Claims Examiner

Job Service Representative I | Department of Family & Medical Leave

The Department of Family & Medical Leave (DFML) is seeking a customer-focused, detail-oriented professional to support the administration and integrity of the Commonwealth. The Job Service Representative I (JSR I) plays a critical role in assisting claimants and employers, reviewing claims escalated from the Contact Center, and ensuring accurate documentation and timely case resolution in accordance with applicable laws, regulations, and policies.

Who we are

DFML’s 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.

What you’d do
The Job Service Representative I, who reports to a Job Service Representative II, is responsible for supporting claims processing and customer service functions, including\:

• Accepts and responds to incoming telephone calls from claimants

• Connects with applicants to guide them through the claim requirements and next steps

• Supports the program's live-chat functionality by responding to claimant inquiries.

• Acknowledges the establishment of new claims and confirms receipt of required materials

• Reviews supporting documents for completeness and accuracy

• Documents all claimant information in the appropriate systems (CRM) following established protocols

• Maintains and monitors pending files to ensure timely progression

• Follows up with claimants or internal staff when additional information is needed

• Completes assigned tasks related to claim processing and case resolution

• Practices all policies and procedures related to PHI and HIPAA

• Ensures all interactions and documentation meet confidentiality, privacy, and program compliance standards

• Identify discrepancies or issues and escalate or remand to the appropriate internal department

• 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

• Advise claimants and employers of appeal rights and procedures.

• Perform related duties as required and assigned

Why should you join DFML?

The idea of working for a “government startup” excites you.

You want to work for a place that values your contributions and ideas, moves quickly in implementing solutions, and at the same time, allows you the flexibility to have a good balance between your personal and professional life.

You will work with a dedicated team who are fueled by our mission of helping the people of the Commonwealth smoothly navigate our program during the big moments in their lives and will value you as both a coworker and as a person.

Who you are\: 

We are seeking candidates who have\: 

• Basic to moderate knowledge of Microsoft Office products (Word, Excel, Powerpoint, Outlook)

• Ability to operate telecommunications equipment, personal computers and peripherals, fax and copier machines, optical scanners, etc.

• Knowledge of the methods of general report writing

• Ability to understand, explain and apply the laws, rules, policies, procedures, etc.

• Knowledge of principles and techniques of accurate, detailed fact-finding.

• Ability to gather information in a telecommunications environment by questioning individuals and by examining records and documents.

• Ability to assemble items of information according to established procedures and to record information received accurately and correctly.

• Ability to analyze and determine the applicability of data, to draw conclusions and make appropriate recommendations

• Ability to analyze facts and arrive at sound conclusions

• Ability to perform basic mathematical/accounting calculations

• Ability to meet deadlines in a timely and accurate manner

• Ability to establish rapport and deal effectively with persons from different ethnic, cultural, and/or economic backgrounds

• Ability to interact empathetically with people who are under physical and/or emotional stress

• Ability to establish and maintain harmonious working relationships with others

• Ability to give oral and written instructions in a precise, understandable manner

• Ability to identify issues and propose actionable solutions

• Ability to maintain accurate records

• 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 

*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.

Job Service Representative I | Department of Family & Medical Leave

The Department of Family & Medical Leave (DFML) is seeking a customer-focused, detail-oriented professional to support the administration and integrity of the Commonwealth. The Job Service Representative I (JSR I) plays a critical role in assisting claimants and employers, reviewing claims escalated from the Contact Center, and ensuring accurate documentation and timely case resolution in accordance with applicable laws, regulations, and policies.

Who we are

DFML’s 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.

What you’d do
The Job Service Representative I, who reports to a Job Service Representative II, is responsible for supporting claims processing and customer service functions, including\:

• Accepts and responds to incoming telephone calls from claimants

• Connects with applicants to guide them through the claim requirements and next steps

• Supports the program's live-chat functionality by responding to claimant inquiries.

• Acknowledges the establishment of new claims and confirms receipt of required materials

• Reviews supporting documents for completeness and accuracy

• Documents all claimant information in the appropriate systems (CRM) following established protocols

• Maintains and monitors pending files to ensure timely progression

• Follows up with claimants or internal staff when additional information is needed

• Completes assigned tasks related to claim processing and case resolution

• Practices all policies and procedures related to PHI and HIPAA

• Ensures all interactions and documentation meet confidentiality, privacy, and program compliance standards

• Identify discrepancies or issues and escalate or remand to the appropriate internal department

• 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

• Advise claimants and employers of appeal rights and procedures.

• Perform related duties as required and assigned

Why should you join DFML?

The idea of working for a “government startup” excites you.

You want to work for a place that values your contributions and ideas, moves quickly in implementing solutions, and at the same time, allows you the flexibility to have a good balance between your personal and professional life.

You will work with a dedicated team who are fueled by our mission of helping the people of the Commonwealth smoothly navigate our program during the big moments in their lives and will value you as both a coworker and as a person.

Who you are\: 

We are seeking candidates who have\: 

• Basic to moderate knowledge of Microsoft Office products (Word, Excel, Powerpoint, Outlook)

• Ability to operate telecommunications equipment, personal computers and peripherals, fax and copier machines, optical scanners, etc.

• Knowledge of the methods of general report writing

• Ability to understand, explain and apply the laws, rules, policies, procedures, etc.

• Knowledge of principles and techniques of accurate, detailed fact-finding.

• Ability to gather information in a telecommunications environment by questioning individuals and by examining records and documents.

• Ability to assemble items of information according to established procedures and to record information received accurately and correctly.

• Ability to analyze and determine the applicability of data, to draw conclusions and make appropriate recommendations

• Ability to analyze facts and arrive at sound conclusions

• Ability to perform basic mathematical/accounting calculations

• Ability to meet deadlines in a timely and accurate manner

• Ability to establish rapport and deal effectively with persons from different ethnic, cultural, and/or economic backgrounds

• Ability to interact empathetically with people who are under physical and/or emotional stress

• Ability to establish and maintain harmonious working relationships with others

• Ability to give oral and written instructions in a precise, understandable manner

• Ability to identify issues and propose actionable solutions

• Ability to maintain accurate records

• 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 

*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.

First consideration will be given to those applicants that apply within the first 14 days.

Applicants must have (A) at least two (2) 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 (B) any equivalent combination of the required experience and the substitutions below.

Substitution\:

I. An Associate's degree may be substituted for one (1) year of the required experience.

II. A Bachelor's degree or higher may be substituted for the required experience.

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.

Want the specifics?Explore our Employee Benefits and Rewards!

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.

First consideration will be given to those applicants that apply within the first 14 days.

Applicants must have (A) at least two (2) 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 (B) any equivalent combination of the required experience and the substitutions below.

Substitution\:

I. An Associate's degree may be substituted for one (1) year of the required experience.

II. A Bachelor's degree or higher may be substituted for the required experience.

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.

Want the specifics?Explore our Employee Benefits and Rewards!

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.

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