State of Massachusetts Appeals and Exemptions Manager - Department of Family Medical Leave in Boston, Massachusetts

The Executive Office of Labor and Workforce Development (EOLWD) manages the Commonwealth's workforce development and labor departments to ensure workers, employers, and the unemployed have the tools and training needed to succeed in the Massachusetts economy.

The Department of Family and Medical Leave (DFML)was established to administer the family and medical leave program which will provide income replacement for Massachusetts workers who take leave from work to care for family members, bond with newborn or adopted children, or to attend to their own serious medical condition.

The Appeals and Exemptions Manager oversees all aspects of the Family and Medical Leave Program relating to plan exemptions and benefit appeals. This includes managing the overall activities and functions of the appeals and exemptions process by ensuring timely review and delivery of constituent services, develop tracking and reporting procedures and conduct data analysis of service delivery.

The Manager will plan, implement and maintain processes that are compliant with state laws and regulations and are consistent with agency policies. The Manager must be responsive to the concerns of the employer community and other stakeholders who are required to comply with the newly enacted legislation.

The Manager will work closely with the Department of Revenue, the Director of the DFML program and the Operations Manager, as well as with external and internal stakeholders, to develop policies, procedures and training to deliver a considerate and uncomplicated customer service experience for employees and the employer community.

Responsibilities:

  • Oversees research, investigation, negotiation and resolution of Paid Family Medical Leave appeals, exemptions and grievances

  • Monitors appeals dispositions for timeliness, consistency and conformity with legal requirements and state standards

  • Develops and documents business processes to handle constituent calls and inquiries, and respond to requests for information

  • Recommends appropriate changes to procedures through written reports to improve efficiency and effectiveness

  • Provide training and direction to employers and state agencies in developing procedures to comply with grievance and appeals requirements

  • Liaisons with internal and external stakeholders where required

  • Reviews and approves final appeal determinations

  • Evaluates the efficiency of appeals and exemptions operations by analyzing data from internal and external stakeholders and line operations staff to determine needed improvements

Preferred Qualifications:

  • A Bachelor’s Degree or higher

  • 5 plus year experience managing the appeals process in a complex, regulated environment

  • Demonstrated understanding of claims processing, efficient operations and program integrity

  • Demonstrated ability to incorporate technology into lean business processes

  • Ability to understand and communicate laws and regulations with multiple constituents

  • Strong aptitude for verbal and written communication, presentation, and relationship development

MINIMUM ENTRANCE REQUIREMENTS:

Applicants must have at least (A) five (5) years of full-time or, equivalent part-time, professional, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration or clinical management of which (B) at least one (1) year must have been in a project management, supervisory or managerial capacity or (C) any equivalent combination of the required experience and substitutions below.

Substitutions:

I. A certificate in a relevant or related field may be substituted for one (1) year of the required (A) experience.

II. A Bachelor’s degree in a related field may be substituted for two (2) years of the required (A) experience.

III. A Graduate degree in a related field may be substituted for three (3) years of the required (A) experience.

IV. A Doctorate degree in a related field may be substituted for four (4) years of the required (A) experience.

An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

Job: *Administrative Services

Organization: *Department of Workforce Development

Title: Appeals and Exemptions Manager - Department of Family Medical Leave

Location: Massachusetts-Boston-19 Staniford Street

Requisition ID: 190000BT