Job Title

Claims Examiner - Job Service Rep I (Long-Term Seasonal) - (260000QX)Department of Family & Medical Leave The Department of Family & MedicalLeave (DFML) is seeking a customer-focused, detail-oriented professionalto support the administration and integrity of the Commonwealth. The JobService Representative I (JSR I) plays a critical role in assistingclaimants and employers, reviewing claims escalated from the ContactCenter, and ensuring accurate documentation and timely case resolutionin accordance with applicable laws, regulations, and policies. Themissio n of DFML is to implement and run the Commonwealths Paid Family &Medical Leave program, which provides income support to Massachusettsworkers and their families during significant life events, whilepartnering with employers to ensure program integrity and compliance.The Job Service Representative I, who reports to a Job ServiceRepresentative II, is responsible for supporting claims processing andcustomer service functions, including: Accepts and responds to incomingtelephone calls from claimants Connects with applicants to guide themthrough the claim requirements and next steps Supports the program'slive-chat functionality by responding to claimant inquiries.Acknowledges the establishment of new claims and confirms receipt ofrequired materials Reviews supporting documents for completeness andaccuracy Documents all claimant information in the appropriate systems(CRM) following established protocols Maintains and monitors pendingfiles to ensure timely progression Follows up with claimants or internalstaff when additional information is needed Completes assigned tasksrelated to claim processing and case resolution Practices all policiesand procedures related to PHI and HIPAA Ensures all interactions anddocumentation meet confidentiality, privacy, and program compliancestandards Identify discrepancies or issues and escalate or remand to theappropriate internal department Prepare accurate case notations withinclaims management system which contain accurate, specific, andsufficient facts to address the standards of the law and allow accurateapplication of law, regulation, and policy Advise claimants andemployers of appeal rights and procedures. Perform related duties asrequired and assigned Why should you join DFML? You want to work for aplace that values your contributions and ideas, moves quickly inimplementing solutions, and at the same time, allows you the flexibilityto have a good balance between your personal and professional life. Youwill work with a dedicated team who are fueled by our mission of helpingthe people of the Commonwealth smoothly navigate our program during thebig moments in their lives and will value you as both a coworker and asa person. Qualifications: Basic to moderate knowledge of MicrosoftOffice products (Word, Excel, Powerpoint, Outlook) Ability to operatetelecommunications equipment, personal computers and peripherals, faxand copier machines, optical scanners, etc. Knowledge of the methods ofgeneral report writing Ability to understand, explain and apply thelaws, rules, policies, procedures, etc. Knowledge of principles andtechniques of accurate, detailed fact-finding. Ability to gatherinformation in a telecommunications environment by questioningindividuals and by examining records and documents. Ability to assembleitems of information according to established procedures and to recordinformation received accurately and correctly. Ability to analyze anddetermine the applicability of data, to draw conclusions and makeappropriate recommendations Ability to analyze facts and arrive at soundconclusions Ability to perform basic mathematical Ability to meetdeadlines in a timely and accurate manner Ability to establish rapportand deal effectively with persons from different ethnic and culturalbackgrounds