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Claims Examiner - Stone Mountain

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Legal
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Vocational Rehabilitation Agency, Georgia - GVRA

CANDIDATES WITH MEDICAL BILLING, MEDICAL CODING, MEDICAL ASSISTING, CNA, AND ACCOUNTING CERTIFICATIONS ARE ENCOURAGED TO APPLY!

We are excited to announce MULTIPLE openings for Claims Examiners-Adjudicator 1!

The Georgia Vocational Rehabilitation Agency operates five integrated and interdependent statutory programs that share a primary goal - to help people with disabilities to become fully productive members of society by achieving independence and meaningful employment. 

The Georgia Disability Adjudication Services (DAS) is a state agency that makes Social Security disability determinations under an agreement with the Social Security Administration. The DAS is fully federally funded. The main Georgia DAS office is in Stone Mountain with branch offices located in Athens, Dalton, Thomasville and Savannah. 

What you will be doing

  • Under general supervision provides professional adjudication of Social Security Administration disability claims
  • Develops and adjudicates decisions for initial claims for Social Security and/or Supplemental Security Income disability benefits in accordance with federal and state laws, regulations, policies and procedures
  • Defines the scope of information pertinent to and supporting the application for benefits and develops a strategy to obtain that information
  • Reads and analyzes medical information and evidence received, compares objective medical findings from differing medical sources
  • Applies judgment to ascertain the existence, nature, and severity of the impairment or impairments
  • Evaluates statements, claims and evidence for sufficiency, consistency, validity and credibility
  • Researches medical and vocational issues through the use of written policy and instructional material or consults medical, vocational or other specialists concerning specific issues of the claim
  • Determines eligibility for disability benefits by preparing a formal determination including completion of forms and an explanation of the determination
  • Determines the type of documents necessary to support a decision
  • Using a legal framework establishes pertinent findings of fact and uses those to rationalize and explain disability decisions
  • Incorporates new material and updates knowledge of program standards as a result of reading, feedback and training


In this role you will:

  • Review initial claims and applications
  • Request additional information from applicant and review data to see if it fits within the scope  of  the disability program
  • Analyze data including diagnostic and assessment tests
  • Contact doctors, psychologists, and other health  care professionals  to obtain  information
  • Evaluate occupational information to assess claimants' work potential; explain program eligibility and interpret medical  and vocational information
  • Compose technical explanations of decisions
  • Keep current on changes in federal rules and  regulations

What’s in it for you!

  • A workplace that balances productivity with enjoyment, and encourages learning and mentoring.
  • Rewarding work in a fast-paced, creative environment with colleagues who are passionate about public service.
  • A workplace that fosters fairness, equity, and inclusion.
  • Work/life balance, 12 paid holidays a year, and a competitive benefits package

Minimum Qualifications

  • Bachelor's degree in a related area from an accredited college or university OR Two years of experience in interpreting and applying laws regarding program eligibility.

Preferred Qualifications:

  • Experience with disability, medical, or insurance claims adjudication or investigation, health care, unemployment, workers compensation, social services, or related
  • Prior case management experience (with a social services agency)
  • Experience in claims processing/management
  • Knowledge of medical terminology
  • Computer skills, familiarity with technology,
  • Bilingual/fluent in speaking, reading and writing a foreign language, especially Spanish

Training Information:

Claims Examiners-Adjudicator 1 Trainees are required to attend an on-site, in-person training for 10-12 weeks as an essential job function. Afterward, in-person attendance in the office is a condition of employment for the first six months. 100% telework is not an option however, the agency may offer a telework schedule as an incentive for employees who meet performance expectations.  Selected candidates must meet this requirement with or without an accommodation.

Working Conditions:

Incumbents working in this job perform duties in an office setting. This is a 40-hour workweek requirement. The position involves managing a high volume workload and demands a high level of accuracy while working with short deadlines affecting a claimant population in need of monetary and medical assistance. Regular attendance is an important part of being successful in this position. Work is performed in an office environment. Strong computer skills are needed due to ongoing changes to applications that affect the way the work is performed.

Background Check Information:

As a condition of employment with Georgia Vocational Rehabilitation Agency, you must successfully complete a mandatory federal and national background check, Pre-employment testing, and additional checks required for your job. In  addition,  employment  with  DAS  is contingent  upon  meeting  the  requirements of Homeland  Security  Presidential Directive-12.

Your conditional job offer and access to Social Security Administration’s (SSA’s) systems, data, information, and/or premises are contingent upon you passing the SSA suitability process.

*Note: This covers the preliminary screening (pre-screen) and the final background adjudication stage of the suitability process.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

AAP/EEO Statement

GVRA provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

 

Reasonable Accommodations

The Georgia Vocational Rehabilitation Agency is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. To request a reasonable accommodation during any step in the hiring process, please contact our HR Team at ada_request@gvs.ga.gov.

Bachelor's degree in a related area from an accredited college or university OR Three years of experience in interpreting and applying laws regarding program eligibility.

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