Job Service Rep II

Commonwealth of Massachusetts • Boston, MA

5d • Hybrid

About The Position

The Department of Family Medical Leave’s (DFML) mission is to implement and run the Commonwealth’s Paid Family & Medical Leave program, which provides income support to Massachusetts workers and their families during significant life events, while partnering with employers to ensure program integrity and compliance.
Lead Claims Examiner/Job Service Representative II, who reports to the Management Analyst III, is based in Boston, MA, and is responsible for the following:
Supervise and provide day-to-day guidance to a team of JSRI, including workload oversight, performance support, and issue escalation.
Facilitate the program integrity of the DFML by ensuring claims filed with the Department of Family and Medical Leave (DFML) are consistent with applicable laws, regulations and policies (M.G.L. Chapter 175M and 458 CMR 2.00)
Investigate, analyze and respond to complex claims filed by claimants seeking DFML benefits that have been escalated from the call center and/or internal DFML departments and staff and research inconsistencies or omissions in reports generated by the agency and/or agency partners computer systems.
Identify discrepancies or issues and escalate or remand to the appropriate internal department.
Collect and review available data to identify, prioritize and resolve atypical eligibility issues.
Review applicant data in cases where client eligibility or suitability is questionable or difficult to determine.
Prepare accurate case notations within claims management system which contain accurate, specific, and sufficient facts to address the standards of the law and allow accurate application of law, regulation, and policy.
Determine validity of information received through the Program Integrity's data match initiatives related to identity and eligibility, and issues written determinations on the same.
Advise claimants and employers of appeal rights and procedures.
Maintain relationships/contact with appropriate department personnel.
Prepare reports, attend meetings and draft correspondence
Assist in performing system testing / reporting as required
Intake reports of potential fraud through the Department’s Fraud Hotline.
Analyze and investigate information received on employer information requests from employers.
Process requests for hearings and escalate to internal DFML appeals.
Performs related duties as required and assigned.
This position follows a hybrid model and currently reports in office one day a week.

Requirements

• At least three (3) years of full time, or equivalent part-time professional or paraprofessional experience in personnel interviewing, vocational counseling, employment counseling, rehabilitation counseling, educational counseling, credit collection, credit interviewing, credit investigation, claims adjudication, claims settlement, claims examining, claims, investigation, claims interviewing, social work or social casework, or any equivalent combination of the required experience and the substitutions below.
• An Associate's degree may be substituted for one (1) year of the required experience.
• A Bachelor's degree or higher may be substituted two (2) years of the required experience.
• A Master's or higher degree may be substituted for the required experience.

Responsibilities

• Supervise and provide day-to-day guidance to a team of JSRI, including workload oversight, performance support, and issue escalation.
• Facilitate the program integrity of the DFML by ensuring claims filed with the Department of Family and Medical Leave (DFML) are consistent with applicable laws, regulations and policies (M.G.L. Chapter 175M and 458 CMR 2.00)
• Investigate, analyze and respond to complex claims filed by claimants seeking DFML benefits that have been escalated from the call center and/or internal DFML departments and staff and research inconsistencies or omissions in reports generated by the agency and/or agency partners computer systems.
• Identify discrepancies or issues and escalate or remand to the appropriate internal department.
• Collect and review available data to identify, prioritize and resolve atypical eligibility issues.
• Review applicant data in cases where client eligibility or suitability is questionable or difficult to determine.
• Prepare accurate case notations within claims management system which contain accurate, specific, and sufficient facts to address the standards of the law and allow accurate application of law, regulation, and policy.
• Determine validity of information received through the Program Integrity's data match initiatives related to identity and eligibility, and issues written determinations on the same.
• Advise claimants and employers of appeal rights and procedures.
• Maintain relationships/contact with appropriate department personnel.
• Prepare reports, attend meetings and draft correspondence
• Assist in performing system testing / reporting as required
• Intake reports of potential fraud through the Department’s Fraud Hotline.
• Analyze and investigate information received on employer information requests from employers.
• Process requests for hearings and escalate to internal DFML appeals.
• Performs related duties as required and assigned.

Benefits

• Comprehensive Benefits
• Outstanding suite of employee benefits that add to the overall value of your compensation package.
• Work experience that supports you, your loved ones, and your future.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level