Social Insurance Specialist

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This job is a government position working to assist people with their social security disability insurance benefits. The purpose of the work is to analyze, evaluate, adjudicate, and authorize cases using established criteria to obtain payment and improve the processing workflow to make payments for claims. The decisions, recommendations, actions, or other work products result in determining entitlement and granting or denying social security disability insurance benefits. Their decisions may affect the design or operation of program processes or procedures. The purpose of the work is to provide program expertise in resolving cases that contain unusual issues or situations or change previous entitlement or benefit decisions. Interpreting and explaining new laws, management initiatives, and court case decision are the necessary parts of the job.

Job Scope

The Social Insurance Specialist performs a comprehensive review of the disability aspects of selected Title II and Title XVI claims. (This is government terminology) He or she conducts continuing review of disability determinations, including initial actions and those claims, which have previously been denied and reconsidered by state agencies.

The job scope also requires the specialist to reaffirm state agency determinations in accordance with the provisions of Titles II and XVI of the Social Security Act, as amended. Besides developing and preparing a variety of reports to highlight serious deficiencies and trends in the quality of state agency operations, a specialist must also review payment and eligibility quality review programs on sample cases to ensure that only claimants who are disabled and incapable of substantial gainful activity receive disability benefits. Specialists provide assistance to examiners on unusually difficult and complex claims. They are also responsible for the accuracy of all disability determinations. One must know how to conduct various types of training for experienced examiners and be able to perform a variety of administrative duties related to disability claims processing.

This occupation is expected to see growth over the next 10 yeas as the baby boomers are still influencing the larger numbers in disability claims. This means the system of social insurance will grow in the government and there will have to be more workers available to process claims and review their status. This trend is expected to continue over the next 10 years.

Specialized Experience

Experience in the development, examination, investigation, adjudication, or authorization of claims for retirement, survivors, and disability insurance, pension programs, health insurance, income maintenance, or related programs. This experience must demonstrate ability to deal courteously and effectively with the public, to exercise ingenuity, and resourcefulness in the development of facts and information, and to work with others. In addition to the specialized experience requirement, applicants must have experience making social security disability decisions at the initial, reconsideration and at the continuing disability review level. Applicants who do not meet this selective placement factor will not receive further consideration for this position.

Qualifications & Requirements

Candidates must have 52 weeks at grade GS-11 or higher. Time-in-grade is a separate requirement from qualifications and must be met by all selected candidates. 52 weeks of specialized experience at least equivalent to the GS-11 level is a good quality in candidates vying for this job. Qualifications in terms of education has been separated into three categories where category one is Qualified Category for candidates who meet the minimum qualification requirements while Well Qualified Category is qualification for candidates who meet the minimum qualification requirements and demonstrate a satisfactory level of the knowledge, skills, and abilities necessary to perform the duties of the position. Lastly, Best Qualified Category is for candidates who meet the minimum qualification requirements and demonstrate a high level of knowledge, skills, and abilities necessary to perform the duties of the position. For GS-11, candidates must have completed at least 1 year of related experience equivalent to the GS-9 level
in the Federal service. Specialized experience include developing, examining, investigating, adjudicating or authorizing claims for retirement, survivors insurance, disability insurance, pension claims or other related experience. As for GS-12, specialized experience is necessary that is experience that equipped the applicant with the knowledge, skills, and abilities to successfully perform the duties of the position. Proof of CTAP/ICTAP or VEOA eligibility is strongly required.

Knowledge, Skills, and Abilities
  • Knowledge of quality reviews of medical and vocational disability claims,
  • Knowledge of regulations, policies and procedures governing the application and administration of a disability program,
  • Knowledge of analytical and evaluative methods and techniques in order to make accurate claims determinations
  • Ability to communicate orally and in writing
  • Works independently using procedures that are conventional and apply to most situations.
Employees use their knowledge to adjudicate claims for benefits under the retirement and survivor’s insurance, supplemental income, or the non-medical aspects of the disability insurance benefit programs.

On the other hand, knowledge of the various titles of the Social Security Act, the Internal Revenue Code, other public laws and regulations that apply to or affect the operation of social insurance programs, and the policies and procedures described in operating instructions for these programs; knowledge of other Federal and State benefit, tax, citizenship, veterans, and welfare programs and international legal agreements, other public, private, and nonprofit retirement programs that interrelate with social insurance programs and some skills in interpreting various legal documents and medical reports in evaluating the age and authenticity of evidence submitted as proof of factors of eligibility are necessary.

Resources: ''Occupations,'' Bureau of Labor and Statistics, copyright 2006

''The position requires that the applicant provide proof of U.S. citizenship to work at the government facility. Security clearance, which can take up to 60 - 150 days to process, must be obtained prior to the commencement of employment. Applicants must be able to pass a background investigation as a contingent term of their employment offer.''

Resources: STG International Specialists, 01/08/2009
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