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QUALITY ASSURANCE REVIEWER
The Quality Assurance Reviewer is responsible for reviewing and analyzing client case records to determine eligibility for assistance programs and processing cases in a timely and efficient manner. This position is governed by state and federal laws and agency/institution policy.
Class Code:
X136C
Job Grade:
GS06
Special Job Requirements:
None
Typical Functions:
Receives, reviews, and verifies cases and case records, regarding food stamps, child care support, Medicaid, employment, welfare payment history, unemployment insurance claims, and child support enforcement. Interviews clients, by telephone, mail, and in person in their homes. Verifies eligibility and responsibility factors by noting surroundings, living arrangements, and lifestyle. Interviews family members, neighbors, and school personnel. Contacts and/or visits banking institutions, insurance companies, schools, and employers to verify available resources. Researches court and courthouse records, including tax and real estate records, child support payments, and wills, to determine additional resources, income, and assets. Documents and reviews information collected during field investigation and ensures compliance with state and federal laws in determining client eligibility. Prepares summary of case findings to explain reasons for changing eligibility; processes overpayments and refers suspected fraud cases; and, closes cases that are determined not eligible for a program service. Conducts provider training as required. Performs other duties as assigned.
Knowledge, Abilities, and Skills:
Knowledge of training principles and practices. Knowledge of subject area being taught. Knowledge of state and federal laws and agency policies and procedures relating to eligibility for assistance programs. Knowledge of basic mathematics. Ability to interpret and apply eligibility guidelines and regulations. Ability to interview, investigate, and document information pertinent to eligibility determinations. Ability to analyze case records to determine compliance with program specifications and recommend appropriate remedial action. Ability to prepare and present oral and written information and reports. Ability to input and retrieve data from a computer.
Minimum Qualifications:
The formal education equivalent of a bachelor’s degree in sociology, psychology, or a related field; plus one year of experience in social service related work. Additional requirements determined by the agency for recruiting purposes require review and approval by the Office of Personnel Management. OTHER JOB RELATED EDUCATION AND/OR EXPERIENCE MAY BE SUBSTITUTED FOR ALL OR PART OF THESE BASIC REQUIREMENTS, EXCEPT FOR CERTIFICATION OR LICENSURE REQUIREMENTS, UPON APPROVAL OF THE QUALIFICATIONS REVIEW COMMITTEE.
Required Certificates:
None
Exempt:
N
