Public Consulting Group

Claims Analyst

Job Locations US-WA-Clarkston | US-NY-Troy
Posted Date 1 month ago(5/23/2022 5:42 PM)
Job ID
2022-8127
# of Openings
1
Category
Customer Service/Support
Type
Regular Full-Time
Practice Area
Human Services

Overview

Company Overview:

  • Public Consulting Group, LLC (PCG) is a leading public sector management consulting and operations improvement firm that partners with health, education, and human services agencies to improve lives. PCG helps primarily public sector health, education, and human services organizations make measurable improvements to their performance and processes to better serve populations in need. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has more than 2,000+ professionals in 45 offices in the United States, Canada and Poland. The firm draws on more than three decades of consulting to public sector clients in all 50 states and Canada to deliver best-practice solutions and measurable results to state and local public agencies, state-operated facilities, and private providers that do business with government agencies. PCG is committed to a diverse workforce which is reflected in our clients and the people they serve. Our organizational culture attracts and rewards people who are results-oriented and interested in making an immediate impact on their community as well as their own career.

SSI/SSDI Overview:

Within the organization PCG has a project team dedicated to providing Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) representation and advocacy work for low income Temporary Assistance for Needy Families (TANF), General Relief populations, Health Care plans and Child Welfare agencies throughout the country.  This project team is referred to as our Social Security Advocacy Management Service SSAMS™ team.  The SSAMS™ team’s projects include the identification, development, application and representation of SSI/SSDI and post entitlement claims at all levels of the adjudication process including attending hearings with our clients before Administrative Law Judges.

 

Responsibilities

 

Overall Responsibilities:

PCG is looking to hire a Claim Analyst. The Claims Analyst is responsible to continue the development process of SSI and SSDI claims after a case has been filed with SSA at all levels of adjudication.  A fully developed claim is defined as a claim that has all the data for the claim entered in the SSAMS database, collection of all required documents, and a complete analysis of the validity of the strength of the claim. The Claims Analyst collects all outstanding or new technical information and medical and school evidence that supports the alleged disability and prepares briefs for claims that require a hearing.  He/She will work closely with social workers, SSA, Disability Determination Services (DDS) and  Office of Hearings Operations (OHO) throughout the application process to ensure a successful outcome of the disability claim.

 

Specific Responsibilities:

  • Obtain and analyze medical, education, employment, and financial information to make effective and timely disability claim decisions.
  • Maintain regular and timely contact with claimants to obtain updated medical and vocational information, updates regarding restrictions and limitations, claim status and decisions, and all other aspects of the claim process to ensure compliance with the claims process.
  • Maintain regular contact with DDS, SSA, and OHO.
  • Maintain regular contact with contracted hearing representatives, including managing availability calendars, preparing hearing files, and executing post-hearing requirements.
  • Adept in evaluating claim validity, including reviewing disability claim denials at the Reconsideration and Hearing levels.
  • Write and prepare briefs to be submitted to Administrative Law Judge.
  • Provide monthly reporting statistics to the Team Lead for designated area of responsibility.
  • Monitor and follow up on outstanding action items to ensure compliance with regulations, service timing, and quality guidelines.
  •  

Qualifications

Required Skills:                                                          

  • Ability to actively listen while collecting pertinent information on the telephone and providing strong customer service skills.
  • Understanding of modern office methods, practices, and practical applications.
  • Ability to maintain a high degree of accuracy, pay strict attention to detail, maintain confidentiality, and work within the grey.
  • Strong communication skills with a high degree of professional written communication is a requisite.
  • Strong interpersonal skills, including the ability to establish working relationships with federal, state and county agencies as well as the general public.
  • Knowledge and understanding of SSA’s laws and regulations.
  • Knowledge and understanding of SSA’s medical, mental, and vocational criteria.
  • Knowledge and understanding of the relationship between SSI/SSDI and Medicaid/ Medicare
  • Ability to work independently as well as in a team environment.

 

Required Experience:

  • Bachelor's degree or 3 years relevant experience.
  • Medical and/or legal background preferred.

 

 

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EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

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