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.
- 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.
- 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.
- 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.
As States nationwide implement advanced fraud prevention and detection solutions and procedures, they are doing so in the face of a record number of claims, which has resulted in a massive adjudication load.
OPTimum Integrity Cloud, our Fraud Prevention and Detection solution stack, is geared towards providing SWAs with the tools they need to seal off the loopholes fraudsters exploit and stop fraud in its tracks.
The third layer of the OPTimum Integrity Cloud trifecta is a Procedural layer called OPTimum Resolve, a solution that streamlines UI investigation and adjudication processes and significantly enhances productivity.
The OPTimum Integrity Cloud fraud-combating strategy uses a layered approach, as depicted in the diagram.
With OPTimum Integrity Cloud, the massive number of claims faced by SWAs today is systematically filtered through several fraud detection layers that each progressively identifying and distinguish valid claimants from fraudsters.
At the end of the filtering process, SWA staff remain with a much smaller population of valid live claimants to process.
That last layer in the OPTimum Integrity Cloud fraud detection stack is OPTimum Resolve, which gives you everything you need to investigate and adjudicate any emergent issues.
OPTimum Resolve is a Case Management System that handles identity issues from end-to-end. The system intelligently distributes issue workload using business rules, allowing staff to address emerging issues faster and more accurately.
OPTimum Resolve uses our proprietary FastPath processing system, which supports automated recommendations based on adverse evidence while significantly expediting issue resolution and boosting agency throughput.
OPTimum Resolve uses a business process engine that simplifies issue resolution into consistent and repeatable steps, guiding staff through the entire issue resolution process. This process-based approach results in consistent and reliable issue determinations across staff pools.
OPTimum Resolve provides streamlined factfinding through narrative entry and configurable question tress, which help gather the true facts required to issue a determination.
OPTimum Resolve also supports direct uploading of evidence artifacts like documents, PDFs, spreadsheets, audio, and video files to the issue file to support faster and more accurate issue resolution. When you use this function, all artifacts related to the issue that have either been pulled in from the claim or comprise uploaded evidence are all viewable from the issue details page.
OPTimum Resolve’s enhanced user interface provides comprehensive views of issue details and related benefit year information. All this information is available from one place, so that staff can focus on resolving issues instead of hunting down information across multiple screens.
The new OPTimum Integrity Cloud subscription-based service provides States with a hands-free approach to implementing our fraud detection solution stack. As an on-demand cloud service, an OPTimum Integrity Cloud subscription does not involve any custom development projects.
Instead, your OPTimum Integrity Cloud subscription taps into an already strong functional base that works with your state-based data. As a cloud service, all the tools in your subscription are continually enhanced by our product and development teams that comprise On Point subject matter experts with extensive state engagement experience. These enhancements are captured in our product road map and updated continuously to address current needs.
For years USDOL and advisors have discussed high-risk technology projects and explored ways of reducing the risk inherent to such projects while supporting higher success rates. OPTimum Integrity Cloud takes that into account.
OPTimum Integrity Cloud uses microservice technology architecture, making the platform straightforward to manage and operating system and cloud hosting provider agnostic. Even though OPTimum Integrity Cloud is primarily optimized for the cloud, on-premises implementations are still available for state-based hosting when required.
Currently hosted implementations utilize Amazon Web Services (AWS), the market leader for all hosted solutions across public and private clouds. We also offer AWS’s FedRamp, a certified cloud infrastructure platform available on a per-state request basis.
With our Single Tenant SaaS Model, each state will have its own single-tenant Virtual Private OPTimum Integrity Cloud instance. Single Tenant hosting provides higher levels of security and a firewall from other state-owned and state-hosted databases.
Our Single Tenant SaaS Model comes with automated monitoring that provides a more hands-free approach and allows our platform team to scale the application layers based on economic downturns like what we are facing today.
The Single Tenant SaaS Model adheres to all of the same security standards and guidelines used annually to audit states.
Early releases of the OPTimum Integrity Cloud require little to no integration with a state’s existing benefits system. Batch processing of issues through ID Proofing and IDH-SAR can be performed based on data extracts, which provides earlier access to the tools with real data.
This preliminary access can help you work through any backlog of issues you currently have and allow you to perform a quick analysis of a group of suspicious claims. These first steps of integration provide a powerful way to have a tremendous impact within the first couple of weeks of a project.
OPTimum Integrity Cloud has a robust set of API’s that are easily consumable by a state’s dev team OR OPT’s implementation team that is highly-experienced with state-based data structures and can make quick work of the integration.
OPTimum Integrity Cloud’s microservice technology eliminates the need for big-bang roll out projects and processes, which significantly lowers the project’s overall risk profile.
Each layer, as you can see in the chart, takes between 2 – 6 weeks from configuration to implementation. ID Proofing has the fastest execution and allows SWAs to quickly have fraud prevention protections in place while ensuring minimal intrusion to existing platforms. ID Proofing is the next best approach to reviewing individuals in person!
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 email@example.com
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
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