In response, UI is now flooded with fraud detection solutions mostly ported from other industries. Fraud detection is only 10% of the work! Massive adjudication backlogs prevent deserving claimants from receiving benefits and force states to pay suspicious claims. Claims intake flow and Fraud prevention are only as powerful as your agency’s ability to adjudicate claims, issue determinations, and block fraudulent payments.
Case management systems available within modern benefit systems and those provided by new vendors are simple task managers. They provide little more than task tracking and task prioritization leaving all the work-to-be-done to overloaded agency staff.
True UI adjudication involves claimant fact-finding, employer fact-finding, analysis of facts, determining fraud/non-fraud, calculating overpayment amounts, generating determination notices, establishing overpayments, and processing appeals. Lack of automation in the preceding steps results in massive backlogs, overloaded agency reps, hiring of 1000’s contractors, increased fraudulent payments, and inhibits providing quality service to deserving claimants.
On Point’s adjudication solutions have been deployed to 15 state workforce agencies, automated over 6 million cases, and captured in excess of $6 Billion. The solutions are true UI tools that automate both clerical and complex UI functions.
OPTimum Resolve solves for all UI Adjudication issue types from Claims intake (seps & non-seps) to Benefit Payment Control (Work & Earnings) issues. It is a complete UI investigation and adjudication system, built on day one for UI. Unlike competing systems that perform simple “task management”. OPTimum Resolve incorporates intimate UI knowledge enabling it to complete each step of the process as required by UI, including but not limited to the following: