Disability Examiner Jobs

Department Information

Description of Job

Hybrid Position

2 Days Onsite

This position exists to determine medical eligibility for disability benefits on all case types for Colorado residents in accordance with Social Security’s disability rules and regulations. Each position is responsible for potential benefits of approximately $1,000,000 or more per year. The position is responsible for adjudicating initial, disabled child, and continuing disability review claims.

Disability Examiners gather medical information from the sources listed by claimants on their applications, and any new sources discovered in the claims adjudication process. They analyze that evidence using very specific and complex Social Security disability criteria, including review of medical documentation, functional documents, knowledge of medical and psychological impairments, and Social Security rules & regulations. Disability Examiners must prepare a medically and legally sufficient rationale based on their analysis of a claimant’s information to justify whether the individual qualifies for disability under Social Security’s rules.

Duties:
Adjudication and Documentation
With supervisory oversight, determines medical eligibility for disability benefits under the SSDI/SSI Program by gathering, evaluating and analyzing medical and non-medical data. Independently reviews and analyzes evidence of illness, injury, disease or other medical conditions and vocational factors, which prevent an individual from working or gaining employment and renders a determination to approve or deny disability benefits. Data is gathered through electronic requests sent via email and SSA/DDS software programs, and through written and verbal correspondence. Data is consolidated and correlated with SSDI/SSI program regulations, directives and agency guidelines to determine applicant’s ability to perform physical/mental work-related functions. Also evaluates continuing eligibility for persons already receiving medical benefits using medical improvement standards. Based on preliminary evidence and Social Security disability regulations, program directives, and agency guidelines, position determines which claims will receive immediate temporary disability payments of about $500 per month plus Medicaid. The determination is carried out by accessing and evaluating electronic data. Acts to prepare medical and psychological assessments independently, which allows experienced adjudicators to expedite the initial determination of disability coordination and consultation with the state agency, medical consultants (SAMC), whose signatory input is required by statute with narrow exceptions. Medical evaluation and analysis are completed and the results are keyboarded into appropriate programs. Documents the disability decision by citing legal references from the Social Security regulations. Writes rationale to explain and justify the disability decision. Decisions and rationale are documented/recorded by keyboarding the information into the appropriate SSA/DDS software programs.

Development
Interviews applicants, various professionals (doctors, lawyers, teachers, etc.) and other interested parties to obtain necessary information. Information is documented by keyboarding it into the appropriate SSA/DDS software programs. Explains the Social Security disability programs to applicants, the public and various other professionals. Communication is accomplished in person, by phone, via SSA/DDS software programs, mail, and email.

Confers and collaborates with DDS contract medical consultants and other DDS specialists to clarify gathered data as needed. Contact is accomplished in person, via SSA/DDS software programs, written and verbal correspondence, and email.

Authorizes the purchase of medical exams, tests and procedures from physicians, hospitals, and laboratories. Authorizations are communicated by keyboarding the information into the appropriate SSA/DDS software programs.

Other Duties as assigned

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

Minimum Qualifications

Education:

• Bachelor's degree from an accredited institution.

Substitutions:

• Experience in an industry, professional environment, or government (State, Federal, County), agency that is highly regulated where a person has to evaluate and apply policy such as: Claims adjuster, examiner or investigator, Project/office management, Business Support Services/Analyst, Supervisory/Management, Accounting/Auditing, Case Management, Paralegal/Contract management, Medical/Veterinarian Technician will substitute for the degree on a year-for-year basis.

Preferred Qualifications:

• Excellent organizational skills
• Keyboarding Proficiency
• Excellent Customer Service skills
• Excellent decision making skills
• Excellent analytical and reasoning abilities
• Excellent written and oral communication skills
• Attention to detail
• Ability to work with diverse constituency

Conditions of Employment:

• Standard Background – Name check and TRAILS
• Former State employees who were disciplinarily terminated or resigned in lieu of termination must disclose the information on the application and provide an explanation why the prior termination or resignation should not disqualify the applicant from the current position. Absent extraordinary circumstances, prior disciplinary termination or resignation in lieu of termination will disqualify the applicant from future State employment with CDHS.
• HSPD-12 (Homeland Security Presidential Directive 12) federal credentialing. Tier 2, (which includes Fair Credit Report)- Completed by DDS

Appeal Rights:
For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov; contact the State Personnel Board for assistance at (303) 866-3300; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.

Supplemental Information

• Paid life insurance
• Strong, secure, yet flexible retirement benefits including a PERA Defined Benefit Plan or PERA Defined Contribution Plan www.copera.org plus 401(k) and 457 plans
• BenefitHub state employee discount program
• 11 paid holidays per year plus vacation and sick leave
• Employer supplemented Health Savings Account
• Employee Wellness program MotivateMe
• Excellent work-life programs, such as flexible schedules, training and more
• Remote work arrangements for eligible positions
• Short- and long-term disability coverage
• Medical and dental health plans

• Some positions may qualify for the Public Service Loan Forgiveness Program. For more

We believe in a people-first approach: To serve the people of Colorado, we develop a culture and work environment that creates an energized, inspired, and healthy team capable of giving their best to Coloradans.

Balance creates quality of life: We want our team to be resilient through a supportive workplace that values flexibility, health and wellness, and employee engagement.

We hold ourselves accountable: We take responsibility through our actions, programs, and results for the state of health and human services in Colorado.

Transparency matters: We are open and honest with employees, our partners, the Coloradans we serve, and the public.

We are ethical: We abide by what is best for those we serve by doing what is right, not what is easy.

Collaboration helps us rise together: We work together with all partners, employees, and clients to achieve the best outcomes for Coloradans.

We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.

ADAA Accommodations: CDHS is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Nancy Schmelzer, at [email protected] or call 1-800-929-0791.

~THE STATE OF COLORADO IS AN EQUAL OPPORTUNITY EMPLOYER~