OPTimum Resolve

Streamline Your Adjudication

The Problem

There has been a record number of initial claims, including for both regular Unemployment Insurance and Pandemic Unemployment Assistance.

There has been a record amount of fraud attempts amounting to potential losses of up to $26 billion.

Today’s fraudsters have three powerful tools in their arsenal. A quick mention of each will make the power behind the solutions we offer more obvious.

  1. Claims Volume: Fraudsters are hiding amongst a record-breaking number of claims, making it as challenging to find fraud as it is finding a needle in a haystack.
  2. Data Breaches: Data breaches have occurred frequently over the past decade, making gigabytes of high quality and accurate PII data available on the dark web, which fraudsters are now readily using.
  3. UI Processes: Fraudsters exploit the challenges SWAs have with keeping up with investigations and adjudication. They know that paying out claims during a time of great need is the foremost mission of UI, and SWAs must play by the rules and follow investigation and adjudication processes.

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The Solution: OPTimum Resolve

  • Resolve is our issue management system that handles identity issues end-to-end
  • It also intelligently distributes issue workload via business rules
  • Additionally, Resolve uses our proprietary FastPath processing that supports automated recommendations based on adverse evidence. This expedites issue resolution and boosts agency throughput.
  • That automated business process is the 4th layer of our strategy. The goal is to automate as many steps within the business process and place the responsibility and the associated work back in the hands of the claimant and employer. The system generates tasks and sends out correspondence to the relevant parties and tracks the responses and determines next steps based on business rules.
  • This trims the work associated with identity issues and allows agency staff to focus more of their time on more complicated issues.
Resolve: Integrated Intelligent Fact-Finding?

  • Resolve provides streamlined intelligent fact-finding through custom narrative entry and/or configurable question trees to gather the true facts. Our fact-finding interview trees guide the claimant, employer, and agent through a comprehensive list of questions designed by adjudication experts to reach an accurate, reliable, and consistent determination.
  • Adjudicators can also upload evidence artifacts like documents, pdfs, spreadsheets, audio, and/or video files to support issue resolution.
  • All artifacts that are related to the issue that have either been pulled in from the claim or uploaded evidence are all viewable from the issue details page.
Resolve: Simple and Comprehensive

  • Resolve uses a business process engine to simplify all issue resolution into consistent and repeatable steps, and guides staff through the entire process.
  • This results in consistent and reliable determinations across all staff.
  • Lastly, the user interface provides comprehensive views of issue details and related benefit year information. This is all in one place so that staff can focus on resolving issues instead of hunting down information across multiple systems.
  • This is the fifth and last layer that helps the agency breakdown otherwise complex issues into simple, manageable steps to achieve efficient and reliable results.
Hosting and Subscription Model

On Point’s subscription model outlines a process that lets EDD take advantage of system capabilities that have been developed and matured over 30 years with our team focusing solely on unemployment insurance technology and automation.  This model eliminates the burden from state agencies managing another application, hardware stack, and dedicated FTEs, instead; your team focuses on their prime objectives of managing and paying benefits to those in need.

The hardware stack is cloud hosted using a state-of-the-art architecture within the AWS cloud and AWS GovCloud platforms.  These environments follow all the same security restrictions and guidelines currently adhered to by UI agencies data centers and on-premises hosted platforms. (i.e NIST 800-53 and FISMA; SOC 2 Audit (coming soon)) 

The On Point modified SaaS model will provide EDD with a single tenant approach to access the environment and software layers through a secure portal.  Each state gets their own VPC which isolates and partitions them from other state hosted platforms and OIC layers.  While in this environment On Point will assure SLAs are being maintained and scaled based on the current economic scenarios, this makes managing recession-based volumes less of a worry for states.  On Point will also provide multiple updates to the applications throughout the year to our subscribers.  There is normally one dot release and one major release for each layer on an annual basis. 

Proven Results

State A was buried with a sizable backlog of claims they suspect was largely fraud. 

  • After filtering through UIdentify over 10% of the claims were discovered to be valid claimants. Those claims were quickly cleared and deserving claimants began receiving benefits.
  • The solution will block the fraud they already suspected in that pool and any claims that result in an issue will be efficiently processed by Resolve.
  • Trends are showing approximately 48,000 claims will go through the Resolve automated non-responsive claimant path, with an MPU of 40 minutes State A stands to save over 39,000 hours of work.
Why Choose On Point Technology?

On Point has been developing and managing integrity solutions for close to 3 decades.  We have team members that span the nation totally centuries of UI experience.  In addition to our experience directly within state workforce agencies, our technology staff also has over 100 years of combined UI experience.

We get UI, it’s 100% of our business since our inception.

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.