist level where the employees perform advanced level
professional work and provide expertise in the disability claims adjudication
process by advising other staff, as well as analyzing and evaluating unusually
complex and difficult cases which encompass sensitive, controversial and
technical issues; evaluate the total effect of multiple interrelated issues;
perform a complete and independent evaluation of all facts and evidence defining
legal and factual issues; research pertinent decisions and other reference
materials; apply laws, regulations, policies and procedures to determine
appropriate action; and apply guidelines and precedents in non-routine
situations. Duties at this level may also include training and mentoring staff.
At this level employees are given wide latitude for exercising independent
judgment.
Knowledge, Skills, and Abilities required at this level include those identified
at Level II plus knowledge of judicial processes; ability is required to apply
judgment and creativity to resolve complex program related issues. This level
requires the ability to perform a complete and independent analysis of all facts
and evidence; to define legal and factual issues; to research precedent
decisions and other reference materials; and to apply relevant laws,
regulations, policies and procedures.
Education and Experience requirements at this level consist of those identified
at Level II plus two additional years of professional level experience in
adjudicating disability determinations for the Social Security Administration in
a designated state agency.
Level IV: Code: K11D Salary Band: L
This is the advanced level where employees are subject matter experts with
responsibility for providing authoritative advice and expert consultative
services related to Disability policy. Incumbents must be able to effectively
communicate program knowledge of a complex, broad and diversified nature to
contacts both internal and external to SSA and make recommendations for program
improvements. Duties may include direct supervision of staff and assisting in
the supervision of a designated unit or team. Incumbents develop and present
initial and ongoing training to staff; perform quality assurance functions in
insuring the timeliness and accuracy of staff decisions and actions; function as
vocational experts at all levels of disability claims; develop and implement
recruitment and monitoring for independent medical providers and resolve
complaints regarding services provided by consultative medical providers.
Knowledge, Skills, and Abilities required at this level include those identified
at Level III plus knowledge of analytical and evaluation methods and techniques.
Ability is required to provide consultation to others in the application of
various policies and guidelines; to perform special studies and program
analysis; and to develop and implement training; to identify different learning
styles and training needs.
Education and Experience requirements at this level consist of those identified
at Level III plus one additional year of professional level experience in
adjudicating disability determinations for the Social Security Administration in
a designated state agency.
NOTE: Experience which was incidental or not reflective of a major
responsibility of the position shall not be accepted as qualifying.