Compliance Officer II - Program Integrity

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 , 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.

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 towards detection and prevention of such activities.
• 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.
• Conducts research and audits into claim overpayments and initiates collections activities through resolution
• Communicates when necessary, verbally and in writing with DFML internal staff, DFML vendors, claimants, members of legislature, and other state agencies.
• Establish and issue overpayment and recoveries notifications to claimants and employers
• Reconcile and credit claimant accounts when appropriate
• Create, Update and Modify Vendor (Claimant) information in MMARs when needed.
• Complete quality and process control checks along all DFML business units
• 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.
• 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. 
• Investigates cases of alleged fraud committed by claimants against the Agency.
• Conducts investigations and adjudicates cases identified through our internal cross matching of information.
• Generates reports of potential eligibility violations from generated queries through our internal cross matching datasets.
• Analyzes and monitors reports and documentation to identify leads.
• Collects data, performs interviews analyze records prepares reports and makes recommendations as appropriate.
• 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.
• Works on special investigation projects and other related projects that support the goals and mission of the Program Integrity unit.
• Maintain reports, records, and files for all activities.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.
• Determine 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, in order to provide information and make appropriate recommendations and to notify appellants and other appropriate parties of appeals decisions.
• 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.
• Conducts quality control audits of outgoing benefit payments.
• Analyzes benefit payments to ensure accuracy and compliance of benefit payments made by the DFML.
• Miscellaneous tasks and reports to ensure that the correct individuals are paid the correct amounts.

Why should you join DFML?  

• The idea of working for a “government startup” excites you 
• 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.

Who You Are:

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 
• Knowledge of database structures.
• Knowledge of reporting software.
• Knowledge of the methods of creating ad hoc data reports.
• Knowledge of methods used to report wage record details.
• Knowledge of Identify theft, fictitious employer schemes and organized fraud.
• Knowledge of the principles, practices and techniques of Investigative procedures.
• Ability to analyze and determine the applicability of data, to draw conclusions and make appropriate recommendations.
• Ability to use investigative techniques to obtain information.
• Ability to understand, explain and apply the laws, rules, regulations, policies, procedures, specifications, standards and guidelines governing PFML Program activities.
• Ability to establish rapport with persons from different ethnic, cultural and/economic backgrounds.
• Ability to deal tactfully with others.
• Ability to establish and maintain harmonious working relationships with others.
• Ability to maintain accurate records.
• Ability to make decisions and act quickly in stressful situations.
• Ability to interact empathetically with people who are under physical and/or emotional stress
• Ability to exercise discretion in handling confidential information.
• Ability to identify issues and propose actionable solutions
• Ability to 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) and equivalent combination of the required experience and the 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.