Claims Examiner

Massachusetts Department of Family and Medical Leave

Published 18 days ago

November 2, 2020
$50,406 - $50,406

The Department of Family and Medical Leave (DFML)’s mission is to implement and run a 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. DFML’s vision is to ensure a Massachusetts workforce that is healthier, more productive, and enjoys a better quality of life. 

The Program Integrity Claims Examiner/Job Service Representative I is responsible for supporting processes within the Department of Family Medical Leave (DFML). The Claims Examiner/Job Service Representative I will review claims escalated by the Contact Center and internal DFML staff in accordance with applicable laws, regulations and policies; Incumbent will perform related duties as required.


1.   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)

2.   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.

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

4.   Collect and review available data to identify, prioritize and resolve atypical eligibility issues.

5.   Write clear, logical written decisions based on relevant laws, rules and regulations.

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 drafts correspondence

12.   Assist in performing system testing / reporting as required

13.   Intake reports of potential fraud through the Department’s Fraud Hotline.

14.   Investigate cases of alleged fraud committed by claimants against the Agency.

15.   Analyze and investigate information received on employer information requests from employers. 

16.   Process requests for hearings. 

17.   Update Appeal Log accurately and in accordance with established policy and procedure.

18.   Performs related duties as required and assigned.

Preferred Qualifications: 

1.   Fluency in a non-English language 

2.   Experience in data analytics

3.   Experience in social work or social casework

Selected candidates will be expected to report to our Boston office on their first day; positions will remain remote until further notice.



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.




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.

Official Title: Job Service Rep I

Primary Location: United States-Massachusetts-Boston-19 Staniford Street

Job: Community and Social Services

Agency: Department of Workforce Development

Schedule: Full-time

Shift: Day

Job Posting: Sep 11, 2020, 9:33:44 AM

Number of Openings: 5

Salary: 50,406.46 - 50,406.46 Yearly

If you have Diversity, Affirmative Action or Equal Employment Opportunity questions or need a Reasonable Accommodation, please contact Diversity Officer / ADA Coordinator: Dennis Johnson - 6176265111

Bargaining Unit: 01-NAGE - Clerical/Administrative

Confidential: No

The Department of Family and Medical Leave (DFML)’s mission is to implement and run a program that provides income support to Massachusetts workers and their families during significant life events while serving as a partner to employers…

Details at a glance

  • On-site Location
  • Full Time Schedule
  • Entry level


19 Staniford Street, Boston, MA 02114

How to Apply

Please apply through the MassCareers website.

Please apply through the MassCareers website.

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