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claims adjudicator

A professional who adjudicates claims for benefits offered under governmental social insurance program, such as those dealing with unemployed, retired, or disabled workers, veterans, dependents, or survivors. Responsibilities include:

  • Reviews and evaluates data on documents and forms, such as claim applications, birth or death certificates, physician's statements, employer's records, vocational evaluation reports, and other similar records.
  • Interviews or corresponds with claimants or agents to elicit information, correct errors or omissions on claim forms, and to investigate questionable data.
  • Authorizes payment of valid claims, or notifies claimant of denied claim and appeal rights.
  • Reevaluates evidence and procures additional information in connection with claims under appeal or in cases requiring investigation of claimant's continuing eligibility for benefits.
  • Prepares written reports of findings.
  • May specialize in one phase of claim program, such as assisting claimant to prepare forms, rating degree of disability, investigating appeals, or answering questions concerning filing requirements and benefits provided.
  • May be designated according to type of benefit-claim adjudicated.
  • May act as consultant to board rating disability.
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Looja

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