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State of Massachusetts Program Integrity Compliance Analyst (Overpayments & Recoveries) in Boston, Massachusetts

About 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. Massachusetts' first-ever digitally native service, Paid Family & Medical Leave, is now available. As we strive to help constituents manage their health and care for their families, we want to be sure that benefits are easy to access by setting a new, higher bar for interacting with the state online. We’re rethinking and transforming how government services normally operate, using best-in-class technologies and techniques to create an experience that feels more like a consumer app than what people usually expect from government. We will interact with people at big moments in their lives—the birth of a child, serious injuries, and potential losses of loved ones. These are stressful, hopeful, and overwhelming times that are experienced by everyone regardless of age, gender, ethnicity, sexuality, or socioeconomic status. We are here to help the working people of the Commonwealth to navigate these major life milestones by providing security and support when they need it most. This will be a large and highly visible program. All Massachusetts employees and many Massachusetts independent contractors will be covered by the PFML law and eligible for benefits. There are approximately 3.7 million eligible workers in Massachusetts. DFML anticipates collecting approximately $1.4 billion in contributions annually and paying up to $1 billion in total benefits annually. The Program Integrity Compliance Analyst (Overpayments & Recoveries) is responsible for conducting investigations for compliance with M.G.L. Chapter 175M and 458 CMR 2.00 , for identifying and investigating cases in accordance with department policies and procedures, identified as a result of the agency’s cross matching of data information systems; for monitoring for compliance purposes, various activities, services and/or functions for the integrity of benefits paid by the Department of Family and Medical Leave through the use of analytical queries and cross-reference analysis; for investigating inconsistencies or omissions in reports generated by the agency’s application systems; for issuing timely determinations and correspondence; determining status and investigates employer information submission surrounding employee leave applications; develops, conducts and analyzes quality review information to evaluate department success and to identify improvement opportunities Responsibilities: * 1. Conducts research and audits into claim overpayments and initiates collections activities through resolution 2. Communicates when necessary, verbally and in writing with DFML internal staff, DFML vendors, claimants, members of legislature, and other state agencies. 3. Establish and issue overpayment and recoveries notifications to claimants and employers 4. Reconcile and credit claimant accounts when appropriate 5. Reviews and analyzes advanced queries and ad hoc reports for patterns associated with Paid Family and Medical Leave and takes appropriate action towards detection and prevention of such activities. 6. Determines and Implements procedures to be used in collecting 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. 7. Create, Update and Modify Vendor (Claimant) information in MMARs when needed. 8. Complete quality and process control checks along all DFML business units 9. Monitors pertinent program areas, various activities, services and/or functions In Benefits and Integrity through analysis, observation, interviews, evaluations and/or conferences to ensure compliance with governing laws, rules, regulations, program goals, etc., and to provide feedback concerning agency programs. 10. Reviews reports, documents, complaints, and pertinent information received from reports, audits, queries, the general public, agency personnel, and other sources concerning alleged violations of laws and regulations in order to determine the appropriateness of the complaint to determine the proper action to be taken and to take that action/or to refer complaints to the appropriate agency. 11. Investigates cases of alleged fraud committed by claimants against the Agency. 12. Conducts investigations and adjudicates cases identified through our internal cross matching of information. 13. Generates reports of potential eligibility violations from generated queries through our internal cross matching datasets. 14. Analyzes and monitors reports and documentation to identify leads. 15. Collects data, performs interviews analyze records prepares reports and makes recommendations as appropriate. 16. Assists the Office of the Attorney General and other law enforcement agencies on cases being considered for criminal prosecution in connection with the DFML programs and operations. 17. Works on special investigation projects and other related projects that support the goals and mission of the Program Integrity unit. 18. Maintain reports, records, and files for all activities. 19. Analyze and investigate information received on employer information requests from employers. Quarterly reports received with out of state employer numbers from agents or data matches must be implemented to determine eligibility and liability dates. 20. Determine employer liability status through an exemption review process in accordance with MGL Chapter 175M. 21. Investigates and resolves cases of employer/employee reported information discrepancies, including employer non-compliance/response. 22. Investigates and resolves cases escalated for discrepancies from other internal business units. 23. Prepares analytical reports, including decisions on hearings conducted, in order to provide information and make appropriate recommendations and to notify appellants and other appropriate parties of appeals decisions. 24. Conducts both informal and formal quality reviews of the work of Contact Center to evaluate quality and identify improvement opportunities and measure defined department success metrics. *Preferred Qualifications: 1. Fluency in a non-English language 2. Knowledge of basic accounting procedures. Selected candidates will be expected to report to our Boston office on their first day; positions will remain remote until further notice. SALARY PLACEMENT IS DETERMINED BY YEARS OF EXPERIENCE AND EDUCATION DIRECTLY RELATED TO THE POSITION AND THE HUMAN RESOURCES DIVISION’S RECRUITING GUIDELINES. IN THE CASE OF A PROMOTIONAL OPPORTUNITY, THE SALARY PROVISIONS OF THE APPLICABLE COLLECTIVE BARGAINING AGREEMENT WILL BE UTILIZED FOR PLACEMENT WITHIN THE SALARY RANGE. Total Compensation: As an employee of the Commonwealth of Massachusetts you are offered a great career opportunity influencing a wide-spectrum of services to the diverse populations we serve - but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits which you should consider towards your overall compensation, including: * 75% state paid medical insurance premium * Reasonable Dental and Vision Plans * Flexible Spending Account and Dependent Care Assistance program * Low cost basic and optional life insurance * Retirement Savings: State Employees' Pension and a Deferred Compensation 457(b) plan * 12 paid holidays per year and competitive Sick, Vacation and Personal Time * Tuition Benefit for employee and spouse at state colleges and universities * Short-Term Disability and Extended Illness program participation options * Incentive-based Wellness Programs * Professional Development and Continuing Education opportunities * Qualified Employer for Public Service Student Loan Forgiveness Program 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, law enforcement or regulatory administration work, or (B) and equivalent combination of the required experience and the substitutions below. Substitutions: A Bachelor's or higher degree may be substituted for a maximum of two years of the required experience.* Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed. *An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply. Job: Compliance and Certification* *Organization: Department of Workforce Development *Title: *Program Integrity Compliance Analyst (Overpayments & Recoveries) Location: Massachusetts-Boston-19 Staniford Street Requisition ID: 210004RN