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:

1. Supervise and provide day-to-day guidance to a team of JSRI, including workload oversight, performance support, and issue escalation.
2. 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)
3. 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.
4. Identify discrepancies or issues and escalate or remand to the appropriate internal department.
5. Collect and review available data to identify, prioritize and resolve atypical eligibility issues.
6. Review applicant data in cases where client eligibility or suitability is questionable or difficult to determine.
7. 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.
8. 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.
9. Advise claimants and employers of appeal rights and procedures.
10. Maintain relationships/contact with appropriate department personnel.
11. Prepare reports, attend meetings and draft correspondence
12. Assist in performing system testing / reporting as required
13. Intake reports of potential fraud through the Department’s Fraud Hotline.
14. Analyze and investigate information received on employer information requests from employers.
15. Process requests for hearings and escalate to internal DFML appeals.
16. Performs related duties as required and assigned.

*This is a Long-Term Seasonal position with an expected duration of ten months from date of hire. The duration of employment is based on available funding and/or DFML workload.

*This position follows a hybrid model and currently reports in office one day a week.

Comprehensive 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.

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An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.