Review Examiner

Review Examiner I | Department of Family & Medical Leave

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, obtaining additional evidence to resolve the appeal without the need of a hearing;

and perform related work and other duties as required.

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.

The Review Examiner I, who reports to the Appeals Manager, is based in Boston, MA
* and is responsible for the following:

• 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.
• Upload and enter 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, conduct administrative hearings in accordance with procedures prescribed by M.G.L. Chapter 30A and 801 CMR 1.02.
• Elicit sufficient evidence and testimony to resolve single party and other appeals involving less complex evidentiary and legal issues of agency determination regarding benefits.
• Write 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.
• Produce 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.
• Perform 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.

• 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.

We’re seeking candidates who have:

• 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…