Job Description

Overview Compliance Officer II | Department of Family & Medical Leave The Compliance Officer is responsible for conducting investigations for compliance with M.G.L. Chapter 175M and 458 CMR 2.00, identifying and investigating cases in accordance with department policies and procedures; monitoring for compliance purposes across activities, services and functions to ensure integrity of benefits paid by the Department of Family and Medical Leave through analytical queries and cross-reference analysis; investigating inconsistencies or omissions in reports generated by the agency’s application systems; issuing timely determinations and correspondence; determining status and investigating employer information submission surrounding employee leave applications; developing, conducting and analyzing quality review information to evaluate department success and identify improvement opportunities. Who we are 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. What you’d do The Compliance Officer II, who reports to the Senior Manager of Benefit Operations & Program Integrity, is based in Boston, MA, and is responsible for the following: Reviews and analyzes advanced queries and ad hoc reports for patterns associated with Paid Family and Medical Leave and takes appropriate action toward detection and prevention of such activities. Determines and implements procedures to collect information and evidence in connection with data audits regarding alleged non-compliance with Massachusetts General Law, Chapter 175M and 458 CMR 2.00 and the associated agency rules, procedures, and regulations. Conducts research and audits into claim overpayments and initiates collections activities through resolution. Communicates with DFML internal staff, DFML vendors, claimants, members of the legislature, and other state agencies, as necessary. Establishes and issues overpayment and recovery notifications to claimants and employers. Reconciles and credits claimant accounts when appropriate. Creates, updates and modifies vendor (claimant) information in MMARs when needed. Completes quality and process control checks along all DFML business units. Monitors program areas, activities, services and functions in Benefits and Integrity through analysis, observation, interviews, evaluations and conferences to ensure compliance with governing laws and regulations and to provide feedback concerning agency programs. Reviews reports, documents, complaints, and information concerning alleged violations of laws and regulations to determine proper action and referrals. Investigates cases of alleged fraud committed by claimants against the Agency. Conducts investigations and adjudicates cases identified through internal cross matching of information. Generates reports of potential eligibility violations from generated queries through internal cross matching datasets. Analyzes and monitors reports and documentation to identify leads. Collects data, performs interviews, analyzes records, prepares reports and makes recommendations as appropriate. Assists the Office of the Attorney General and other law enforcement agencies on cases considered for criminal prosecution in connection with DFML programs and operations. Works on special investigation projects and other related projects supporting the Program Integrity unit. Maintains reports, records and files for all activities. Analyzes and investigates information received on employer information requests from employers; quarterly reports with out-of-state employer numbers must be reviewed to determine eligibility and liability dates. Determines employer liability status through an exemption review process in accordance with MGL Chapter 175M. Investigates and resolves cases of employer/employee reported information discrepancies, including employer non-compliance/response. Investigates and resolves cases escalated for discrepancies from other internal business units. Prepares analytical reports, including decisions on hearings conducted, to inform and notify appellants and other parties of decisions. Conducts formal and informal quality reviews of the work of the Contact Center to evaluate quality and identify improvement opportunities and measure department metrics. Performs quality control audits of outgoing benefit payments and analyzes benefit payments for accuracy and compliance. Handles miscellaneous tasks and reports to ensure correct payments. Why should you join DFML? The idea of working for a “government startup” excites you. You value contributions and ideas, a quick pace for solution delivery, and a healthy personal/professional life balance. You will work with a dedicated team committed to helping the people of the Commonwealth navigate the program and will be valued as a coworker and person. Who you are We’re seeking candidates who have: Great curiosity and judgment; motivated to pursue and implement better solutions. A commitment to diversity, equity, and inclusion. Flexibility and mission-driven issue spotting and problem resolution experience. Ability to write concisely and express thoughts clearly. Knowledge of database structures. Knowledge of reporting software and ad hoc data reporting methods. Knowledge of wage record reporting details. Knowledge of identity theft, fictitious employer schemes and organized fraud. Knowledge of investigative procedures. Ability to analyze data to draw conclusions and make recommendations. Ability to use investigative techniques to obtain information. Ability to understand, explain and apply PFML program laws, rules, regulations, policies, procedures, and guidelines. Ability to establish rapport with people from diverse backgrounds. Ability to interact tactfully and maintain harmonious working relationships. Ability to maintain accurate records and make decisions in stressful situations. Ability to handle confidential information with discretion. Ability to identify issues and propose actionable solutions, and exercise sound judgment. Ability to work independently. First consideration will be given to those applicants that apply within the first 14 days. Minimum Entrance Requirements: Applicants must have at least (A) three years of full-time, or equivalent part-time, experience in investigatory or law enforcement work, or (B) an equivalent combination of the required experience and substitutions below. Substitutions: An Associate's or higher degree may be substituted for the required experience.* *Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed. 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. #J-18808-Ljbffr Mass.gov

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