Review Examiner I

Commonwealth of Massachusetts • Boston, MA

2d • Hybrid

About The Position

DFML is looking for an organized and independent self-starter to facilitate the appeals process through research, analysis, and investigation. The Review Examiner I is responsible for conducting hearings on appeals of claims for agency services or benefits; for promptly preparing and implementing decisions on hearings conducted; for documenting information and evidence; for preparing reports, including decisions on hearings conducted; for reviewing appeals and, when possible, obtains additional evidence to resolve the appeal without the need of a hearing; and perform related work and other duties as required. Who we are DFML’s mission is to implement and run the Commonwealth’s Paid Family & Medical Leave program that provides income support to Massachusetts workers and their families during significant life events while serving as a partner to employers to deliver program integrity. What you’d do The Review Examiner I, who reports to the Appeals Manager, is based in Boston, MA and is responsible for the following:

Requirements

• Great curiosity and judgment; motivated in pursuing/implementing better solutions when needed
• A commitment to diversity, equity, and inclusion in their work and workplace
• Flexibility and mission-driven issue spotting / problem resolution experience
• Ability to write concisely to express thoughts clearly and develop ideas in a logical sequence.
• Ability to understand, explain and apply the laws and rules governing the presentation and admissibility of evidence
• Knowledge of the methods of general report writing.
• Ability to understand, explain and apply the laws and rules governing the presentation and admissibility of evidence.
• Ability to understand, explain and apply the laws, rules, policies, procedures, etc. governing assigned unit activities.
• Ability to read and interpret legal documents such as decisions, briefs, and opinions.
• Ability to analyze and determine the applicability of data, to draw conclusions and making appropriate recommendations.
• Ability to gather information through questioning individuals.
• Ability to gather information by examining records and documents.
• Ability to assemble items of information in accordance with established procedures.
• Ability to determine the proper format and procedure for assembling items of information.
• Ability to write concisely, to express thoughts clearly and to develop ideas in logical sequence.
• Ability to maintain accurate records.
• Ability to prepare general reports.
• Ability to give written and oral instructions in a precise, understandable manner.
• Ability to communicate effectively in oral expression.
• Ability to make decisions and act quickly in stressful situations.
• Ability to exercise discretion in handling confidential infor­mation.
• Ability to exercise sound judgment.
• Ability to work independently.
• Ability to deal tactfully with others.
• Ability to establish and maintain harmonious working relationships with others.
• Applicants must have at least (A) three years of full-time, professional experience, the major duties of which included the adjudication, examination and/or review of claims, benefits and/or taxes; the practice of law; labor relations work; claims investigation or adjustment work; credit management or credit investigation work; or (B) any equivalent combination of the required experience and the substitutions below.

Responsibilities

• Resolve appeals prior to hearing by analyzing data obtained from investigations and applying relevant laws, rules, regulations, and precedents to formulate legal conclusions concerning eligibility for benefits in dispute.
• Review cases prior to and after the hearing to resolve any questions, obtain needed evidence/information necessary to dispose of pending appeals, or consult with agency staff to resolve problem.
• Uploads and data enters decisions into online system within a timely manner that is reasonable and attains the DFML guidelines for promptness.
• In accordance with M.G.L. Chapter 175M, 458 CMR 2.00, conducts administrative hearings in accordance with procedures prescribed by M.G.L. Chapter 30A and 801 CMR 1.02.
• Elicits sufficient evidence and testimony to resolve single party and other appeals involving less complex evidentiary and legal issues of agency determination regarding benefits.
• Writes clear and concise decisions, which contain findings of facts sufficient to support the ultimate findings and conclusion of law, which comply with statutory provisions, case law, and agency policy.
• Produces accurate written decisions verifying and ensuring proper form and conformance with data and procedures.
• Create and preserve oral and written records of proceedings for use in further study or appeal of case.
• Performs all job duties in a manner to enhance the agency’s achievement of its customer service and operational goals.
• Prepare case management reports.
• Perform other related work as required.

Benefits

• When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.
• Want the specifics? Explore our Employee Benefits and Rewards!

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 5,001-10,000 employees