Janet England

• Independently reviews, adjudicates, and finally authorizes claims for monthly benefits, entitlement to HI/SMI benefits, and/or Income Related Monthly Adjustment Amount
• Reviews and adjudicates the non-medical factors of entitlement on claims for disability benefits
• Adjudicates complex claims where field offices are unable to make determinations
• Reviews and prepares the input form, entitlement factors and Medicare factors, for automated or Benefit Authorizer processing
• Recognizes situations that warrant field office investigation of the possible need for a representative payee, and effectuates change of payee actions, as necessary
• Conducts initial review of Administrative Law Judge (ALJ) disability case reversals
• Review includes reading and interpreting ALJ decision, determining correct medical coding and establishing the proper review period, considering all medical and vocational factors
• Prepares reversal for SSA systems processing
• Completes development and evaluation of all facts and evidence; reviews material forwarded from the District Office (DO), determines issues in any claim or referred post-adjudicative action, prepares formal or informal determinations relating the facts, evidence, and issues to the requirements of the Social Security Act and policies including appropriate precedent cases
• Resolves subsequent post adjudicative issues, i.e., workers’ compensation, government pension offset, earnings discrepancies, month of retirement, self-employment earnings, representative payee issues, attorney fees, earnings reappraisal, etc
• Protects the integrity of SSA programs through identification, investigation, and resolution of potential program abuse/fraud
• When appropriate, determines the need for and makes referrals to the appropriate component
• Properly safeguards personally identifiable information (PII) from loss, theft, or improper disclosure including inadvertent disclosure, and immediately notifies management of any breach, loss or potential loss of PII in any form
• Develops facts through direct, mail, electronic, or telephone contacts with District Offices, with beneficiaries or with third parties for the resolution of discrepancies and to obtain complete information
• Revises or reverses determinations made by other claims personnel in the PSC, FO or other components that do not involve formal reconsideration decisions
• Recommends modifications in procedure, policy, or systems, and advises the supervisor or senior specialist/team leader of significant problem areas and/or trends in types of errors encountered in the processing of claims through the module
• Works as an integral part of the module, taking all actions necessary to improve overall processing time and quality
• Performs screening operations to expedite the movement of action control records to minimize the backlog of cases in the module’s paperless queues
• Performs workload queue management applying the National, Regional, and local workload priorities/goals in order to provide effective and efficient customer service
• Performs special projects and duties required to achieve the total module goals
• Participates in studies, projects, etc
• Initiated by the module, section, program service center or central office; analyzes data and prepares reports of study results as required
• As required, assists in training claims authorizer trainees and other personnel by conducting formal or informal classes and/or reviewing and discussing the various aspects of claims, post adjudicative work and the automated case processing system as a mentor or advisor
• Analyzes and prepares detailed reports of trainee’s progress to management, orally or through the appropriate system
• Responds to contacts from beneficiaries, the public or other SSA staff by researching inquiries or initiating action to make changes to the claims or beneficiary record
• When the Immediate Claims Taking function is assigned:
• Conducts interviews to obtain, clarify, and verify information about individual applicants' initial eligibility for retirement, survivors, and health insurance benefits
• Examines evidence to evaluate its validity and acceptability in establishing entitlement to benefits
• Assists the applicant in securing evidence
• Ensures all necessary evidence is obtained including any post adjudicative development
• Finally adjudicates and authorizes for payment, without subsequent review, claims for benefits and eligibility to RSHI benefits
• Finally disallows RSHI claims lacking in insured status or any other factor of entitlement and previously denied RSHI claims
• Composes proper award and disallowance notices affecting entitlement of the individual applying for benefits
• Protects the rights of individuals by assuring claimants and/or their personal representative understand the claimant’s legal rights and obligations under the Act and its relationship to other social welfare and benefit programs
• Protects the integrity of SSA programs through identification, investigation, and resolution of potential program abuse situations
• Conducts interviews to obtain, clarify and verify information about individual applicant’s eligibility for Medicare Part D premium subsidy assistance and effectuates related actions to update or establish SSA records
• Work Continuing Disability Reviews
• Post earnings to a beneficiary’s record
• Review alerted cases to determine whether a continuing disability exists, based on earnings
• Process work reports that have been received in the FO, PC/ODO, or a Tele-service center
• Review work reports, such as paystubs, a letter, phone call or employer report, prepare a SSA-820 or SSA-821 to decide if the beneficiary is performing work above SGA
• Determine if the beneficiary is entitled to a Trial Work Period or has completed the Trial Work Period
• Issue beneficiary’s notices to inform them of continuing benefits or a Disability Cessation
• Expedited Reinstatement of benefits
• Internet Unit
• Independently reviews, processes, and adjudicates I-DIB, RIB, Reconsiderations and Hearings submitted online by claimants and attorneys
• Independently processes all attorney mail and enters representative information into RASR
• Automation Coach
• Responsible for determining the Automation needs of the office
• Prepare and provide needed training
• Coordinate the Highlight Reel and NFL’s new publication highlighting the best in Automation
• Convey with local management to schedule training for staff of the topics included in the Highlight Reel
• TXVI Crossover Training
• Citizenship & Alien Status
• Living Arrangements & Institutions
• Resources
• Types of Income
• Eligibility for other Benefits, Claims Clearance, Rep Payee & Claims Development.
• Post-Eligibility & Redeterminations
• Suspension/Term Events and Payment/Non-Receipts
• Special Systems
• Advanced Query Reading
• Continuing disability Reviews
• Overpayments
• Windfall Offset
• Representative Fees
• Underpayments
• Highest number of Redeterminations completed each year in the Title XVI unit since becoming SSI certified in 07/15/2016
• Consistently processing Age 18 Redeterminations and Continuing Disability Reviews in a timely manner, so they can be sent to Disability Determination Services for processing
• Performs other duties as assigned
• Supported the development of new claims management software, providing valuable input based on experience and expertise in disability claims handling.
• Managed high caseloads effectively, ensuring all disability claims were processed promptly and accurately.
• Identified fraudulent claims by conducting detailed investigations and applying expert knowledge of disability guidelines and regulations.
• Participated in ongoing professional development opportunities to stay current with industry trends and best practices, enhancing personal expertise as a Disability Claims Specialist.
• Developed individualized return-to-work plans for clients, facilitating a smooth transition back into the workforce after recovery from their disabilities.
• Mentored junior team members in handling complex cases, resulting in better decision-making and improved overall team performance.
• Effectively negotiated settlements for disputed claims, minimizing company exposure while maintaining client satisfaction levels.
• Assisted in creating training materials for new staff members that led to increased understanding of company policies and procedures related to disability claims management.

• Independently reviews, adjudicates, and finally authorizes claims for monthly benefits, entitlement to HI/SMI benefits, and/or Income Related Monthly Adjustment Amount
• Reviews and adjudicates the non-medical factors of entitlement on claims for disability benefits
• Adjudicates complex claims where field offices are unable to make determinations
• Reviews and prepares the input form, entitlement factors and Medicare factors, for automated or Benefit Authorizer processing
• Recognizes situations that warrant field office investigation of the possible need for a representative payee, and effectuates change of payee actions, as necessary
• Conducts initial review of Administrative Law Judge (ALJ) disability case reversals
• Review includes reading and interpreting ALJ decision, determining correct medical coding and establishing the proper review period, considering all medical and vocational factors
• Prepares reversal for SSA systems processing
• Completes development and evaluation of all facts and evidence; reviews material forwarded from the District Office (DO), determines issues in any claim or referred post-adjudicative action, prepares formal or informal determinations relating the facts, evidence, and issues to the requirements of the Social Security Act and policies including appropriate precedent cases
• Resolves subsequent post adjudicative issues, i.e., workers’ compensation, government pension offset, earnings discrepancies, month of retirement, self-employment earnings, representative payee issues, attorney fees, earnings reappraisal, etc
• Protects the integrity of SSA programs through identification, investigation, and resolution of potential program abuse/fraud
• When appropriate, determines the need for and makes referrals to the appropriate component
• Properly safeguards personally identifiable information (PII) from loss, theft, or improper disclosure including inadvertent disclosure, and immediately notifies management of any breach, loss or potential loss of PII in any form
• Develops facts through direct, mail, electronic, or telephone contacts with District Offices, with beneficiaries or with third parties for the resolution of discrepancies and to obtain complete information
• Revises or reverses determinations made by other claims personnel in the PSC, FO or other components that do not involve formal reconsideration decisions
• Recommends modifications in procedure, policy, or systems, and advises the supervisor or senior specialist/team leader of significant problem areas and/or trends in types of errors encountered in the processing of claims through the module
• Works as an integral part of the module, taking all actions necessary to improve overall processing time and quality
• Performs screening operations to expedite the movement of action control records to minimize the backlog of cases in the module’s paperless queues
• Performs workload queue management applying the National, Regional, and local workload priorities/goals to provide effective and efficient customer service
• Performs special projects and duties required to achieve the total module goals
• Participates in studies, projects, etc
• Initiated by the module, section, program service center or central office; analyzes data and prepares reports of study results as required
• As required, assists in training claims authorizer trainees and other personnel by conducting formal or informal classes and/or reviewing and discussing the various aspects of claims, post adjudicative work and the automated case processing system as a mentor or advisor
• Analyzes and prepares detailed reports of trainee’s progress to management, orally or through the appropriate system
• Responds to contacts from beneficiaries, the public or other SSA staff by researching inquiries or initiating action to make changes to the claims or beneficiary record
• When the Immediate Claims Taking function is assigned:
• Conducts interviews to obtain, clarify, and verify information about individual applicants' initial eligibility for retirement, survivors, and health insurance benefits
• Examines evidence to evaluate its validity and acceptability in establishing entitlement to benefits
• Assists the applicant in securing evidence
• Ensures all necessary evidence is obtained including any post adjudicative development
• Finally adjudicates and authorizes for payment, without subsequent review, claims for benefits and eligibility to RSHI benefits
• Finally disallows RSHI claims lacking in insured status or any other factor of entitlement and previously denied RSHI claims
• Composes proper award and disallowance notices affecting entitlement of the individual applying for benefits
• Protects the rights of individuals by assuring claimants and/or their personal representative understand the claimant’s legal rights and obligations under the Act and its relationship to other social welfare and benefit programs
• Protects the integrity of SSA programs through identification, investigation, and resolution of potential program abuse situations
• Conducts interviews to obtain, clarify and verify information about individual applicant’s eligibility for Medicare Part D premium subsidy assistance and effectuates related actions to update or establish SSA records
• Work CDR’s
• Post earnings to a beneficiary’s record
• Review alerted cases to determine whether a continuing disability exists, based on earnings
• Process work reports that have been received in the FO, PC/ODO, or a Tele-service center
• Review work reports, such as paystubs, a letter, phone call or employer report, prepare a SSA-820 or SSA-821 to decide if the beneficiary is performing work above SGA
• Determine if the beneficiary is entitled to a Trial Work Period or has completed the Trial Work Period
• Issue beneficiary’s notices to inform them of continuing benefits or a Disability Cessation
• Expedited Reinstatement of benefits
• Internet Unit
• Independently reviews, processes, and adjudicates I-DIB, RIB, Reconsiderations and Hearings submitted online by claimants and attorneys
• Independently processes all attorney mail and enters representative information into POTS
• Performs other duties as assigned
• Managed high caseloads effectively, ensuring all disability claims were processed promptly and accurately.
• Identified fraudulent claims by conducting detailed investigations and applying expert knowledge of disability guidelines and regulations.
• Participated in ongoing professional development opportunities to stay current with industry trends and best practices, enhancing personal expertise as a Disability Claims Specialist.
• Supported the development of new claims management software, providing valuable input based on experience and expertise in disability claims handling.
• Developed individualized return-to-work plans for clients, facilitating a smooth transition back into the workforce after recovery from their disabilities.

• Verifying claimant information upon contact according to the procedures set forth by the Social Security Administration by using their Social Security number, mother's maiden name, place of birth, birth date and picture identification
• I assist the public on a daily basis with their immediate needs
• My position includes answering a wide variety of questions about disability and retirement benefits, interviewing the individual, investigating the situation at hand, and offering options or solutions to the claimant
• Maintained productivity and quality standards at all times.
• I schedule appointments for claimants to file for benefits
• Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
• I have taken over PUPS/RPS for Title XVI with putting claimants into suspension for either themselves or their Representative Payees being incarcerated
• Consistently demonstrated a strong work ethic, arriving punctually for shifts and maintaining focus on providing top-tier service throughout entire workday.
• I process all the SS5’s for the prisons that we have an MOU agreement
• Maintained comprehensive knowledge of company products and services, ensuring accurate information was relayed to customers at all times.
• I help with processing monthly wage reporters for our SSI recipients as well as inputting child support payments into MSSICS
• Operated in dynamic, high-volume environments to provide skilled assistance to more than [Number] customers each day.
• I process change of living arrangements for our SSI recipients into MSSICS
• Accepted payments and updated accounts with latest information.
• I have taken over the ERPA Non-Responder and Exception cases, sending out notices to Representative Payees asking them to complete the SSA-L732
• I place beneficiaries into suspension if the Representative Payees fail to return the representative payee reports
• I process all SSA-L732’s and place beneficiaries back into pay
• I was also a Timekeeper for the Suffolk office, verifying each employees time sheets.
• Every morning I would pull up the daily appointments and mail out disability packets to claimants wishing to apply for disability benefits
• Change of address for claimants
• Setting up direct deposit for claimant checks
• Processing IP/CPS payments
• Issuing new and replacement Social Security cards
• Processing death notices
• Processing W4V’s for tax withholding
• Re-instating student benefits based on full-time enrollment in high school
• Special Wage payments and earnings corrections
• Processing Waivers for Title 2 and Title XVI
• Payment arrangements for Overpayments
• Inputting monthly wage reports into IWAG
• Inputting monthly child support payments into MSSICS
• Inputting change of living arrangements into MSSICS
• Managing PUPS/RPS for Title XVI
• Managing ERPA Non-Responder and Exception cases
• Processing changes of Representative Payees
• Timekeeper for the Suffolk office
• Mailing out disability packets daily
• Assisting individuals in establishing their entitlement to receive benefits

As a Supported Living, , I provided direct individualized support services to children and adults with disabilities to enable them to lead self-directed lives in their own homes and to contribute to and be included in their communities in an ethical, holistic and professional, non-judgmental manner that helps build upon the individual’s strengths, choices and capabilities

• Obtaining needed medical, social, psychosocial, educational, financial, vocational, and other services
• Participated in the provision of crisis intervention services to participants
• Established a safe and nurturing living environment for clients by maintaining clean, organized spaces and addressing any potential hazards.
• Travels to/visits consumers' residences or apartments to provide counsel and assistance and to help the consumers, within their capabilities and interests, in maintaining the greatest degree of independent living
• Continuously sought opportunities for professional growth and development to enhance overall service delivery within the role of Supported Living Specialist.
• Helps the consumer to modify attitudes and patterns of behavior by increasing understanding of self and others
• Promoted community integration by assisting clients in accessing local resources and participating in events.
• Counsels consumers individually or in small groups regarding plans for meeting service needs, and aids the consumers to mobilize inner capabilities and environmental resources to attain goals
• Improved clients'' quality of life through daily assistance with personal care, meal preparation, and medication management.
• Secures information, such as medical, psychological, and social factors contributing to the individual's situation, and evaluates these and the individual's capabilities
• Collaborated with interdisciplinary teams to develop comprehensive care plans tailored to individual needs.
• Completes and maintains consumer treatment plans to include quarterly service-plan reviews, assessments, medical records, and changes in treatment and/or medications either manually or using a computer
• Maintains a case-record for each resident/consumer and completes required forms
• Continually documents consumer treatment progress
• Reviews service plans and performs follow-up to determine quantity and quality service provided
• Accesses and records individual and community resource information and treatment plans manually or using a computer
• Maintains up-to-date, accurate individual case records on each assigned consumer and develops measurable and objective service plans that maximize consumer rehabilitative abilities in accordance with regulatory guidelines
• Provides supportive counseling in 1:1 or group formats that assist the consumer to modify attitudes and behaviors as needed
• Obtains and develops resource information for consumers in all aspects of their care; disseminates this information to consumers in a manner that is clear and understandable
• Uses cognitive-behavioral techniques (e.g., role-plays, skills training, plans of action) to assist the consumer in meeting service plan goals
• Explains the types of clinical services, recreational activities, and programs available to consumers; instructs the consumer in daily living skills, socialization skill enhancement and conflict resolution
• Refers consumers to community resources and other organizations
• Accompanies consumers on regularly scheduled or emergency visits to medical treatment facilities, social agencies, government offices, or other locations associated with the treatment or assistance of the consumer
• Immediately reports serious incidents, serious incident allegations, incidents, or sensitive situations to supervisors
• Completes incident reports and accounts for consumers and files missing person reports on consumers not accounted for in accordance with policy and procedure
• Performs regular inspections of the consumer's residence to ensure the safety of the consumers, accountability, and cleanliness of consumer's residence
• Executes emergency plans as outlined in the policy and procedure manual
• Administers CPR or first aid to staff or consumers who are injured
• Assists in the orientation of new personnel when requested
• Complies with attendance and timekeeping rules and reports reliably and regularly to work on an on-going basis
• Attends regularly scheduled clinical meetings, staff meetings and supervision as well as in-service training and development activities
• Complies with agency infection control policies
• Advocates on behalf of consumer with outside service providers and within the agency
• Assists resident/consumer in finding and getting into vocational training or other training opportunities, and works with other team members (Substance Abuse Specialist, Nurse) in addressing the needs of consumers
• Assists consumers in applying for benefits such as, Social Security Disability, Medicaid, Medicare, WIC, AFDC, and Section 8 housing through HUD
• Dates Of Employment in This Position (Specify The Dates at Each Grade Level) Exact Title of Your
• Position
• Grade From (Mo., Day, and Yr.) To (Mo., Day, and Yr.) Supported Living Specialist, Detailed Description of Duties: (Do not attach Position Description)
• As a Supported Living, , I provided direct individualized support services to children and adults with disabilities to enable them to lead self-directed lives in their own homes and to contribute to and be included in their communities in an ethical, holistic, and professional, non-judgmental manner that helps build upon the individual’s strengths, choices and capabilities
• Job Duties:
• Obtaining needed medical, social, psychosocial, educational, financial, vocational and other services
• Participated in the provision of crisis intervention services to participants
• Travels to/visits consumers' residences or apartments to provide counsel and assistance and to help the consumers, within their capabilities and interests, in maintaining the greatest degree of independent living
• Helps the consumer to modify attitudes and patterns of behavior by increasing understanding of self and others
• Counsels consumers individually or in small groups regarding plans for meeting service needs, and aids the consumers to mobilize inner capabilities and environmental resources to attain goals
• Secures information, such as medical, psychological, and social factors contributing to the individual's situation, and evaluates these and the individual's capabilities
• Completes and maintains consumer treatment plans to include quarterly service-plan reviews, assessments, medical records, and changes in treatment and/or medications either manually or using a computer
• Maintains a case-record for each resident/consumer and completes required forms
• Continually documents consumer treatment progress
• Reviews service plans and performs follow-up to determine quantity and quality service provided
• Accesses and records individual and community resource information and treatment plans manually or using a computer
• Maintains up-to-date, accurate individual case records on each assigned consumer and develops measurable and objective service plans that maximize consumer rehabilitative abilities in accordance with regulatory guidelines
• Provides supportive counseling in 1:1 or group formats that assist the consumer to modify attitudes and behaviors as needed
• Obtains and develops resource information for consumers in all aspects of their care; disseminates this information to consumers in a manner that is clear and understandable
• Uses cognitive-behavioral techniques (e.g., role-plays, skills training, plans of action) to assist the consumer in meeting service plan goals
• Explains the types of clinical services, recreational activities, and programs available to consumers; instructs the consumer in daily living skills, socialization skill enhancement and conflict resolution
• Refers consumers to community resources and other organizations
• Accompanies consumers on regularly scheduled or emergency visits to medical treatment facilities, social agencies, government offices, or other locations associated with the treatment or assistance of the consumer
• Immediately reports serious incidents, serious incident allegations, incidents, or sensitive situations to supervisors
• Completes incident reports and accounts for consumers and files missing person reports on consumers not accounted for in accordance with policy and procedure
• Performs regular inspections of the consumer's residence to ensure the safety of the consumers, accountability, and cleanliness of consumer's residence
• Executes emergency plans as outlined in the policy and procedure manual
• Administers CPR or first aid to staff or consumers who are injured
• Assists in the orientation of new personnel when requested
• Complies with attendance and timekeeping rules and reports reliably and regularly to work on an on-going basis
• Attends regularly scheduled clinical meetings, staff meetings and supervision as well as in-service training and development activities
• Complies with agency infection control policies
• Advocates on behalf of consumer with outside service providers and within the agency
• Assists resident/consumer in finding and getting into vocational training or other training opportunities, and works with other team members (Substance Abuse Specialist, Nurse) in addressing the needs of consumers
• Assists consumers in applying for benefits such as, Social Security Disability, Medicaid, Medicare, WIC, AFDC and Section 8 housing through HUD
• II
• DETAILS AND DEVELOPMENTAL ASSIGNMENTS
• List all details or developmental assignments you have participated in for 30 calendar days or longer which are relevant to the position being filled
• Specify beginning and ending dates and give a brief description of the duties performed
• If more space is needed, provide information in same format on blank sheet or use Continuation Form-45A
• Date Began (MM/DD/YY) Date Ended (MM/DD/YY) Duties While on Detail, Present
• Taking over the PUPS/RPS workload for Supplemental Security Income Title XIV
• I receive a list of claimants from local and state prisons that may be receiving Social Security Income
• My responsibilities include researching the prison systems using the internet to see if the claimant is still incarcerated
• If they have been incarcerated for 30 days or more, I then put their benefits into suspension and do a change of living arrangement to place them in N22
• Once a claimant is released from incarceration and they bring proof into the local field office, I then place them back into pay and update their living arrangements
• If there is an overpayment on their record from being incarcerated, payment arrangements are made at that time to withhold up to $71.00 per month from their check until the overpayment is paid in full
• If the Representative Payee for a claimant has been incarcerated for 30 days or more, I put the claimant into suspension until a new Representative Payee can be developed
• I then send a notice out to the claimant informing them of the suspension and the need for them to come into the office with their choice of a new Representative Payee so they can be put back into pay
• Taking over the ERPA Non-Responder and Exception cases
• I access our local ERPA system and pull up the list of Representative Payees who have not responded to our requests to fill out the Representative Payee report or who have made mistakes while filling out the forms
• My responsibilities include sending out the SSA-L732 to the Representative Payee and including a letter asking them to return the form as soon as possible
• If the Representative Payee fails to return the SSA-732, the beneficiary is then placed into suspension and a letter is sent out to the number holder as well as the Representative Payee notifying them of the suspension
• They are told that they need to visit their local office to complete the Representative Payee report for the beneficiary to be taken out of suspension
• Once I receive the SSA-732 back from the Representative Payee, I then take the beneficiary out of suspension and clear the beneficiary’s name from the ERPA Non-Responder or Exceptions list.
• Developed strong rapport with clients and families, fostering trust and open communication during difficult times.