Current UI State Workforce Agency Environment
Situation: Fraud schemes exploitation of UI pandemic response
• States have recently fallen victim to a massive uptick in domestic and international organized fraud. These fraud schemes involve mass identity theft and fraudulently filing of claims on behalf of the stolen identities, which have resulted in many millions of dollars being siphoned away from the state UI Trust Funds.
Objective: A holistics layered approach to combat fraud:
• Fraud Prevention: Proactive crossmatches and audits designed to find fraud before claims are paid
• Fraud Detection: Thorough data analysis of existing claims to stop fraud in its tracks. Intelligent, preemptive identification of fraud schemes that improves over time
• Lead Management: Investigation and adjudication support through lead tracking, managing, and reportingrackPredictive
• Collections: Recovery of overpayments in accordance to UI policy.
• Enforcement: Legal procedings on uncollectable overpayents through liens, garnishments or civial action.
OPTimum Integrity Cloud Solution
On Point Technology (OPT): Renowned experts in UI Fraud solutions
- Founded by former state and federal agency staff and executives, On Point has been combating UI fraud for more than 30 years.
- OPT has deployed UI fraud solutions in over 20 UI State Workforce Agencies.
OPTimum Integrity Cloud: SWA Integrity Solution
- OPT Integrity Cloud is a comprehensive approach to integrity made up of functional layers that span across the claims journey from initial application through overpayment discovery and recovery. The Integrity Cloud provides solutions for prevention, detection, adjudication, collection, and enforcement.
- OPT has completely re-architected its industry leading integrity products using microservice technology. This provides state workforce agencies the ability to subscribe to individual layers of functionality. Implement only the layers valuable today and have access to future layers as needs evolve.
- OPT Integrity Cloud can be hosted both on-premise or in the cloud (private or OPT hosted cloud).
OPTimum solution squarely addressing the urgent integrity needs of SWAs
Detection & Proactive pattern recognition: OPTimum Aware – ID Theft
- Fraud prevention – Advanced ID Theft pattern analysis of benefit system claim data that results in high-quality leads for investigators to pursue. Preconfigured with known patterns including attributes to combat the latest scheme perpetrated by the West African fraud ring labeled Scattered Canary.
- FraudX – Proprietary scoring algorithm, based upon decades of UI fraud investigative knowledge combined with data science that ranks fraud likelihood and drives investigation priority.
Prevention & Detection: OPTimum Aware – Integrity Data Hub (IDH) SWA portal
- Suspicious Actors Repository – Crossmatches in real-time or batch against NASWA’s IDH-SAR to detect suspicious actors filing for benefits and allows states to stop fraudsters before incurring large trust fund losses. Allows states to report suspicious activity, including the Scattered Canary scheme, to IDH to ensure that any recurring in-state and cross-state fraud patterns are utilized within future crossmatches.
- Identity Verification – NASWA is currently developing an Identity Verification service that will be included in the IDH offering. OPTimum Aware – IDH is fully aligned with NAWSA’s roadmap and will provide IDV functionality as soon as the NASWA service is available.
Analytical data interrogation: OPTimum fraud audicts data
- Deceased claimant – crossmatch of claims utilizing deceased identities
- Incarcerated claimant – crossmatch of claims utilizing incarcerated identities
- New Hire – crossmatch against the new hire repository
- SUTA Dumping – identification of tax avoidance through employee transfer
- Misclassified workers – identification of tax avoidance through 1099o
- Fictitious Employer – fraud claims detection of fake businesso
- PUA audits – self employment fraud patter recognition o Worforce reporter – OPT SME data pattern analysis service.
- OPTimum Integrity Cloud is designed to deliver continuous value over time. Our solutions are built upon micro-service architecture that allows for flexible implementation and feature agility. As new trends emerge, we are in the unique position to adjust quickly and solve for future challenges.
- The OPTimum Integrity cloud roadmap of solutions includes:
- Optimum Intelligent Fact Finding
- OPTimum Resolve (Includes modules for First level Adjudication and Benefit Payment Control)
- OPTimum Appeals
- OPTimum Recover (Collections)
- OPTimum Enforce (Legal enforcement)
- OPTimum Claims Intake
- OPTimum Chatbot
“We achieved our ROI in only 6 ½ weeks using Barts” — State Workforce BPC Manager
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From Business Process Analysis to Data Migration,
we have a full range of services to help deliver the highest return.