The Solution: OPTimum Resolve – On Point Technology, LLC

A Modular Solution for UI Adjudication

Modern benefit systems fared no better than legacy systems during the recession.

OPTimum Resolve

Modern benefit systems fared no better than legacy systems during the recession.

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:

Resolve Features

Import, and adjudicate cases from any program including the PUA, FPUC, and PEUC.
Manual and automated issue creation.
Gathers facts from Claimants and Employers through intelligent question trees.
Presents side-by-side fact-finding results enabling agency staff to easily identify differences and similarities between employer and claimant responses.
Determines fraud or non-fraud designation based on state-supplied business rules.
Generates notices of determinations fully customized for the state.
Issue based workflows allow for automated and manual task generation.
Automates issues assignment based on state’s business rules.
Provides ability to reassign issues in mass.
Allows uploading of issue related documentation to the issues.
Allows for manual and automatic creation of Issue Narratives.
Provides self-maintenance of state users and business rules.
Provides a view of the benefit year, claim, continued claim, employer information, and issue Information.
Calculates overpayment and penalty amounts.
Allows for automatic and manual resolution of issues.
Performs fraud analysis, then provides UI agents a “rapid review” screen allowing for one-click determination generation.

Your Next Steps

Contact On Point to discuss a custom strategy for your individual state workforce agency. The short implementation timeline for Resolve can be done in advance of any modernization project, ensuring you can immediately reduce your adjudication backlog and safeguard against the accumulation of future backlogs. This strategy would allow you to continue to pay deserving claims while saving millions by blocking fraudulent payments. As part of our Resolve implementation, On Point would commit to integrating initially with your legacy system but also with the modernized system.

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