Disability Determination Adjudicator III

at State of Vermont in Waterbury, Vermont, United States

Job Description

This position reviews and decides the medical eligibility, including initial claims, appeals and continuing eligibility, of applicants and beneficiaries for the Social Security and Medicaid disability programs in the Office of Disability Determination Services in the Department for Children and Families. Responsibilities include seeking and investigating, then analyzing and evaluating, medical and psychological evidence, subjective and objective data, and medical and non-medical statements and opinions, for the purpose of concluding applicant's degree of medical improvement and current functional capacity to work. When performing reviews of continuing eligibility, great care must be taken to ensure the beneficiary is afforded all substantive and technical legal due process rights before determining to cease benefits. The incumbent must ensure that no stone is left unturned in the total investigation and documentation of the determination before a final cessation of benefits is effectuated. This class also reviews the appeals of benefit cessation decisions by other adjudicators and either overturns the cessation decision or prepares the case for the disability hearing. This class differs from the DDS Claims Adjudicator II level in that the incumbent reviews the claims of beneficiaries who have potentially been receiving benefits for many years, and in that it has broad independent authority and judicial discretion for the medical/functional assessment of pediatric and childhood mental impairments, as well as adult physical and mental impairments. In addition to the knowledge, skills and abilities required at the II level, this position requires the incorporation of Social Security's medical improvement review standards and a thorough comprehension of all the ramifications of pediatric and childhood mental impairments. This class also determines the continuing eligibility of child beneficiaries through a complex evaluation of medical improvement, including a comparative analysis of the child's functional changes over time in relation to maturational timeline norms. This class differs from the Senior Adjudicator level in that it does not involve disability hearings, office-wide quality review, training development/presentation, and other assistant supervisory responsibilities. Work is performed under the supervision of the Disability Determination Operations Supervisor. All employees of the Agency of Human Services perform their respective functions adhering to four key practices: customer service, holistic service, strengths-based relationships and results orientation.

Incumbents must organize and cope with highly complex, detailed information and a heavy caseload with exacting requirements for simultaneous quality, timeliness, productivity and cost-effectiveness. Duties are performed largely in a standard office setting and/or telework. Duties are normally performed during regular office hours, but some flexibility is granted based on employee and office needs. Very occasional weekend hours may be required. Due to the nature of cases involved (contested disability determinations and possible loss of benefits), it may be necessary to deal with emotional and sensitive issues, by telephone, with claimants who have severe disabilities and dire financial needs, and with their attorneys and other advocates.