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What Does a Disability Claims Adjudicator Do?

by Trudy Brunot

More than 2.8 million people applied for Social Security disability benefits in 2012. Available to those who paid Social Security tax on their earnings, their disabled children or surviving spouses, disability benefits provide income when a physical or mental impairment renders work impossible. Disability claims adjudicators in state agencies and Social Security Administration field offices process claims and determine benefits eligibility.

Key Responsibilities

Disability claims adjudicators handle assigned cases from claims receipt to eligibility decision. After an initial review, they decide if the claim needs additional medical, employment, or educational documentation to confirm the presence and extent of a disability that prevents the applicant from working. They make appointments for examinations, diagnostic tests and consultations with health care professionals to gather information, interview claimants and analyze employment potential. Disability claims adjudicators then decide whether a claimant meets the eligibility requirements after studying and evaluating this evidence.

Additional Duties

Drafting detailed, personalized correspondence to inform claimants of their benefit amount or ineligibility falls to the disability claim adjudicator. Closing a case includes authorizing payment for professional services used to evaluate a claim. Disability claim adjudicators may be called to evaluate appealed cases, mentor trainees and conduct quality audits.

Qualifications

Most states classify this position as a civil service job requiring state residency. Some states, such as Pennsylvania, require applicants to take a test; all states view a bachelor's degree as the minimum education for consideration. Due to the complexity of the legal and procedural aspects of the job, applicants enter as trainees and undergo up to 12 weeks of intensive training followed by a probationary period. You must be willing to spend a large portion of your day on the phone.

Attributes and Skills

Communication skills, both oral and written, are important in claims adjudication, as is the ability to use a variety of computer applications. Disability claims adjudicators have an aptitude for learning medical terminology and conditions, as well as interpreting procedures and regulations. They work well under pressure and can juggle cases in various stages of review simultaneously. Applicants fluent in Spanish and English are increasingly needed.