Claims Examiner III

Posting  – Posted – Health & Human Services Comm – MEPD Disability Det EOAPD – Community and Social Services – Eligible for Telework – Other Locations (5) – $3000 - $4999 per month

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more.

Are you a highly motivated, compassionate and dedicated individual looking for a rewarding career assisting the most vulnerable citizens of Texas in need of food, medical care, cash assistance and other social services? If so, the Texas Health and Human Services Commission (HHSC) Access and Eligibility Services (AES) division is looking for individuals who want to join an exciting, dynamic team working in a high-performing and innovative environment.

AES provides an integrated and streamlined approach to connect individuals to services and supports that reduce institutionalization, allow individuals to remain in their communities, and promote economic and personal self-sufficiency. AES is built upon its core values of respect, ownership, collaboration, and integrity with a goal of delivering best-in-class customer service to clients and stakeholders.

Our staff are well organized, able to multi-task, possess the ability to learn policy regulations, thrive in a challenging, fast-paced, and evolving environment, have good communication skills, a positive attitude, strong work ethic and a desire to help others.

This position is responsible for implementation of the disability determination policies/procedures. It reviews medical and social history information to determine applicant’s ability to perform substantial gainful activity under the Disability Determination application and review process for cases. The position consults with staff physician, regional staff, medical providers, and legislators. It interprets program policies and procedures, prepares appeal summaries and participates in Fair Hearings for appeal cases.

It works closely with the Disability Determination Manager to develop and maintain uniformity of disability determination processes and decisions. The position assists the Manager in conducting presentations and training of disability determination policy and procedures to agency staff and others as requested. It also coordinates policy/procedure changes with appropriate policy staff and provides technical supervision to clerical support staff. Travel may be required up to 40% of the time.

• Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
• Provides interpretation and application of federal disability requirements and procedures in the disability determination process for Medicaid applicants.
• Receives social and medical records from the Medicaid Eligibility Specialist and may have direct contact with Medicaid applicants occasionally. The position interprets the medical and social records and applies the Federal SSI Listings of Impairments using the five-step Sequential Evaluation Process to determine if the applicants meet federal requirements for disability eligibility. Errors of interpretations could result in loss of benefits or harm to the applicant’s health.
  
  Errors also could possibly result in federal sanctions and loss of Medicaid funds.
• Assists in the development of policies, procedures, rules, regulations or standards on disability determination cases.
• Provides complex technical assistance to regional staff, medical providers, legislators, and general public on policies, procedures, rules, regulations, standards or requirements in disability cases for Medicaid eligible applicants.
• Assists in the development and presentation of training on disability determination policy and…