Adjudication, during the Covid recession, was the biggest UI benefit system failure.

UI101

UI Vulnerability

The pandemic recession has made it clear, one of the most vulnerable points of UI system/process when responding to a recession is “Issue Adjudication”. UI systems performed moderately well in terms of claims intake, intake certs and paying benefits. The failures occurred due to the volume of claim issues detected and the manual effort required adjudicating each issue.
UI101

Largest Expenditure of Effort

FY2022 allocations have been released and this is a very typical scenario, adjudication was a major workload on the states. The amount of effort and the volume of the workload makes adjudication the largest expenditure of effort. Our updated offering sets out to solve this problem.
UI101

The Solution

Basic case management systems do not completely and appropriately perform the activities required by the UI program. A solution that just detects fraud and generates leads leaves 90% of effort, in the form of adjudication, to agency staff. Fraud isn’t prevented and stopped until adjudication is complete.

On Point customers on average fully automated 3 of every 4 BPC issues. OPTimum Resolve extends that capability across all adjudication issues. This translates into a 400% productivity increase in adjudication throughput!

UI101

The Solution

Basic case management systems do not completely and appropriately perform the activities required by the UI program. A solution that just detects fraud and generates leads leaves 90% of effort, in the form of adjudication, to agency staff. Fraud isn’t prevented and stopped until adjudication is complete.

On Point customers on average fully automated 3 of every 4 BPC issues. OPTimum Resolve extends that capability across all adjudication issues. This translates into a 400% productivity increase in adjudication throughput!

Resolve

Automates all stages of the UI adjudication process. Gathers facts from Claimants and Employers through intelligent question trees, performs analysis, then provides UI agents a “rapid review” screen allowing for one-click determination generation. Solves for all UI issue types including Identity, Seps & Non-Seps and Wage & Earnings issues.

The value of Resolve 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 complete adjudication and stop fraud.

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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
  • New Hire issues
  • Able & Available 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.
  • 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
  • Developing rules that base collection activities on law, policy, and precedent
  • Collecting overpayments based on collectability rules

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