The UI Problem
The biggest contributor to UI’s challenges during the pandemic recession is lack of complete high quality automation tools to detect, analyze, and manage fraudulent activities. Basic fraud detection and task management/case management systems do not completely and appropriately perform the activities required by the UI program. The output of these systems is generation of massive backlogs for staff to work manually. Solutions that provide a long list of detected “leads” does not prevent fraud when 90% of the effort to close a case remains to be done manually by staff.
The value of On Point’s solutions is based on coverage of all Issue Types and robustness of the automation of the activities required by the UI program. These aspects are critical to assess completeness of solutions to detect, analyze, and manage fraudulent activities. This evaluation framework makes clear the contribution to increase SWA’s capabilities a solution must provide.
Complete UI fraud detection must include the numerous issue types that threaten trust funds.
Identity issues
Monetary & non-monetary issues
Separation & non-separation issues
Income issues
Benefit Year Earnings issues
Able & Available issues
New Hire issues
Typically, detection of fraud represents 10% of the work. If the following “required UI Integrity functions” are not automated with high quality, massive backlogs will be the result.
Streamline identity verification
Layered automated fraud detection
Conducting Claimant Fact-finding
Conducting Employer fact-finding
Issuing notifications to the parties of adverse evidence
Conducting rebuttal interviews
Issuing determinations and redeterminations
Establishing overpayments
Processing appeals
Collecting overpayments based on collectability rules
The OPTimum Integrity Cloud is a complete holistic approach to integrity. It provides integrative technology to detect, analyze, and manage fraudulent activity. It also recoups overpayment monies improperly paid to UI claimants. It does so through enhanced capabilities across all 5 stages of integrity, from prevention and detection, to adjudication, collection, and enforcement. The OPTimum Integrity Cloud’s modular approach encourages SWA to implement the independent modules that pinpoint the enhanced capabilities SWA’s seeks. Each module is architected to seamlessly integrate with other solutions within the SWA’s ecosystem.
Identity proofing solution specifically created for UI, fully automated and requiring no human intervention. Its browser-based live ID barcode scan can be integrated within claim processing, run in batch-mode against a backlog, or initiated by a UI agent in real time.
Streamlines integration between the UI agency and the Integrity Data Hub. Subscription ensures compliance as evolution of IDH continues. Manages leads within the lead tracker so investigators can prioritize their leads and expedite their investigations.
Is part of the OPTimum Leads module and provides advanced analytics that create and proactively refine a database of known bad actors. Leverages decades of UI fraud investigative knowledge combined with data science. Batch results are scored and grouped for prioritization.
Provides a set of powerful data analytics and crossmatch modules to further detect fraud and discover additional fraud attributes that can be used in investigations and management of fraudulent activities. The list of Leads analysis and crossmatch modules consists of the following: Incarcerations, Deceased, Fictitious Employer, SUTA dumping, Benefit Wage crossmatch, National Directory of New Hire, and State Directory of New Hire.
The UI industry’s only full adjudication system. It’s much more than the “Case Management” systems being marketed in the UI space today. OPTimum Resolve automates and orchestrates adjudication of ALL UI issue types including Identity Issues, Separations & Non-Separations, and Wage & Earnings issues. It also performs ALL UI due process functions such as issue specific fact finding, claimant & employer response reconciliation, overpayment calculation, fraud determinations, determination notice generation, and establishment of overpayments within the benefit system.
Improve the management of collections by fully automating the vast majority of your overpayments. Our software captures, tracks, and manages the recovery of overpaid benefits while simplifying your staffs’ recouping workflow. Designed to be configurable, OPTimum Recover accommodates each state’s unique laws and regulations, thereby supporting your agencies’ integrity mission. Our easy-to-read screens and intuitive, user-friendly reports mean your staff can quickly access a summary of each account and administrators can effectively manage their collection staff’s performance.
Creates and manages legal actions based on UI business rules. The system can be configured to support Liens, Garnishments, Civil Actions, and Criminal Actions.
More On The OPTimum Integrity Cloud
Backlog resolution flow- Meeting the demands of UI in wake of the pandemic recession and fortifying the UI program for the future requires a coordinated flow of integrity capabilities. Aligning and sequencing SWA integrity solutions creates a powerful enterprise integrity flow that stops fraud, eliminates backlogs, and completes policy and due process program required UI Integrity functions”. The OPTimum Integrity Cloud enables an enterprise integrity flow that meets the objectives of SWA.
1. ID proofing solution enables the claimant to prove their identity.
2. After filtering out validated claimants, interrogation of the remainder population occurs.
3. At this point in the flow, the state then has fraud scores associated with each of the claims. Based on state business rules claims can be ranked by score and processed as follows:
4. With validated claimants filtered, fraud deterred, and unresponsive claimants processed, left are the issues only adjudicators can solve.
5. Automate adjudication, collection, and enforcement processes.
6. OPTimum Resolve automates fact finding, recommendations based on available evidence and establishes overpayments.
7. Collection of overpayments is automated by OPTimum Recover.
8. And lastly for Overpayments where collections activity are being ignored, automation of Legal remedies is performed by OPTimum Enforce.
9. Stacking these solutions as such, creates workflows that squarely solve these major integrity goals
10. OIC blocks fraud upfront, detects exceptions that slip through the cracks, and streamlines the integrity workload to keep the backlog low and the trust fund solvent.
OPTimum Integrity Cloud:
A Modern and Modular Solution
The OPTimum Integrity Cloud was specifically architected to separate the functionality of a program into independent, interchangeable modules, such that each contains everything necessary to execute only one aspect of the desired functionality. These modules can be independently created, modified, replaced, or exchanged with other modules or between different systems, offering a new modern strategy to obtain the goals of modernization. This result in a UI solution ecosystem that evolves to serve the changing needs of the nation’s workforce.