States have recently fallen victim to a vast increase in domestic and international organized fraud. These fraud schemes involve mass identity theft and fraudulent filing of claims on behalf of the stolen identities. The result has been many millions of dollars being siphoned away from state UI Trust Funds.
Data breaches over the past decade have provided bad actors with high quality identity data. Bad Actor use the dark web as a “supermarket” for the data they need to file successful UI claims. Now with the currency they have they can hire people to take all the risks and equipment to try and remain undetected.
OPTimum Integrity Cloud is a comprehensive approach to integrity made up of Functional Layers that span the entire claims journey, from Initial Claim Application to Overpayment Discovery and Recovery. OPTimum Integrity Cloud provides solutions for prevention, detection, adjudication, collection, and enforcement.
On Point Technology has completely re-architected its industry-leading integrity suite of products using microservice technology. This approach provides state workforce agencies the ability to subscribe to individual functionality layers and activate only the layers that are valuable today while guaranteeing access to future functionality layers as needs evolve.
The current fraud crisis requires SWA’s to focus on the prevention and detection of all fraud currently taking place.
OPTimum Integrity Cloud excels in Identity Proofing and the Prevention and Detection of Fraud by using a 3-Layer Approach that triangulates fraud and attacks it weaknesses.
How it Works? – Fraud Triangulation
OPTimum Integrity Cloud Identity Proofing stops organized fraud in its tracks. Quickly and accurately validate if a person is who they claim to be. Identity Proofing crossmatches the individual’s driver’s license or state-issued ID against the national Drivers’ License Data Verification Service.
Using a mobile device or desktop computer with a camera, the Unemployment Insurance applicant scans the barcode on the back of their license or ID. The detailed information in that bar code, containing up to seventeen data elements, is immediately matched against the national repository to verify the person’s identity.
The live scan proves in real-time that the individual has a state-issued Identification in their possession. The process is quick and easy, having minimal impact on legitimate claimants.
As fraudsters rely on stolen data and do not have a physical ID, this will absolutely stop the fraud.
Identity theft has become commonplace in the digital world. Fraudsters have developed complex schemes that leverage high-quality, personally identifiable information (PII) to file fraudulent unemployment insurance claims. Because these schemes are so challenging to detect, fraudulent claims continue until funds are exhausted, costing the UI trust fund millions of dollars. OPTimum’s ID Theft FraudX™ module uses data collected by Unemployment Insurance (UI) Agencies, machine learning and data science to help identify claims that are highly indicative of identity theft behavior – including larger-scale fraud schemes. ID Theft FraudX™ targets these complex schemes and continuously monitors claims data to quickly adapt to ever-evolving fraud schemes, alert the agency of suspicious data patterns, and help mitigate existing fraud and prevent future fraud.
Integrate your systems with the Integrity Data Hub (IDH) provided by NASWA and gain entry to the multi-state Suspicious Actor Repository. Bad actors continually attempt to defraud SWAs across the nation, and by collaboratively identifying known bad actors, you can prevent this fraud from invading your program.
Fully-automated integration with IDH is critical to capturing its value. Increasing the number of crossmatched claims increases the number of bad actors blocked from defrauding the UI program nationwide as they continue to file claims from one state to another. Reporting to IDH-SAR also serves as a much-needed intra-state crossmatch mechanism that ensures bad actors are entirely blocked. Independently working SWAs are a missed opportunity at curtailing this situation. The key to maximizing the IDH value is an IDH integration that automatically cross-references all claims, integrates leads back into the benefits system, and has lead management tools to support investigations and communications back to IDH. OPTimum’s SAR module squarely achieves these strategic goals.
On Point Technology’s Fictitious Employer (FE) FraudX solution scores and ranks employers based on numerous attributes that have been proven to identify Fictitious Employers. The higher the FraudX score, the more likely that the employer is fictitious and being used as a front to fraudulently receive unemployment money. FraudX allows UI agencies to efficiently manage their workforce by putting their investigative resources on the cases with the highest FraudX score. In a recent FE FraudX deployment, over 80% of the top FraudX scores were identified as Fictitious Employers. Fictitious employers have become increasingly common as fronts to fraudulently receive unemployment insurance funds. Our Fictitious Employer FraudX addresses this problem head on and ensures that the Fictitious Employers are detected early, minimizing trust fund losses, reducing employer pool charges, and helping safeguard the true-identity owner.
Each section in the OPTimum Integrity Cloud flow chart represents an independent functionality layer that can be added to your existing benefits and tax systems. Adding a functionality layer from any one of the phases to any part of the claims journey instantly enhances the integrity functionality of the entire claims journey.
The initial phases squarely tackle organized fraud while latter phases provide support to take on the claims adjudication workload.
Adjudication, Collections and Enforcement
OPTimum Integrity Cloud caters to enterprise-level solution requirements such as Adjudication, Collections and Enforcement, with each respective solution listed below:
- Resolve: Automated investigation & adjudication support system.
- Recover: Automated UI collections system.
- Enforce: Automated legal enforcement system.
These three layers work exceptionally well together but are also autonomous. This microservice architecture allows for the selection and deployment of the one or more functionalities or layers that are most helpful today while supporting the future implementation of additional layers as the needs and goals of TWC evolve.
OPTimum Integrity Cloud can be delivered as an OnPoint-hosted cloud solution utilizing AWS FedRamp on GovCloud or as an “on-premises” public or private cloud solution. An OPTimum AWS hosted cloud solution can be made available almost instantaneously and can rapidly scale up as the state’s claims load increases. If an on-premises deployment is preferred, we will work with your internal team or IaaS provider to assess and setup the required environment, undertake the required knowledge transfer, and deploy the solution with a high level of efficiency and quality.
SWA’s can have an instance of On Point’s Identity Proofing application activated and stopping fraud within days. With OPTimum Integrity Cloud, months-long implementations are a thing of the past. Our suite of products is architected for rapid days-long deployment within a state workforce agency.
Fraud continues at record levels while trust funds are dangerously low and being depleted at an unprecedented rate. OPTimum Integrity Cloud will have an immediate impact. Book a virtual demonstration today by calling 866.482.0189 or emailing firstname.lastname@example.org
We look forward to demonstrating how OPTimum Integrity Cloud can help transform fraud detection in your state.
STATE A – Benefits and Tax ID Theft FraudX
— During a controlled pilot and estimate
$2,500,000 of potential Overpayments were detected
$19,000,000 OP overpayments prevented
Put Our Expertise To Work For You
From Business Process Analysis to Data Migration,
we have a full range of services to help deliver the highest return.