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Disability Determination Quality Assurance Senior Reviewer

at Department of Labor in New Castle, Delaware, United States

Job Description

isability Determination Quality Assurance Senior Reviewer Recruitment #112223-MDDZ32-600800 Opening Date 11/23/2023 12:00:00 AM Closing Date 12/6/2023 11:59:00 PM Type of Recruitment Open Competitive Salary Yearly: $47,778.00/Min - $59,723.00/Mid Salary Plan M37 Pay Grade 14 Shift Hours 8:00am - 4:30pm Employment Type Actual Vacancy Employment Term Regular Agency DOL/Voc Rehab Svcs / Location(s) Dis Det Svs at Creekwood: (920 W. Basin Road, New Castle, DE, 19720) Contact Name DOL/DHR Contact Phone 302-761-8015 Summary Statement The incumbent reports to the Disability Quality Administrator and is responsible for conducting reviews of disability claims processed by adjudicators. The Reviewer identifies deficiencies in case work, documents the findings, cites to relevant policy, and provides next step actions to bring the claim into compliance. Essential Functions Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here. Reviews a sample of disability claims to determine the adequacy of case development, the documentation of determinations, and the accuracy of decisions based upon the facts and program guidelines in order to monitor the quality of the adjudication process. Prepares written reports identifying and describing findings which include decisional and significant technical deficiencies in the adjudication process and the resulting reports for the purpose of providing direction to adjudicators to make corrective action in the case decision. Conducts a review of corrective actions and final case decision of returned cases upon completion of remedial action to assure accurate completion of case adjudication. Identifies substantive and procedural issues with adjudicator and medical consultant working relationships and information exchanges; analyzes delays in operational work flow and identifies training needs and problems. Participates in special studies and case reviews; reports findings to the Quality Assurance Administrator for administrative action. Assists with the total program evaluation and identifies weaknesses and deficiencies in the electronic case processing systems, quality and integration of medical consultant assessments, all support functions, and basic claim adjudication processes. Assists in providing training to adjudicators and medical consultants in deficiency areas (e.g., claim processing operations) to correct problems. Reviews claims returned by federal components (Office of Disability Operations/Disability Quality Board) noting trends in federal returns; compares these returns to deficiencies noted internally in order to determine if Quality Assurance is consistent with federal review and return policy. May assist the Quality Assurance Administrator in preparing monthly and quarterly reports of Quality Assurance findings to the Deputy Director.
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Job Posting: 1216492

Posted On: Nov 27, 2023

Updated On: Dec 06, 2023

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