DHS SENIOR DISABILITY CLAIMS EXAMINER - 04222025-67288

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/HRC0013768_DHS_SR_Disability_Claims_Exmr_Davidson_042825.pdf

This position is designed as Work from Home (Remote)

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: Bachelors degree and experience equivalent to three years of full-time professional disability claims examination work.

Substitution of Experience for Education: Associate degree and two years of full-time professional disability claims examination work may be substituted for the required bachelors degree.

Necessary Special Qualifications: Applicants for this class must:

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 considerable difficulty. An employee in this class is responsible for determining initial, reconsideration, continuing disability, and pre-hearing claimant eligibility for disability benefits. This classification performs responsibilities under general supervision at the lead level. This class differs from that of the Disability Claims Examiner 2 in that an incumbent of the latter performs duties with a lesser degree of autonomy and increased responsibility for disability determinations.

Responsibilities

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

Competencies (KSA's)

-Knowledge of medicine, psychology practices, and federal disability regulations.
-Skilled in providing customer service, actively listening and learning, thinking critically, and quickly making sound, quality decisions.
-Skilled in mediation and negotiation.
-Ability to use oral and written communication effectively and with sensitivity to problems.
-Competent in understanding others and acting with empathy, integrity, and trust.
-Competent in managing a caseload and prioritizing workload to meet deadlines and accomplish goals.

Tools & Equipment

-General office equipment
-Computer/laptop/tablet
-Multifunction Printer (Print/scan/fax/copy)
-Cell phone