Disability Determination Quality Assurance Senior Reviewer

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 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.

JOB REQUIREMENTS for Disability Determination Quality Assurance Senior Reviewer

Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

1. Three years experience in evaluating disability claims and making disability determinations.
2. Six months experience in disability adjudication appeal and review process.
3. Six months experience in interpreting Social Security Administration laws, rules, regulations, standards, policies and procedures.
4. Six months experience in program evaluation which includes evaluating programs and services to identify problems, determine compliance and evaluate the effectiveness and efficiency to ensure program goals and overall objectives are met.
5. Six months experience in recommending alternatives, improvements, courses of action and other changes based on findings.
6. Six months experience in narrative report writing. 

The State of Delaware recognizes the value of telework and flexible working schedules. This position is eligible for Telework according to the State of Delaware’s Alternative Work Arrangement Policy. More information will be shared at the time of interview.

Applicants must be legally authorized to work in the United States. The State of Delaware Executive Branch participates in the Federal E-Verify system where the State will provide the federal government with each new hires Form I-9 information to confirm that you are authorized to work in the U.S. For more information refer to our job seeker resources.

Criminal background check: A satisfactory criminal background check is required as a condition of hire. The recruiting agency may require the applicant to pay for the criminal background check as part of the conditional offer of hire.

To learn more about the comprehensive benefit package please visit our website at https://dhr.delaware.gov/benefits/

The application and supplemental questionnaire are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position.  It is essential that you provide complete and accurate information on your application and the supplemental questionnaire to include dates of employment, job title and job duties.  For education and training, list name of educational provider, training course titles and summary of course content.   Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment, education and training history as it relates to the job requirements.

Once you have submitted your application on-line, all future correspondence related to your application will be sent via email.  Please keep your contact information current.  You may also view all correspondence sent to you by the State of Delaware in the “My Applications” tab at StateJobs.Delaware.gov.

Accommodations are available for applicants with disabilities in all phases of the application and employment process.  To request an auxiliary aid or service please call (302) 739-5458. TDD users should call the Delaware Relay Service Number 1-800-232-5460 for assistance.

The State of Delaware is an Equal Opportunity employer and values a diverse workforce. We strongly encourage and seek out a workforce representative of Delaware including race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression.