New Jersey Department of Labor

New Jersey Department of LaborUnemployment Insurance Modernization Project

Business Process Conceptual Design

April 2003

Executive Summary

Why Modernize UI?New Jersey demographics are changing rapidly - tides within the workforce employer base are shifting and substantial numbers of New Jersey’s current workforce are “baby-boomers”, including a huge number of the agency’s own employees. This shift in demographics is also shifting customer service needs. These needs are substantially different from the last State UI modernization effort (mid -1980s).

Impacted by the counter-cyclical effects of the first major economic downturn in over a decade, the agency is currently suffering with a substantially increased workload, an increasingly frustrated staff, and greater employer and claimant demands.

The US congress, through the Reed Act has provided substantial funds to the States (including New Jersey), to streamline and modernize their Unemployment Insurance services.

Executive Summary…

Why Modernize UI? (cont.)The UI Division recognizes the need and possesses the commitment (and the funding) to improve UI customer service by combining industry best practices, redesigning workflow effectively and efficiently, and by updating supporting technology.

In recent years, legacy systems and associated business processes, some of which are more than two decades old, have been updated with patchwork ingenuity. However, investments in replacement infrastructure were cost-prohibitive, so these systems have sadly fallen far behind in their ability to serve today’s workload demands and customer expectations. As a result, all stakeholders suffer.


Why This Approach?A basic business tenet is that systems must support business processes. So, before a modern UI system is designed and built, the Division has taken the critical step of reviewing and redesigning its business processes.

Leadership has also recognized that the best approach to developing business processes requires a collaborative effort – input from across the UI Division (from front-line staff through to senior managers) and from its customers (claimants, employers and partner agencies).


AnalysisAnalysisThink


DesignDesignDefin

e

DesignDesignDefin

e

PlanPlan

Do

PlanPlan

Do

UI Process Review

Managing the Program

Review current stateID gaps with vision

Deliverables

Design business processesDesign architecture

Detail all requirementsGet approval for new system design

Review initiativesPlanningAgree controls

Manage projectReview interdependencies

Plan deliveryPlan migrationConsider change needs

Detailed work planBaseline description

Business process conceptual designTechnical architectureInterface document

RequirementsStrategic plan

Implementation RFPs

Manage the change

PlanPlan

Do

PlanPlan

Do

UI Process Review



Deliverables









Implementation RFPs

Manage the change



DesignDesignDefin

e

DesignDesignDefin

e

PlanPlan

Do

PlanPlan

Do

UI Process Review



Deliverables









Implementation RFPs

Manage the change

PlanPlan

Do

PlanPlan

Do

UI Process Review



Deliverables








Requirements

Strategic plan

Implementation RFPs

Manage the change

Nov 2002 –Feb 2003

Feb – May 2003

May – July 2003

Draft strategic plan

This deliverable is part of a series of tasks that leads to a strategic plan for modernization of UI services:

Successful Projects Start With a Vision!


Framework

Blueprint

Vision

Objectives and Measurements

Principles

* The technology and systems blueprint will be addressed in the technical architecture phase.

UI o

rgan

izat

ion

an

d cu

ltur

eU

I org

aniz

atio

n

and

cult

ure

EnablersEnablers

The Business Process Conceptual Design sets out both a framework and blueprint for UI Modernization…

Our Vision for UI ModernizationWe will deliver revolutionized unemployment insurance services, while maintaining the integrity of the Trust Fund

At each point of customer contact, we will provide a fair, friendly and high quality service to every member of the workforce community For claimants, we will help them to focus on reemployment by making

the claims process timely, efficient, and informative. We will also help them to access related government services by improving referrals from UI, in partnership with the workforce community

For employers, we will simplify correspondence and improve our responsiveness. We will treat employers as partners in the provision of unemployment insurance

For staff, we will empower them to deliver superior service by ensuring a stable work environment, creating equal opportunities for career growth and providing appropriate tools and training to do the job. We will treat our employees with the same professionalism and respect they are expected to share with every UI customer.


The Vision, Objectives and Business Design Principles Set the Framework for UI ModernizationThe phrases highlighted in red (in the vision) illustrate the need to: Maintain the integrity of the trust fund Provide timely and efficient services Work as a partner to other workforce services (Disability, Workforce

New Jersey, etc.) Improve responsiveness to customer (whether claimant, employer, or

internal agency) needs Provide superior customer service Provide an environment where our employees can succeed

These and the business design principles together provide the boundaries and guidelines for future UI Modernization projects


Creating the Blueprint: Where Did We Start?With a framework established, we needed to create a blueprint to describe the UI of the future.

We started with the acknowledgement that certain processes are necessary to delivering UI services, both today and in the future. These processes include:

Claim intake Adjudication Certification Appeals Payments Controls

Revolutionizing UI is not about replacing these processes but rather making them more efficient, timely and, in parallel, enabling our staff to provide

superior customer service


Selected Interfac ing Agencies

Financial management

Performance management

Operations / process management

System management

Investigation

Inquiry / Triage

Triage

Entry

Continued certification

Intake Determination

Determination

Re-determination

Lower-Authority Appeal (AT)

Higher-Authority Appeal (BoR)

Adjudication

Prevent overpayment

Triage

Entry



Determination

Re-determination



Adjudication

Prevent overpayment

Core Process

Organization and Culture

Business and Technical Enablers

Employer AccountsEmployer Accounts

TreasuryTreasury

BankBank

TDITDI

Workforce New JerseyWorkforce New Jersey

Attorney GeneralAttorney General

Dept of Human ServicesDept of Human Services

One Stop partnersOne Stop partners

Creating the Blueprint: Changes






System management

Investigation

Inquiry / Triage

Triage

Entry



Determination

Re-determination



Adjudication

Prevent overpayment

Triage

Entry



Determination

Re-determination



Adjudication

Prevent overpayment

Core Process




TreasuryTreasury

BankBank

TDITDI





Enabling customers to self serve wherever possible

Improving coordination between UI partners through phone/internet web links

Providing multiple means for customers to communicate with us in real-time (phone, internet, in person) and for us to communicate with our customers Establishing a triage

function that enables a quick assessment of a customer’s needs and linking him/her to the service that they need

Enabling UI staff to view and work with a claimant’s or employer’s full case information easily (everything from claims to appeals information)

Enabling claimants and employers to interact with UI on a 24 hour, 7 day a week basis

Allowing claimants and employers to update specific information (e.g. address, etc.) depending on the claim processing step

Enabling claimants and employers to access (by phone or internet) their own case information






System management

Investigation

Inquiry / Triage

Triage

Entry



Determination

Re-determination



Adjudication

Prevent overpayment

Triage

Entry



Determination

Re-determination



Adjudication

Prevent overpayment

Core Process




TreasuryTreasury

BankBank

TDITDI





Enabling what if analysis on process changes before they are implemented – understanding the ramifications of decisions early

Providing meaningful training and career paths better to enable our workforce

Linking performance throughout the agency - from Division objectives & measures to PARs

Preventing improper payments or overpayments by performing systematic cross checks at multiple points in the life of a claim (at claim entry, certification, etc.)

Providing UI staff with the ability to create their own reports

Create a channel for comments that enables all staff to propose process / policy improvements and a and feedback loop to inform them of the resultsProviding different

payment options: direct deposit and debit cards

Creating the Blueprint: Changes (Cont.)

Showing all UI staff the end-to-end process, where their roles fit in, and how their efforts contribute to overall success

Making It HappenContinued contribution from all members of UI is key; the business redesign workshops and interviews involved over 120 UI stakeholders, from front-line staff to senior managers and included union representatives.

These modernized UI conceptual business processes have been designed by the people who will live through the change and

provide these services in the future

The time is right, funding is available and the motivation is there to create a revolutionary new UI for New Jersey.

We hope that you will enjoy reading the rest of this document to see in detail how NJ UI will fulfill its vision.


Contents

Contents of the Business Process Conceptual DesignExecutive Summary 2 Contents 18Introduction: This Document Is the Framework and Blueprint for UI Modernization 21Our Approach: Facilitating UI to Develop Your Own Framework and Blueprint 25Articulating the Vision in Terms of Objectives and Measurements 33 UI Modernization Objectives, as Redefined in April ‘03 39

Business Design Principles to Guide Future Operations and Change Projects 43 Design Principles for Our External Customers, Internal Customers and for Agency Excellence 47 Elaborating on Key Design Principles 50

Our Blueprint for Revolutionized Unemployment Insurance Services 61 Introduction 63 Simplified, Efficient, Responsive Processes 66

– Triage and Inquiry 67

– Intake and Adjudication 85

– Continued Claims and Payments 99

– Preventing Overpayments 112

– Investigating Overpayments 123

– Appeals 137

– Policy and Procedures 153

– Financial Processes 170

– Internal Controls 189

Contents…

Simplified, Efficient, Responsive Processes (Cont.)

– Process Enablers

192

– New and Changed External Process Interfaces

204

– Process Differences, by Benefit Program

211 Real-time Information to Transform Management Responsiveness 217 Creating the Right Environment: Organization and Culture Changes 224

Building the Momentum for Change 236 What UI Modernization Means to Our Stakeholders 238 Our Inclusive Approach has Supported Our Change Objectives 244

Next Steps 249

Contents…

Contents (cont.)

Contents (cont.)Appendices: Appendix A: Customer Focus Group Reports Appendix B: Process Scenarios Appendix C: Best Practices Crosswalk Appendix D: Management Information Example Appendix E: Detailed Implementation Ideas Appendix F: Policy and Procedure Impacts Appendix G: Cross-walk With RFP Requirements Appendix H: Cross-walk With Business & Systems Characteristics List Appendix I: Cross-walk With Parallel Initiatives

Contents…

Introduction: This Business Process Conceptual Design is the Framework & Blueprint

for UI Modernization

Why a Conceptual Business Process Design?Situation

NJDOL Division of Unemployment Insurance has received federal Reed Act money and made the commitment to spend some of this money modernizing its business processes and IT systems for UI.

Challenge

The core IT system supporting NJDOL was built in 1975 with the last major upgrade in 1984. The associated business processes have not had a major review since 1984. The existing UI functions and associated IT systems are not operating efficiently nor providing the level of customer service needed.

Articulate the vision in terms of objectives and

measurements

Design principles guide future

operations and change projects

A high level blueprint articulates and confirms

the vision, objectives and design principles

Building the momentum for

change

Answer

The Division of UI needs to redesign its business processes before it designs its new IT system. This deliverable, the Business Process Conceptual Design, and the process undertaken to create it will provide both the framework for action and a blueprint that articulates the envisioned end-state. Both also contribute to the change process (already started within the agency) that is needed to ensure project success.

Purpose and Audience…

This Design Document Provides Both a Framework and Blueprint for UI Modernization…


measurements

Design principles guide future operations

and change projects



Building the momentum for change

Begin the change process

Framework

Blueprint

Vision


Principles

* The technology and system s blueprint will be addressed in the technical architecture phase.

UI o

rgan

izat

ion

an

d c

ultu

reU

I org

aniz

atio

n

and

cul

ture

EnablersEnablers


As Such, It Is a Firm Foundation on Which to Build Detailed PlansThis Conceptual Business Process Design sets out a framework for action and a strategic blueprint for the delivery of UI services in the medium term future. This design will be the foundation from which the UI Modernization team – in partnership with experts from all relevant parts of the organization – will develop the Technical Architecture and the Strategic Implementation Plan. The Strategic Implementation Plan (due in July 2003) will set out the timetable for both design and implementation projects.

Our primary audiences are:

• Senior Management, Income Security

• Subject Matter Experts across UI

• UI Modernization core team

• IT specialists in DIT, OIT and UI Systems Management

• Managers and experts within interfacing organizations – our workforce partners



DesignDesignDefin

e

DesignDesignDefin

e

PlanPlan

Do

PlanPlan

Do

UI Process Review



Deliverables









Implementation RFPs

Manage the change

PlanPlan

Do

PlanPlan

Do

UI Process Review



Deliverables









Implementation RFPs

Manage the change



DesignDesignDefin

e

DesignDesignDefin

e

PlanPlan

Do

PlanPlan

Do

UI Process Review



Deliverables









Implementation RFPs

Manage the change

PlanPlan

Do

PlanPlan

Do

UI Process Review



Deliverables








Requirements

Strategic plan

Implementation RFPs

Manage the change

Nov 2002 –Feb 2003

Feb – May 2003

May – July 2003


High level plan, UI Modernization Nov 2002 – July 2003


Our Approach: Facilitating UI to Develop Your Own

Framework and Blueprint

Scope of the Business Process Conceptual DesignIn this, the Business Processes Conceptual Design phase of the project, the team was chartered to develop: A detailed description of the reengineered Division of UI processes and the workflow for these processes.

Beyond the core functions (e.g. Claim intake), these new processes needed to accommodate the following list of UI benefit programs:

– Unemployment insurance Standard, in-state benefits Interstate unemployment insurance Combined wage claims UCFE (prior federal employees seeking unemployment benefits) UCX (prior US military employees seeking unemployment benefits) All extensions

– Disability During Unemployment

– Additional Benefits during Training

– Self-Employment Assistance

– Disaster Unemployment Assistance

– Trade Re-adjustment Act assistance

This description also needed to validate and update the Business and Systems Characteristics and Systems Initiatives that are currently underway. These were incorporated into the business design principles for UI Modernization, in a session with the UI Modernization Project Team.

Approach…

State Guidelines for the Approach to the Business Process Conceptual DesignAs part of the RFP, the State provided approach parameters for this effort:

• Work closely with the project manager and the subject matter experts

• Ensure that each business function is addressed in the reengineered processes and meets the objectives of the Division for a seamless and integrated service

• Employ an efficient combination of document reviews, interviewing, process observation, and collaborative group discussion (focus groups) in order to analyze current business processes and identify and develop

the reengineered business processes, workflow, and interfaces.

• Interview and conduct focus groups to obtain input from external customers (including claimants, employers and employer agents)

We also added a framework of principles to control project delivery throughout UI Modernization:

• Manage change as a core project theme, recognizing that our employees are central to successful change

• The UI Modernization Project will not threaten the job security of our employees

• Throughout the design and delivery of new processes and system tools, we must maintain the integrity of services - benefits, system, data, trust fund

• All new processes and systems must be flexible and easy to change – for example, changes required by new legislation

• The Department of Labor does not want to outsource support of any resulting system(s) to a vendor – and we must plan accordingly

• Achieve UI Modernization within reasonable costs

Approach…

Our Methodology: Build and IterateThe methodology – particularly applied in workshops - to build out the new conceptual business processes emphasizes best practices used many large government projects…

Vision

Ideas Key points from the Vision

PrinciplesKey points affirmed by the Project Team

ObjectivesFocused principles

MeasurementsDetermining objective fulfillment

TechnicalArchitecture

Business Processes

The view of the future

Approach…

Our Methodology: Build and Iterate (cont.) Vision –The team started by developing the Vision (in our Kickoff workshops – Late November, 2002).

The vision defines the future UI by describing, in broad terms, the key attributes and stakeholder characteristics for our claimants, employers, and employees.

Key Ideas - Using the vision and the external and internal interviews, we identified key ideas. These included:

– Revolutionary Customer Service

– Partnership with the Workforce Community

– A Stable Work Environment

– Professionalism and Respect to our customers and fellow employees Principles - The key ideas were further refined to identify the underlying principles (principles being an

affirmation of a key idea at a greater level of detail). An example:

– Make the customer experience easy, efficient and informed – so that each customer can make the right choices for themselves (e.g., access, payment and correspondence methods)

These principles helped to direct and define the business processes Objectives and Measurements - Through follow-up sessions, the vision and principles were used to

identify the key objectives and their corresponding measurements. The objectives (based on the Principles) provide the actions needed to achieve the vision. An example of one of our objectives and its corresponding measurement is:

– Objective: Deliver timely seamless service without sacrificing quality

• Measurement: Identify the average number of handoffs when processing an initial claim

This methodology builds an integrated approach: from where we are going (the vision) to determining that the process and project is a success (measurements)

Approach…

Business Process Conceptual Design Schedule

Claimants Employers Employer agents Claimant advocates

Intake to adjudication Continued claims, appeals, and

inquiry Control of benefit payments Financial processes Policy and procedures One Stops/Workforce New

Jersey Organization and Culture Management Information Consolidation and

communication approaches

February (2003) March (2003)

Customer Interviews Expert Workshops

Other DOL partners Federal DOL

representatives CWA Other partner

agencies

Partner Interviews

April (2003)

Approach…

Breakdown of the Schedule: Interviews & Workshops

Before starting the redesign workshops, the project team met with NJDOL UI customers to gain a better understanding of their needs and issues with the existing processes, recognizing existing process steps that work well, and identifying any additional quick wins. Claimant information was gathered through interviews and focus groups help at One Stop centers. Employer and employer agent information was developed from a series of focus groups. We also met with claimant advocates to better understand the customer experience during the appeals processes.

Expert workshops have been the heart of this redesign phase. Our approach was to enable UI staff to redesign the future UI through a collaborative and informed process. Representatives in each of these eight sessions included front line staff through to senior UI managers as well as other DOL experts. Each workshop discussed and developed new processes in an open forum, where participation and free discussion was encouraged. Each session started with a review of the vision, moved on to the identification of key principles and finished with the development of future process steps. Further iteration on the detailed process steps was developed using scenarios.

After the completion of the conceptual process redesign workshops, we met with key partner agencies to review potential changes to the way we work with them. These sessions helped us to confirm process interface changes, given the new UI processes. In addition, we met with two key stakeholders with no ‘process’ interface – namely the CWA (Communication Workers of America) and officials from the Federal Department of Labor – to ensure that we continue to solicit their advice and support.

Customer Interviews

Expert Workshops

Partner Interviews

Approach…

Key Benefits of Our ApproachOver the past 11 weeks, we have found that Identifying customer needs early, before the workshops, allowed non-front-line UI representatives to better

understand the processes from both the customer and front-line worker’s perspectives Focused workshop sessions on a particular component of the overall process (e.g. One Stops) – allowed

participants to focus on a specific set of functions and not get overwhelmed by the enormity of the entire UI process Participation from a broad spectrum of UI functional groups in each workshop provided “out of the box” comments

and ideas, allowing people to hear, listen, and learn from people across the spectrum of UI functions Participation from a broad range of employees in differing roles provided the ability to hear how a process might

work from a multitude of different perspectives Participation from over 120 UI personnel provided the ability to get a broad perspective of a process (everyone has

a chance to contribute to the answer), to arrive at a solution designed by the organization (not by a small team or by the consultants), and to start the mindset change needed by UI to successfully implement the solution

Having the members of the team focus on informed facilitation and note-taking allowed the UI members of the Team and the workshop participants to focus on designing the new processes

Quick documentation and communication – getting results out quickly to other affected parties – provided the ability to keep everyone engaged and maintained project momentum

Identifying “quick wins” got people excited about the possibility that things might change now. Not all process improvements need to wait until the completion of the project before they are acted upon. Some of these initiatives were started before the end of the project

Please note that, throughout this document, we refer to UI staff as ‘representatives’ rather than agents. We use this generic term to avoid any confusion with the current ‘claims agent’ role.

Approach…

Articulating the Vision in Terms of Objectives and

Measurements

Articulating the Vision in Terms of Objectives and Measurements


measurements






change

The Division of UI needs to redesign its business processes before it designs its new IT system. This deliverable, the Business Process Conceptual Design, and the process undertaken to create it will provide both the framework for action and a blueprint that articulates the envisioned end-state. Both also contribute to the change process (already started within the agency) needed to ensure project success.

Objectives & measures for

external customers


internal customers


agency excellence

The vision statement for unemployment

insurance

Vision, objectives & measurements…

Vision, Objectives and Measurements Provide Clear Endpoint for Us to Target


Framework

Blueprint

Vision


Principles


UI o

rgan

izat

ion

an

d cu

ltu

reU

I org

aniz

atio

n

and

cult

ure

EnablersEnablers

The UI Modernization vision expresses our desired end-state for the initiative. Our objectives and measurements

provide specific targets to aim for, that should together deliver the vision.

The objectives also fit with the Department of Labor’s overarching goals.

Our Vision for Modernized Unemployment InsuranceWe will deliver revolutionized unemployment insurance services, while maintaining the

integrity of the Trust Fund:

At each point of customer contact, we will provide a fair, friendly and high quality service to

every member of the workforce community.

For claimants, we will help them to focus on reemployment by making the claims process timely,

efficient and informative. We will also help them to access related government services by improving referrals

from UI, in partnership with the workforce community.

For employers, we will simplify correspondence and improve our responsiveness. We will treat

employers as partners in the provision of unemployment insurance.

For staff, we will empower them to deliver superior service by ensuring a stable work environment,

creating equal opportunities for career growth and providing appropriate tools and training to do the job. We

will treat our employees with the same professionalism and respect they are expected to share with every UI

customer.


Objectives and MeasurementsObjectives and their associated measurements are key components of a successful project framework. These are not established in one session but created through an iterative process that last through project implementation. In most cases, objectives are fully defined during the strategic design phase (now) and measurements in the requirements definition phase (so that the project team(s) have a clear understanding of the expectations). Measurements can also be honed through the project testing phase.

Developing objectives and measurements for UI Modernization: As a function of creating the vision (late November), we created the first view of the project’s objectives

and measurements We have revisited the objectives and measurements following the Conceptual Business Process Design

– results on the following slides We will continue to refine the objectives and measurements through to the end of July:

– At completion of the Technical Architecture – possibly to add objectives and to iterate further on the defined objectives and measurements

– During strategic planning – objectives will be fully defined and we will make the measurements more specific (but not finalized)

When RFPs are developed, objectives and measurements must be fully defined, and the agency must be confident that they represent exactly the targets we want to achieve

Framework

Blueprint

Vision


Principles

Vision


Principles

Busines

s pro

cess

es

Busines

s pro

cess

es

Partn

er in

terfa

ces

Partn

er in

terfa

ces

UI o

rgan

izat

ion

an

d cu

lture

UI o

rgan

izat

ion

an

d cu

lture M

anagement

information

Technology and

systems *

EnablersEnablersEnablers

Objectives are the targets for the vision

Measurements quantify whether the objective is reached


UI Modernization Objectives, as defined in November 2002Customer objectives (claimant and employer) Ensure that claimants are aware of reemployment and other related services as early as possible Ensure that process transfers between specialized units are seamless to the customer Allow customers to self-serve wherever feasible Improve responsiveness to employer and claimant inquiries Meet our customers’ expectations on making services accessible

Objectives for excellence• Exceed the Federal timeliness targets but not as the expense of high quality, fair decision-making

• Achieve efficiency improvements through specialization

• Strive to ensure we communicate clearly on all occasions, with all stakeholders

• Be able to support initiatives led by our workforce partners through close co-operation and data-sharing

Staff objectives• Ensure that our staff have the knowledge, tools and support necessary to deliver the best service they

can


UI Modernization Objectives, as redefined in April 03Objectives for external customers (claimant and employer)

1. Ensure that claimants are aware of reemployment and other related services as early as possible

2. Deliver timely, seamless service without sacrificing quality

3. Provide superior customer service

Objectives for excellence4. Be able to support initiatives led by our workforce partners through close co-operation and data-sharing

Objectives for internal customers (staff)5. Ensure that our staff have the knowledge, tools and support necessary to deliver the best service they

can


Objectives and Possible Measurements (4/03)Objective 1:Ensure that claimants are aware of reemployment and other related services as early as possiblePossible Measurements: Number of times people transferred from UI to our workforce partners within various key timeframes Number of people that

– activated their OSOS pended records (web)

– used scan card in One Stop Center Number of events per claimant

Objective 2:Deliver timely and seamless service without sacrificing qualityPossible Measures: Timely – Federal Standards for transaction times Seamless transfers

– Number of handoffs obvious to the customer

– Amount of time between steps Quality – QPI measures


Objectives and Possible Measurements (4/03)Objective 3:

Provide superior customer service

Possible Measurements: Percentage of self-serve Time on inquiries Surveys of customer satisfaction and trends in services used Reduction in wait time Number of contacts per customer Number of employees requiring retraining Number of repeated steps or rework Number of appeals that are really inquiries


Objectives and Possible Measurements (4/03)Objective 4:Be able to support initiatives led by our workforce partners through close co-operation and data-sharing Possible Measurements: Number of file sharing incidents Number of IT problem tickets open relate to file transfers Number of duplications of same element data entries Violations of service level agreements Numbers of complaints from partners Number of partner surveys Work related injuries

Objective 5:Ensure that our staff have the knowledge, tools and support necessary to deliver superior service

Possible Measurements: Number of days absent and staff turnover Skill assessment surveys and follow-up of results of training Frequency of retraining Gap between the time training is requested and delivered Number of resolutions of calls to the help desk Trend in type of grievances filed Customer service survey feedback


Business Design Principles to Guide Future Operations

and Change Projects

Principles to Guide Future Operations and Change Projects


measurements






change


The business design principles

Explaining key principles that came out of the workshops

Business design principles to guide

future activity

Business design principles…

Framework

Blueprint

Vision


Principles


UI o

rgan

izat

ion

an

d cu

lture

UI o

rgan

izat

ion

an

d cu

lture

EnablersEnablers

Business Design Principles Support UI Modernization Objectives

The design principles support UI Modernization objectives and can therefore be categorized to support the different groups of objectives

External customers (claimants, employers &

partners)

Internal customers (staff & managers)

Agency excellence


Business Design Principles Provide a Guiding Framework

The business design principles should inform every aspect of future service delivery. They will be a constant reference point in the detailed design of UI Modernization projects

Framework

Blueprint

Vision


Principles


UI o

rgan

izat

ion

an

d cu

lture

UI o

rgan

izat

ion

an

d cu

lture

EnablersEnablers

The business design principles provide a guiding framework for The UI Modernization blueprint How we deliver services going forward Future design, development and delivery of change initiatives across UI


Design Principles for Our External Customers Our customers are our claimants, New Jersey employers, our partners and NJDOL staff – and we will

treat them all with respect. (See diagram below as illustration). Treat customers as people, not numbers… after all, it could be you on the other end Make the customer experience easy, efficient and informed – so that each customer can make the right

choices for them (e.g., access, payment and correspondence methods) Communicate clearly, in a way the customer will understand – including the language they understand

wherever possible UI is a gateway to reemployment services: educate customers about workforce services throughout the

process and transfer them quickly and seamlessly, via effective collaboration with workforce partners Minimize cost barriers to customer access (e.g., with a local phone number per One Stop) Encourage remote self-service (via phone, web or email), while preserving in-person service for those

who need it Ensure there are sufficient public access terminals to enable remote self-service for all constituencies Achieve a high-quality determination or decision as soon as possible Customers have the right not to participate in UI processes (e.g., drop out of an appeal / stop certifying)

but must be informed of the implications Where insufficient information is available to make a firm decision, our default position is to pay benefits Customers will be able to access a holistic UI electronic case file remotely Streamline communications using modern tools and encourage customers to use the same tools,

particularly employers


Design Principles for Our Internal Customers Our staff is central to successful change Make the Division of UI a fulfilling place to work Ensure that staff have the tools and training they need to succeed Communicate: listen and give customers and staff the information and assistance they need - in a way

they’ll understand Automate the repetitive tasks, thereby freeing up staff to help our customers Ensure the physical environment is conducive to staff productivity Managers and all staff should be held accountable for realistic performance targets which are sensitive

to variation Where needed, redirect inquiries to the right person to resolve a problem, first time


Design Principles for Agency Excellence Maintain equally the integrity of systems, processes and finances Apply rules fairly and consistently and maintain regard for due process Prevent incorrect payments, before they happen Get it right first time, reducing rework Continuous improvement is a mainstay to ongoing success – and we’ve all got a role in achieving it Optimize staff resources by balancing workload across the state Align activities and performance with annually-reviewed strategic goals / objectives, and measure

performance against objectives

Technical excellence (sub-set): There is one system and uniform, easy to access data Use tools effectively to enable performance management, development and policy improvement Use workflow and case management to optimize end-to-end case processing Get accurate data from the start – and reuse it to avoid redundancy


ELABORATING ON KEY DESIGN PRINCIPLESSome of the principles listed above evolved during the workshop sessions. In the following pages we provide further detail on these principles. They are:

A focus on customer service – broken down into a number of principles:

– Treat customers as people, not numbers… after all, it could be you on the other end

– Make the customer experience easy, efficient and informed – so that each customer can make the right choices for them (e.g., access, payment and correspondence methods)

– Encourage remote self-service (via phone, web or email), while preserving in-person service for those who need it

– Achieve a high-quality determination or decision as soon as possible

– Where insufficient information is available to make a firm decision, our default position is to pay benefits

Customers will be able to access a holistic UI electronic case file remotely Encourage remote self-service (via phone, web or email) UI as the gateway to reemployment services Our staff is central to successful change Getting it right first time, reducing rework Continuous improvement is a mainstay to ongoing success There is one system and uniform, easy to access data


A Focus on Customer ServiceWhat is it? A focus on customer service is a value to which UI Modernization aspires. Achieving great customer service means that every aspect of the agency is aligned to deliver services that our customers (claimants, employers, staff, partners) recognize and appreciate.

A focus on customer service therefore includes (but is not limited to): Providing a fast, friendly and personalized service Listening, showing empathy for our customers and resolving their needs – whether they are

employers, claimants or others Redirect to the right person, first time Respecting our customers – and our staff Ensuring our end-to-end processes are designed, managed and delivered from a customer-centric

perspective – for example, not failing our customers because ‘our system is down’ Provide clear, easy to understand information via all channels – IVR, web, paper and in-person

Purpose? To improve both the UI customer experience and UI as a place to work.

What will it look like? See overleaf for the results of a workshop brainstorm on this topic – some of these ideas were translated into the customer service related principles on the previous slide. Note also that agency sees every aspect of the business contributing to delivering a great service.


A Focus on Customer Service: Workshop Brainstorm

Satisfied customers– Smiling faces

– Earned trust and respect from customers

– Positive public opinion

– Able to resolve problems quickly and accurately

– Exceed expectations Good information quickly

– Correct and consistent information

– Fast & accurate

– No waiting time

– Clear understanding of the need

– Easy access – remote in particular Personalized service

– Customer is the only person that matters

• Treat each need and person individually

• Anticipate customer’s needs

– Take the time to listen

– Consider the audience and their abilities

Strive to act the way we want to be treated– Knowledgeable, friendly, efficient

assistance

– Good communications

– Provide follow up

– Customer gets benefit of the doubt

– Genuine concern

– Treat people with respect

– Provide sense of security Minimal handoffs

– Minimize handoffs

– No complex phone trees Others

– Reflection of positive work environment

– (Trend of ever improving service – can’t continually keep “ratcheting up the bar”, set it at the right level)

– Customer confidence that the system will work


The comments below are the result of a brainstorm conducted in workshop 8 of the business process conceptual design. They show desirable characteristics of a focus on customer service, not a full definition.

Also needed: Cross-training of staff Smooth and integrated (IT) services

– Integrated picture of the customer

– Integrated processes The right environment to enable people to focus on customer service

Issues: Setting the desired level of service Managing the expectations of the customers – customers’ expectations are high: we are benchmarked

with services provided by the private sector

Summary: We are in a customer service business (externally and internally) Providing good customer service will make all of our jobs easier Front line staff attitudes and the right tools are key to the organization’s success Must provide advice and options to customers so they can make the right choices for them

Employee positive

Customer positive

We should enable

A Focus on Customer Service: Workshop Brainstorm (cont.)


Customers Will Be Able to Access a Holistic UI Electronic Case File RemotelyWhat is it? The ability of the customer (claimant or employer) to access claim-specific information via the web or phone.

This will enable the claimant to: Identify the status of their claim, or previous claim (including appeals, approved training or even investigations into the claim) Review information used to make the determination (e.g., see the wages and weeks information) Make informed decisions and understand their next steps better (e.g., by using a ‘pre-monetary’ calculator) See the available benefits and to assess the impact of deductions or garnishments

It will enable the employer to: Review live and historical claims against the company, including information used to make determinations Review charges, with an explanation of the impact on the employer’s experience rating (to be requested

from Employer Accounts)

Purpose? To enable our customers to understand the status of their claims. This achieves the following benefits: More of our clients can self-serve, at times convenient to them and without queuing for assistance The Division of UI and partners will also be able to see the entire customer history (exact length of history

stored to be determined, owing to cost/benefit implications – e.g., 3/10/15 years?) The volume of simple inquiries and issues will reduce (such as change of address), thereby freeing up staff to concentrate on those customers with more complex needs

[Greater access will need to be accompanied by a feedback mechanism, so that customers can voice satisfaction/issues/requests more easily – thereby allow faster continuous improvement].


Encourage Remote Self ServiceWhat is it? A key principle for UI Modernization is that customers should be able to self-serve wherever feasible. In practical terms, this means that customers will access information 24/7 as well as conducting major interactions with the agency at any time, including: Research a question and find an answer Access their electronic case files via the phone and via the web. Customers will be able to view all

case information Change key information (e.g., address) Start the claim process (file a new claim or re-open an existing claim) Certify for continued claims Protest a determination or decision, and file an appeal Make a complaint or provide positive feedback

Purpose? To enable our customers to interact with the agency at times convenient to them, achieving three significant benefits: Enable our customers to access information at any time The volume of simple inquiries and issues will reduce (such as change of address), thereby freeing

staff up to concentrate on those customers with more complex needs Reduced repetitiveness of some UI roles – thereby making the work more interesting

To ensure customers adopt the self-serve option as far as possible, all services should be designed and tested from the customer perspective


UI As the Gateway to Reemployment ServicesWhat is it? UI is often the first contact many customers have with government workforce services; we also understand that – for the majority of our customers – the final outcome should be a new job. We will facilitate our customers to achieve this outcome by transferring customers and information to our workforce partners quickly and effectively.

Purpose? UI should become an effective access point to all workforce services, recognizing that unemployment benefits should be transitional, rather than an end point. While putting these transfers in place, UI will still remain focused on delivering the agency’s core services.

What will it look like? The Division of UI will: Provide claimants with workforce information at appropriate times at UI access points (on phone, web

and hard copy)

– e.g., play reemployment services information when/if claimants are on hold

– e.g., integrate access to the UI website with those of our workforce partners Where requested by workforce partners, transfer customers from UI at key stages of the claim lifecycle

(so they can be targeted for services). The preferred forms of transfer are:

1. Immediate and seamless transfer (e.g., phone transfer to waiting Workforce representative)

2. Immediate scheduling for an appointment

3. Assist the customer by making the appointment on his/her behalf Make UI databases accessible for our workforce partners to query, again so that they can target services

at appropriate sub-sections of the UI population There is even the possibility, in time, of linking UI information with information from other agencies

(through common databases, etc) to see an even more complete picture of the customer.


Our Staff Is Central to Successful ChangeWhat is it? Placing staff at the heart of modernizing Unemployment Insurance services by recognizing that technology, processes and management are all enablers: our staff delivers the service.

Purpose? The changes described in this modernization blueprint will only be effective if they are informed and embraced by our staff.

What will it look like? The discussion on organization and culture changes to support the business process redesign has only just begun. However, some of the ideas include:

In terms of participating in the modernization process: Ongoing involvement in all the planning steps of UI Modernization and the resulting projects Ongoing communication about change events, plans and how to get involved in UI Modernization

In terms of culture change: Making jobs more interesting Putting more responsibility in the hands of front-line personnel Reviewing training, development and career paths, including a new dedicated team within the Division to focus on UI-specific training Encouraging cross-training and easier promotions across functional units Investigating how to reduce stress in front-line roles Continuing the review of the physical environments within which people work Early assessment of the impact of new technologies on peoples’ day-to-day jobs Tying performance reviews to outcomes Ensuring we publicize modernization changes and events as they happen – to all staff


Getting It Right First Time!What is it? The principle of getting it right first time forces us to focus on making accurate, high quality determinations as early as possible

Purpose? An explicit focus on getting it right first time will mean that obstacles to delivering the best determination possible are addressed first. As we increase the percentage of time we get it right first time, rework will reduce, thereby freeing up time to focus on more value-added activities.

What will it look like? Accurate wage data transfers Accurate identity validation up front Gathering accurate eligibility information, once only Encouraging faster correspondence via modern methods such as email (and file transfer for large

employers) By using workflow capability, preventing work from moving on to the next step until completed correctly

in the current step Performance management activities focused on the front-end of the process Proactive system checks done early and through-out the life of the claim looking for problem situations

that if resolved quickly and early will prevent overpayments and rework


Continuous Improvement Is a Mainstay of Ongoing SuccessWhat is it? Continuous improvement is the recognition that any one single initiative won’t deliver fundamental performance improvements. Improvement is a continuous process, requiring the participation of everyone in the organization.

Purpose? To make sure we are relentlessly focused on providing our customers with the best service we possibly can.

What will it look like?

At an organizational level All parts of the organization will have performance targets, that support overall agency objectives Mechanisms to enable everyone to propose process and policy improvements, at any time Continuous analysis of current policies, procedures and performance to identify improvement

opportunities A small team dedicated to performance improvement, working as internal consultants to managers

across the State

At a personal level An ongoing commitment to developing everyone’s skills - through training and career development Constant opportunities to get involved in improvement ideas Personal performance targets that tie directly to agency objectives


One System and Uniform, Easy to Access, DataWhat is it? A single, shared system for all UI services – where data is only entered once, stored in one place, modified in one place and accessed many times.

Purpose?

The principle of a single system means minimizing interfaces and in doing so removing the many difficulties that arise from transferring information between systems.

Uniform data means (a) storing data in one place, (b) modifying it in one place and (c) controlling edits to data so that it is as ‘clean’ – and therefore as reliable - as possible.

Both of these measures will maximize consistency and minimize data-entry rework – thereby helping to reduce customer frustration, make data querying easier... And more!

What will it look like? Single data repository with controlled fields Single system, multiple modules (as far as possible) Interfaces that maximize data transfer Single sign on Reduce need for staff to know multiple systems and modules Easier to train staff – system will have common, intuitive logic found in many modern applications


Our Blueprint for Revolutionized

Unemployment Insurance Services

Our Blueprint for Revolutionized UI Services


measurements






change


Underpinning business and

technical enablers

Create the right environment:

organization and culture change

Management information: lynchpin

of continuous improvement

Redesigned processes:

simplified, efficient, responsive

Effective process

interfaces

Introduction to our blueprint…

Introduction to Our Blueprint

Framework

Blueprint

Vision


Principles


UI o

rgan

izat

ion

an

d cu

ltur

eU

I org

aniz

atio

n

and

cult

ure

EnablersEnablers

The high-level blueprint presents a snapshot of the overall processes, outputs, and interfaces that will exist in the future UI organization. The diagram on the following page includes: The core UI process, from the initial filing of a

claim – or intake – through to all possible process outputs

The processes used during the life of a claim (e.g. investigation and triage)

The management activities that support the delivery of excellence, and

A selection of interfacing agencies.

Following the high-level blueprint is a separate diagram that highlights a number of the key messages and reinforces the key concepts discussed earlier.


Core Processes of UI Modernization


Selected Interfacing Agencies




System management

Investigation

Inquiry / Triage

Triage

Entry



Determination

Re-determination

Lower- Authority Appeal (AT)

Higher- Authority Appeal (BoR)

Adjudication

Prevent overpayment

Triage

Entry



Determination

Re-determination



Adjudication

Prevent overpayment

Core Process



Employer Accounts

Treasury

Bank

TDI

Workforce New Jersey

Attorney General

Dept of Human Services

One Stop partners

Selected Interfacing Agencies




System management

Investigation

Inquiry / Triage

Triage

Entry



Determination

Re-determination



Adjudication

Prevent overpayment

Triage

Entry



Determination

Re-determination



Adjudication

Prevent overpayment

Adjudication

Prevent overpayment

Core Process




TreasuryTreasury

BankBank

TDITDI





Introduction to Our Blueprint: Key PointsOur core business of

providing benefits does not change

Overpayments are identified

ASAP

Triage and

inquiry are

available at every

step

All business processes are

underpinned by efficient

management of every portion of

the business

Interfaces are expanded to include additional partners


SIMPLIFIED, EFFICIENT, RESPONSIVE PROCESSESThe processes covered here are the core processes that enable effective and efficient delivery of benefits: Triage and Inquiry

Intake and Adjudication

Continued Claims

Preventing Overpayments

Appeals

Policy and Procedures – Developing, Communicating, Monitoring & Remedial Action

Financial Processes

Internal Controls


TRIAGE AND INQUIRY PROCESS

Introduction to Triage and Inquiry Triage is a function that will:

– Be immediately accessible via local cost phone numbers, the web, or a one-stop triage representative (or “greeter”)

– Route customers quickly and efficiently to the services they need, whether those services be provided by the Division of UI or one of its partners

– Route customers with more complex inquiries or needs to a customer service representative

– Allow customers to get answers to straight-forward questions on their own, quickly

(Please see section on Business Enablers for further information)

Triage . . .

Self serviceAutomated directory & information provision

(phone/web)Basic triage

Agent assesses need quickly and directs to appropriate service

Assisted triageAgent invests time to understand whole need –for

customers requiring a guiding hand






Workforce partner service

Introduction to Triage and Inquiry (cont.) This section presents the new triage process for claimants and employers, in the following order:

– Claimant Triage

• High-level view of the process: inputs and outputs

• Process map

- Summary of what’s new

- Detailed explanatory notes

• Underlying business principles

– Employer Triage


• Process map




Please note that the process maps included in this section are not intended to present the full, exhaustive list of possible outputs from the system.

Triage . . .

INPUTS OUTPUTS

Claimant Triage – High-Level View of the Process

Triage . . .

Claimant Triage, Conceptual Process Diagram v0.2

Triage function(Joint UI-workforce partners service)

Division of UICustomer(claimant, other)

1. Make contact

4. Assisted triage(for complex needs)

5. File a claim

6. Certify forcontinued weeks

9. Transfer forimmediate non-UI

specialist assistance

7. Schedule for(re) adjudication

3. Address simplequestion(s)

8. Manage debt

2. Present menuof options

(basic triage)

Claimant Triage Process

• Current or potential claimant contacts to:

• File a claim or appeal• Ask a question (e.g. am I

eligible?)• Check claim status• Certify continued claim• Schedule an appointment• Make a repayment• Access reemployment

services• Change key info (e.g.

address)• Etc.

• Claimant or potential claimants questions are answered

• Appointment is scheduled (e.g. for fact finding)

• Self-service options accomplished (e.g. address changes)

• Seamlessly and directly routed to the appropriate UI process

• Routed to a Partner Service• Etc.

Claimant Triage, Conceptual Process Diagram

Triage function(Joint UI-workforce partners service)

Division of UICustomer(claimant, other)

1. Make contact


5. File a claim

6. Certify forcontinued weeks



7. Schedule for(re) adjudication


8. Manage debt

10. Change keyinformation


(basic triage)

Claimant triage: What’s New

Triage . . .

Please note that this process map does not include all possible outputs from the employer triage and inquiry process.

3

2

5

4

1

6

Claimant triage: What’s New (cont.)• Where possible, claimants will be able to interact with the agency in their own languageMenu of options will be akin to the IVR entry point, but will provide access to a broader range of services (including UI, DI and workforce partner services). Triage services will cover UI and DDU. Early, initial assessment of customer needs Access to self-service options (see below) Access via a local phone number, web or One-Stop greeter Access to other Partner services (Workforce New Jersey) Through the IVR or web, be able to change your own information without an agent Triage representation will include representatives from our workforce partners as well as UI Triage representative to answer questions about any/all workforce services and direct customers to

the appropriate service Up-to-date, searchable lists of “Frequently Asked Questions” (FAQs) and their answers (in person,

web and possibly phone) Disability during unemployment triage will be integrated into the same service Representative assisted counseling and support, newly available via IVR and possibly also web

system Easy and fast routing to key UI activities: claim filing, continued claim certification, adjudication

scheduling, appeal filing and debt collection – via any of the entry channels (web, phone, One Stop) (In time) Seamless transfer to specialist services within and outside of the Division of UI

Triage will also provide easy access to self-service options: including the FAQs described above, change of address, review of electronic case file (ECF) contents – such as continued claim filing schedule, status of claim, etc.

Triage . . .

1

2

3

4

5

6

6

Claimant Triage: Explanation and Enablers1 Process: Make contact: claimant and other customers can enter the UI system via a single phone, web

access point (extending the concept of One-Stop to phone and web) or by visiting a One Stop. The new phone and web service will be jointly provided by UI and our workforce partners.

UI Modernization also has a stated aim that 95%+ of all claimants should use either phone or web, so that resources can be freed up to assist those who need hands-on help.

Technology: A key enabler is a local phone number for access to Triage, UI and partner (e.g. workforce services. Integrate web and phone service – e.g., ‘get representative to call me’ button in web applications, and information on phone queue wait times provided on website. Also PIN security.

2 Process: Present menu of options (basic triage) – either on phone, web or in-person. Intent is to provide a fast initial assessment of customer need and provide customers with an understanding of and access to the broad range of available UI and workforce partner services.

Triage and IVR phone trees will cover all UI and DDU benefits.

Self-help options should be prominent, enabling many to access information easily without agent intervention (e.g., change address, understand the certification requirements, etc.)

Basic triage must not become a bottleneck to accessing services behind this ‘single front end’

Transfer to specialist services. These services should be joined as seamlessly as possible. Preferred methods for transfer: (a) immediate transfer to available service provider, (b) automatic scheduling of appointments on behalf of these customers, (c) for least seamless services, triage representative should arrange the appointment(s) on behalf of the customer, (d) internet links to partner services.

(Note: Basic triage currently exists in segments of the UI organization, in the “greeter” function in one-stops and the initial phone tree).

Technology: Voice response IVR software will allow customers to state what their need is and the IVR will route to the appropriate service area. Internet will provide links to appropriate services (within or outside of UI)

Triage . . .

Claimant Triage: Explanations and Enablers (cont.)3 Process: Address simple questions (self help). Customers are directed to the FAQ component of the

phone or internet applications. Customers are encouraged to find the answer and if unable to do so, link to the agent assisted triage (at any point in the process customers can link to the agent assisted triage component).

Technology: From phone inquiries, voice response software will allow people to ask simple questions and route to the associated FAQ answers, On the internet, the system will provide links from questions to the associated FAQ answers. Where appropriate both the phone and internet will route customers to needed services

4 Process: Agent assisted triage – for the minority with greatest needs, for questions unanswered by FAQs, or for customers who opt for assisted triage. Customers are connected to triage representatives (on the phone, a “chat room” - instant messenger or a phone number( to call) if on the web, or in person at a One Stop). Triage representatives will assist with needs and direct the customer to any or all services.

Triage representation will include representatives from our workforce partners as well as UI Triage representative role is complex, requiring knowledge of a wide range of government

services. It should be highly valued in the organization, so as to encourage experienced, skilled staff to serve as triage representatives.

Technology: Chat Room, or instant messenger for those using the web

Triage . . .

The following process steps are the major transfers within the UI system…The principles shown here apply equally to customers needing to access the whole range of UI services: disability insurance, customer complaints, appeal filing, etc.

Claimant Triage: Explanations and Enablers (cont.)5 Process: File a claim or appeal. For people who want to move directly to filing a new claim, re-opening

an existing claim, or filing an appeal, they should be able to do so quickly, without struggling to navigate a tree of options (phone, web)

The customer’s preferred method of notification will be solicited at the point of first claim filing – and will be recorded as part of their electronic case file.

(See Intake to Adjudication and Appeals Process sections for further information)

Technology: Security: If the caller opts for a transaction from triage (claim entry, etc.), SSN and PIN number are required, and the system performs identity validation in the background. (When a claimant first chooses to select a transaction – primarily to file a claim – they will need to establish their PIN number. This option will be made available from triage, with both self-service and assisted options provided.)

Audit Trail: The system records and time-date stamps all transactions in the audit trail

Cross-matches: As a claimant enters information (phone or web), the system performs cross checks against specific databases. The system flags issues and routes to UI representative or professional investigator through the workflow module

6 Process: Certifying for continued weeks. A large proportion of callers will need to certify and so again should be able to do so quickly, without struggling to navigate a tree of options

Assumption: all certifications in future will be either telephone or web based (minimal mail) and web certification will be acknowledged via email.

(See continued claims process for further information)

Technology: See above (step 5)

Triage . . .

Claimant Triage: Explanations and Enablers (cont.)7 Process: Schedule for re-determination. If a claimant has had their benefits suspended for one of many

reasons, they will be able to quickly self-schedule for adjudication or re-determination

Technology: Enablers for this step include the automated scheduling and workflow systems

8 Process: Debt management. Customers needing to contact collections should again be clearly directed to the right service area

Technology: See above (step 5)

9 Process: Transfers to non-UI services should ideally be as seamless as those within UI. These transfers are outside the scope of UI Modernization. The Division will collaborate with these partners to achieve best results

Technology: Early phases of UI Modernization will provide phone numbers and links to partner services (e.g. Employment Services). Later phases will provide more integration between partners and might involve automated scheduling, data transfers, coordinated workflows

10 Process: Claimants will be able to access their electronic case file information and make changes to key information - for example, address - without having to speak to an agent (unless they wish to do so).

Technology: Electronic case file, IVR, web access

Triage . . .

Claimant Triage: Business Design Principles Immediate routing for services, based on simple but comprehensive menu of options Filter out claims with issues early and handle these rapidly Be akin to a real “one stop” Provide a reassuring environment that acknowledges the emotional aspects of the process Make access free and immediate Responsiveness – quick answers Provide a choice of access method Address customer needs quickly Minimize in-person contact / service (but make it available to those who need it) Triage co-presented with Employment Services/other partners Client-friendly service Facilitate self-service Claimants should be able to change all key information (e.g. address) info Enable customer informed choice regarding accessing UI representatives (e.g. provide actual wait times via

web application and IVR) UI representatives should see all key info, all claim information, all tracking info – with appropriate limits on

access (e.g. draft AT decisions, medical info) UI representatives should be trained on how to use key information (e.g. Address) UI should ensure there is sufficient queuing capacity to handle the volume of customers

Triage . . .

INPUTS OUTPUTS

Employer Triage – High-Level View of the Process

Triage . . .

Employer Triage Process

• Employer contacts to:• Alert UI to an issue• Check claim / appeal status• Schedule an appointment• File an appeal• Change key info (address)• Protest a charge• Etc.

• Employer’s questions are answered

• Appointment is scheduled (e.g. for fact finding)

• Self-service options accomplished (e.g. changing an address)

• Seamlessly and directly routed to the appropriate partners, including:

• Treasury• Employer accounts

• Etc.

Employer entry, Conceptual Process Diagram v0.2

Division of UITriage function(Joint UI-Fiscal partners service)

Employer



7. Protest acharge

1. Make contact

6. Make a refund

8. Log an appeal




(basic triage)

Employer triage, Conceptual Process Diagram

Division of UITriage function(Joint UI-Fiscal partners service)

Employer



6. Protest a(potential) charge

1. Make contact

7. Log an appeal




(basic triage)

Employer Triage: What’s New

Triage . . .

3

2

4

1

Please note that this process map does not include all possible outputs from the employer triage and inquiry process.

Employer Triage: What’s New (cont.)Menu of options will be similar to the IVR entry point, but will provide access to Division of UI and Employer Accounts services Early, initial assessment of employer needs Access to self-help options Access via integrated UI – Employer Accounts IVR system (with possible later joint representation in

the triage representative function) Connections to Partner services (where applicable) Disability during unemployment triage will be integrated into the same service

This service will probably make use of the Treasury employer PIN security already established. Triage representative to answer simple, quick questions about UI and Employer Accounts services Up-to-date, searchable lists of “Frequently Asked Questions” and their answers (web, and possibly

phone) Agent assisted counseling and support, newly available via IVR and possibly also web system

Easy and fast routing to key UI activities for employers (e.g. protesting of charges, appeal filing), via any of the entry channels

Seamless transfer to specialist services within and outside of the Division of UI

Triage . . .

1

2

3

4

Employer Triage: Explanations and Enablers1 Process: Make contact. To ‘triage’ employer tax inquiries and direct them to the appropriate specialists

via a single entry point., UI operations should co-present its employer services with Employer Accounts (and possibly Treasury, should they so choose) as closely as possible.

At the start, this should include effective integration of the Employer Accounts and UI IVR systems and appropriate links on each agency’s website (Note: Employer Accounts uses the My New Jersey portal as the access point.)

As a later, optional phase, employer triage should be jointly resourced by Employer Accounts and UI staff, accessed by a single phone number.

Technology: A key enabler is the effective integration of the UI and Employer Accounts IVR systems – and appropriate web links from UI to Employer Accounts and vice versa. Also employer authentication, using PKI or PINs.

2 Process: Present menu of options (basic triage) – either on phone or web. Do a fast initial assessment of employer needs

Self-help options should be prominent, enabling many to access information easily without intervention (e.g., change address, see UI activity against the employer, see tax rate). Effective routing to partners or co-presentation of information will be critical.

Change of primary address will need to be done via Employer Accounts or Treasury, change of secondary addresses (e.g., address where UI notifications or tax returns are sent) may be done via UI or Employer Accounts web page.

Employer authentication: this will require use of a PIN number, which is likely to be the PIN selected by Revenue and identified on the WR30.

Basic triage must not become a bottleneck to accessing services behind this ‘single front end’

Technology: Again, effective integration of UI and Employer Accounts IVR and web will be important.

An additional enabler is an IVR system with underpinning voice response software

Triage . . .

Employer Triage: Explanations and Enablers (cont.)3 Process: Assisted triage – for employers with complex needs. These customers to be filtered off from

main triage ‘system’ for advice on potential service needs

This may eventually be resourced by Employer Accounts and UI staff jointly

Technology: Assisted triage will be facilitated by a workflow system, and instant messenger for those via the web.

4 Process: Transfer for immediate non-UI assistance. This idea has so far only been discussed within UI. As a result, we do not yet know how transfers to Treasury and Employer Accounts would work.

Technology:Assisted triage will be facilitated by workflow and automated scheduling systems.

5 Process: Address questions. Simple questions are handled through FAQs by the employer (whether on the phone or internet. For questions unanswered by FAQ or if opting out, the employer will connect to a Triage representative by way of a phone connection, a “chat room” - instant messenger or a phone number( to call) if on the web, or in person at a One Stop).

Technology: Voice response software will allow people to ask questions which are routed to either FAQs answers or to a triage representative (depending on the amount of self help used by the employer). On the web, the employer would use FAQ screens for self help. The system provides instant messenger for those questions unanswered by FAQs answers or where the employer has opted for personalized assistance.

6, 7 – example employer reasons for contacting UI

Triage . . .

Employer Triage: Explanations and Enablers (cont.)6 Process: Protest a charge. An employer may wish to protest a current or potential UI claim charge as

the charge is hitting his/her company. These calls would be either be directed to a UI representative to log and to schedule a fact-finding.

Charging decisions will be fed automatically to Employer Accounts to inform experience rating. Employers will be informed that this transfer of information has occurred, so they do not unnecessarily contact Employer Accounts.

Technology: Enablers include a workflow system, and integrated Employer Accounts-UI web and IVR

7 Process: Log an appeal. Appeals will be possible by phone, web and letter.

Technology: A key enabler for phone appeals is voice-to-text software that converts a spoken message to a written appeal. Likewise the employer can file an appeal through the internet. The workflow system will route the appeal once received (by any channel) to the appropriate appeals staff

Triage . . .

Employer Triage: Business Design Principles Immediate routing for services Make access free and immediate Responsiveness – quick answers Provide a choice of access method Address customer needs quickly Minimize in-person contact / service (but make it available to those who need it) Client-friendly service Facilitate self-service Employers should be able to make auto changes to profile, ideally through Revenue, but should be able

to view profile via UI

– View: claims against company, scheduled calls & hearings, etc. UI representatives should see all key information (e.g. addresses), all claim information, all tracking

information – with appropriate limits on access (e.g. draft AT decisions, medical info) UI representatives should be trained on how to use key information (e.g. address)

Triage . . .

INTAKE AND ADJUDICATION PROCESS

Introduction to Intake and Adjudication This section presents the new intake and adjudication processes, in the following order:

– Intake and Adjudication


• Process map




Intake and Adjudication . . .

INPUTS OUTPUTS

Intake and Adjudication – High-Level View of the Process

Intake and Adjudication Process• Claimant:

• Decision to file a claim• Provide information

• Employer:• Provide information

(separation, etc.)• Mass layoffs: provision of

separation information at time of layoff

• Claimant:• Receive determination

(and information on next steps)

• Employer:• Receive determination

(and information on next steps)

• Receive non-charging determination


Intake and Adjudication, Conceptual Process Diagram, v0.2

Division of UI EmployerClaimant

1. Select to file aclaim

4. Validateclaimant's

identity

5. Assess fornon-qualifying

facts

7. Provideeligibility

information

8. Automateddetermination

Agent assistance NOT needed

6. Gatherremaining

information fromclaimant

10. Schedulefact-finding

9. Can animmediate

determinationbe made?

Agent assistance needed

No

14. Conduct factfinding

13. Review caseinformation prior

to appt

15. Makedetermination


information

11. Providefurther

information

2. For lay-offs,employer may sendin case information

early3. Enter

identifyinginformation

Yes

16. Notify ofdetermination &

next steps

20. Receive non-charging

determination

17. Receivedetermination

19. Notifyemployer of non-

chargingdetermination


Intake and Adjudication, Conceptual Process Diagram, v0.2Intake and Adjudication: What’s NewDivision of UI EmployerClaimant

1. Select to file aclaim

4. Validateclaimant's

identity

5. Assess fornon-qualifying

facts


information

8. Automateddetermination

Agent assistance NOT needed

6. Gatherremaining

information fromclaimant


9. Can animmediate

determinationbe made?

Agent assistance needed

No

14. Conduct factfinding

13. Review caseinformation prior

to appt

15. Makedetermination


information

11. Providefurther

information

2. For lay-offs,employer may sendin case information

early3. Enter

identifyinginformation

Yes

16. Notify ofdetermination &

next steps

20. Receive non-charging

determination


19. Notifyemployer of non-

chargingdetermination


1

3

2

5

4


Intake and Adjudication: What’s New Where possible, claimants will be able to interact with the agency in their own language In the case of mass layoffs, the Division of UI will encourage and enable employers to identify

individuals that were laid off, and provide non-monetary information (in advance via electronic means). This will reduce administrative elements of the response team’s work.

Employers have also requested the opportunity to review wage record (WR30) information, post-submission to confirm the right data was entered.

This information is stored in the system, and retrieved when one of these individuals files a claim At the stage of identity verification and eligibility validation, additional systems cross-checks will be

performed. If and when a flag is raised, an investigation will be triggered and an automatic notification can be sent to the claimant alerting them of the investigation. (See Preventing Overpayments for additional detail)

The key change here is the filtering off of claims that do not need UI representative intervention. These claims are filed via phone or web (only). At the point where the claimant has entered all information the CRM component of the system will either create a Electronic Case File for the Claimant or append an existing file.

Automated determination is a key element of processing claims-without-agents.

All notification (of claimants and employers) will be generated automatically – with a preference being for electronic communication methods.

As noted in the Triage and Inquiry Process, the customer’s preferred method of notification will be solicited at the point of entering the system for the first time (intake) – and will be recorded as part of their electronic case file. Employers’ preferred contact methods will also be recorded in their electronic case file.

Employers (and claimants, where possible) will be encouraged to provide information electronically to the Division of UI – whether via email or web forms.

All subsequent actions on a claim update the employer’s and claimant’s Electronic Case Files


1

2

3

4

5

Intake and Adjudication: Explanation and Enablers1 Process: Potential claimants will be able to select to file a new claim (or re-open one) via the telephone

or web. If a potential claimant is in a One Stop facility, he/she may receive help filing their claim via either of these methods – paper claims will not be accepted. Instead, claimants that are not able to self-serve will be assisted. These representatives (using the web) will work with claimant to enter their information and file a claim on their behalf. Submission of other claim information – for example, medical certification – will continue to be accepted on paper. (It should be noted that NJDOL will maintain the ability to create and process paper claims as a business continuity option.)

Technology: Voice recognition, voice-to-text software

2 Process: Employers conducting temporary or mass lay-offs will be enabled to submit non-monetary information electronically and in bulk to the Department, along with details of the employees affected. This information will be used to create a ‘template’ claim for those employees, which will be stored (in the new UI system) until such time as they file a claim. The resulting claims process will be faster and more consistent for those affected by lay-offs. It will also reduce administrative elements of the response team’s work, allowing them to focus on providing other assistance.

Employers have also requested the ability to review wage record (WR30) information post-submission, as an extra guarantee that the information has been transferred correctly. [This request to be discussed with Employer Accounts].

Technology: Ability to capture, store, and incorporate monetary and non-monetary information submitted early in the case of mass-layoffs; workflow system. These inputs either create or append the Electronic Case File for the Claimant.

3 Process: Enter identifying information. The claimant will be asked to select or enter his/her SSN and other identifying information.

Degree of identity information desired has not been defined (e.g., do we want to continue to allow claimants to file initial claims before SSN has been validated? Do we want to require additional identifying information?)

Technology: Voice recognition, voice-to-text software, ability to capture and store incomplete information


Intake and Adjudication: Explanation and Enablers (cont.)

4 Process: Validate claimant’s identity. As soon as the social security number is entered, the system will run cross-checks to assess if that social security number is valid – running checks against a Federal SSN database and against the INS SAVE system. (See Preventing Overpayments Section for details on other ongoing cross-checks.)

If a cross-check raises a serious potential problem with the claim, notification will be sent to a professional investigator to investigate the claim before any payment is made. The claim process will continue. Claimants will be notified that an investigation is ongoing (to deter ineligible claimants)

Technology: Automatic notification system, workflow, validation cross-checks (both real-time and batch)

5 Process: Assess for non-qualifying facts. The underlying principle is that as much information as possible to inform the claim should be provided via up front system feeds. So, in parallel to identity verification, the system will run cross-checks to assess if that social security number has any potential disqualifying factors attached to it (e.g., if it is registered on a company’s new hire or employee list). (See preventing overpayments for details.)

Again, if a cross-check raises a serious potential problem with the claim, notification will be sent to a professional investigator to investigate the claim before any payment is made, and a notice will be generated to the claimant. Exactly what should be sent to a professional investigator and what could be handled by a skilled claims representative is to be defined.

Technology: Automatic notification system, workflow, validation cross-checks, creation or update to the claimant’s Electronic Case File (CRM).



6 Process: Gather remaining information from the client. Where further information is required, the claimant will be asked questions through a series of automated prompts.

Information requested should include interaction preferences: what language would you prefer to work in? what address (postal or email) would you like as your preferred address for the Department of Labor?

Information gathering from points 2 to 6 must be as accurate as possible. Use should be made of tools and techniques to ensure accurate data collection – e.g., O*NET connector, automatic translation of address into county code etc

Technology: Enablers include the O*NET connector, validation software, voice recognition, voice-to-text software. A CRM solution includes many features that will allow for basic customer data verification including the creation of the Electronic Case File

7 Process: Provide eligibility information. Claimant provides information required for step 6.

Technology: None required.

8 Process: Unassisted claims or claims-without-agents. Wherever a claim can be determined without fact-finding (i.e.., in the case of single-party issues), an automated determination can be made. These claims-without-agents are vanilla claims for which all information can be captured by the system without needing human intervention.

Key assumption for phone filing: a voice recognition system must be able to collect address information accurately. Based on this assumption, the team estimated that approximately 60 - 70% of claims might qualify as unassisted.

Technology: Voice recognition, voice-to-text software, customer relationship management system (Electronic Case File), workflow system



9 Process: Assisted claims: Where (a) the system determines, by type of information outstanding (e.g., reason for separation), that the claim requires human intervention or (b) a claimant opts to work with a representative, the claim should be routed immediately to the next available representative.

The representative will assess the eligibility problem and resolve it if possible (in some cases, because the system will transfer all claims that might have issues, no real issue will be found. In this situation, the NJDOL rep will cross-check the information flagged by the system, add extra detail as needed, and complete the application with the help of the claimant).

Where a determination cannot be made immediately – I.e., all two-party issues - the representative will schedule a fact-finding as soon as possible.

When a claimant is filing outside of business hours (expanded to span 7am to 7pm), he/she should be given a choice to (a) phone the agency within 2 days (in business hours) and then be routed immediately to a representative or (b) have a representative call him/her the next day

Technology: Workflow system, customer relationship management system (Electronic Case File)

10 Process: Schedule fact-finding. The representative will schedule a detailed fact-finding interview as soon as possible. The relevant employer(s) will receive notice and a request for the requisite information – via the medium that employer has requested on its profile (email / internet / hard copy).

Fact-findings are scheduled as soon as possible. The agency will ensure that its workload is not the major factor in delaying fact-finding interviews.

Technology: Automated scheduling through the workflow system, expert system (to identify required information and generate requests for this information)



11 Process: Claimant provides eligibility information. The claimant may be asked to supplement his/her basic claim information with details on bonus, pension, wages/weeks etc. As it arrives that information must be appended immediately to the appropriate electronic case file (I.e., imaged, if on paper).

Technology: Internet eligibility screens, Workflow, customer relationship management system (Electronic Case File) – eligibility information, imaging capability (if documentation sent in by claimant or employer)

12 Process: Employer provides eligibility information. The employer may be asked to provide information on the specific claim – for example with details on bonus, pension, wages/weeks, reason for separation etc. Employers will be strongly encouraged to provide this information via electronic means (e.g. via email, or a web form). As it arrives that information must also be appended immediately to the appropriate electronic case file.

Technology: Internet eligibility screens, Workflow, customer relationship management system (Electronic Case File) – eligibility information, imaging (if documentation sent in by claimant or employer)



13 Process: Review case information prior to fact-finding appointment. Shortly before the appointment, the examiner reviews all claim information pertaining to the issues at hand. The system will store the flagged issues as well as any comments from the representative who scheduled the meeting. Any information sent in by either the claimant or his/her employers is accessible on the case file.

In some cases, an eligibility determination may be possible without full fact-finding (if both parties have sent in information and it agrees – e.g., on the reason for separation). In this situation, the examiner should be able to make a determination immediately and cancel the appointments. The examiner will build this review into their workload.

Technology: Customer relationship management system (Electronic Case File) – review comments, workflow, automated scheduling, imaging (if documentation sent in by claimant or employer)

14 Process: Conduct fact-finding. The examiner conducts fact-finding interviews with the claimant and employer(s) to determine eligibility. All information gathered during fact-finding is entered into the case file (including the fact-finding statement). Based on the information and prior steps, the examiner may take an affidavit or schedule a next step that allows employers to respond to requests for information.

Technology: Fact finding via email, instant messenger, or internet screens, Imaging (if documentation sent in by claimant or employer), Customer relationship management system (Electronic Case File) for fact finding information



15 Process: Make determination. Based on the information available, the examiner must make a determination. As well as allowing examiners to view standard reasons for denial/approval, the system will allow examiners to add free text reasons.

Technology: Customer relationship management system (Electronic Case File) for determination information

16 Process: Notify of determination and next steps. Notification is generated automatically.

Technology: Workflow and automated notification system (email, posted mail), Customer relationship management system (Electronic Case File) for next steps

17 Process: Employer notification – by method and to address specified in the key information (e.g. address)

Technology: Workflow and automated notification system (email, posted mail), Customer relationship management system (Electronic Case File) for employer notification dates and particulars

18 Process: Claimant notification – by method and to address specified in the key information. Next steps (dependent on determination) should include information on certification, appeal rights, reemployment assistance, and inquiries.

Technology: Workflow and automated notification system, Customer relationship management system (Electronic Case File) for claimant notification dates and particulars



19 Process: Notify employer(s) of non-charging determination.

Requires fuller analysis. Issues include:

Should non-charging be elevated to the importance of claims adjudication? What would be the impact on the Trust Fund and workload?

Should non-charging work be integrated into the claims workload or separated out? If separated out (a) would non-charging determinations simply need to be done before first payment? (b) would a parallel stream create extra set of correspondence for claimants and employers?

Should non-charging remain an employer-triggered process

Technology: Workflow, automated notification system (email, postal mail), Customer relationship management system (Electronic Case File) for employer case file determination information


Intake and Adjudication: Business Design PrinciplesPrinciples for customers Quick filing Provide a choice of access methods 90% + of our claimants will file via internet or phone – freeing up time to assist others who need more

assistance

Principles for employers Allow employers to pro-actively send qualifying information to agency Enable e-communication with employers

Principles for the agency Maintain a customer-focus Eliminate as much paperwork as possible Best management of wage data Claims-without-agents where possible Must follow due process Balance workload across state – optimizing staff and office utilization Share information with other functional groups efficiently Get it right the first time


CONTINUED CLAIMS AND PAYMENTS

Introduction to Continued Claims and Payments This section presents the new continued claims and payments process, in the following order:

– Continued Claims and Payments


• Process map




Note: the terms “suspend” and “suspended claim” are used in this section to emphasize a key difference of the new continued claims process – that claims will not be “pended” indefinitely. The goal is for suspended claims to be addressed immediately for in-business-hour certification attempts or within 48-hours for out-of-business-hour certification attempts where the claimant has chosen to contact the agency. (See process map and detailed explanatory notes for further clarification.)

Continued Claims and Payment . . .

INPUTS OUTPUTS

Continued Claims and Payment – High-Level View of the Process

Continued Claims and Payment Process• Claimant contacts Division to

certify • Claimant contacts UI after initial

claim has been filed• Claimant contacts UI after

continued claim has been suspended

• Payment• Claimant notified (of

successful, suspended, or denied certification)

• Claimant reminded if fails to contact UI after certification was suspended

• Routing to adjudication process

• Routing for preventative investigation

• Routed to an agent


Continued Claims: Conceptual Process Diagram

Claimant Division of Unemployment Insurance

9. Suspendcertification andnotify claimant

5. Approvecontinued claim

(automatic)

1. Contact UI

Flagged, ornon-preferred

answers

Preferredanswers

6. Make payment(automatic)

2. Validate identityand access profile

7. Receivepayment

After bus. hrs In bus. hrs

15. Schedulefact finding

16. Route toadjudication

Two-party issue

One-partyissue

Yes

Don'tknow

No

13. Determineineligible (part/

whole)

14. Deny

17. Notify andprovide contact

options

19. Claimantto initiatecontact

18. Selectpreferred option

21. UI toinitiatecontact

No call within48 hrs

23. Contact UI,after cert

suspended

3. Route forpreventativeinvestigation

10.Immediately

route to agent

20. Sendreminder

(automatic)

22. Allocateas workload

item

Call within 48 hrs

8. Notify claimant &update claimant profile

(automatic)

12. Assess ifclaimant eligible

11. Identify ifone or twoparty issue

4. Validateeligibility

Continued Claims: Conceptual Process DiagramContinued Claims & Payment: What’s NewClaimant Division of Unemployment Insurance


5. Approve continuedclaim (automatic)

1. Contact UI


answers

Preferredanswers



7. Receivepayment




Two-party issue

One-partyissue

Yes

Don'tknow

No


whole)

14. Deny


options






suspended


10.Immediately

route to agent

20. Sendreminder

(automatic)

Call within 48 hrs


(automatic)




Agentcorrectserrors

22. Establishoverpayment

1 4

8

7 5

69

3

2

10

Continued Claims

and Payment

. . .

Continued Claims and Payment: New and Enhanced Functionality

At the stage of identity verification and eligibility validation, additional systems cross-checks will be performed. If and when a flag is raised, an investigation is triggered and an automatic notification is sent to the claimant alerting them of the investigation. (See Preventing Overpayments for additional detail)

Automatic payments are facilitated by the additional of direct deposit and/or UI debit cards as payment options. (A full cost/benefit analysis will determine the option(s) selected)

Automatic notification is provided to the claimant at the end of the certification process via the means selected by the claimant during intake.

If any issues are encountered during certification, a claimant is notified that the claim has been suspended and what the precise ramifications of the claim suspension. In business hours (7 AM to 7 PM), the claims are routed directly to an agent (or provided the opportunity to resolve the issues by conversing with a UI representative via instant messenger technology).

Claimants calling during business hours will be immediately routed to a representative, who will be able to determine whether the claimant is eligible, whether fact finding is required, or whether the claimant should be paid immediately.

The speed with which certification issues can be resolved depends on whether there are multiple-party issues. The process has been altered to streamline the resolution of single-party issues, and allow for the best allocation of adjudication resources for other issues.

Claimants will be immediately notified if their certification attempt made out-of-business hours (7 PM to 7 AM) is suspended and provided their next step options.

Claimants are able to select their preferred option for resolution of any issues encountered during certification.


1

2

3

4

5

6

7

8

Continued Claims and Payment: New and Enhanced Functionality (cont.)

If issues are encountered during out-of-business hour certification, claimants will be provided the option of calling NJDOL UI during business hours and being routed directly to someone who will access their electronic case file and resolve the issue (or they can re-access the certification web site) – or they can choose to have NJDOL call them back.

Claimants who fail to contact the agency within the agreed amount of time will be issued one automatic reminder via the means selected at intake. After this reminder, NJDOL UI will not proactively follow up.

The benefit of this process step has not been fully investigated.


9

10

Continued Claims and Payment: Explanation and Enablers

1 Process: Claimants will contact NJDOL UI to certify via phone, web, or in-person in a One Stop. (The stated aim is that at least 95% of all claimants use either phone or web, so that resources can be freed up in One Stops to assist those who need hands-on help).

Technology: No additional enablers required.

2 Process: Validate identity and access profile. Claimants will provide identifying information (likely SSN and pin number) so UI representative can verify identity and access claimant electronic case file.

Identity validation process has not been defined.

Technology: Workflow, potentially additional identify validation crosschecks.

3 Process: Route for preventative investigation. Where a cross-check flags a potentially serious eligibility issue, notification is sent to a professional investigator to trigger an investigation. (See Preventing Overpayments for additional information).

Not confirmed how this will work when in parallel with certification process

Technology: Automatic notification

4 Process: Validate eligibility – using a pre-established set of questions, validate claimant eligibility for continued benefits. A large majority of certifications should be conducted on the phone or over the web (even if representative assistance is needed).

Idea: provide reemployment services information when claimants are waiting.

Technology: Workflow


Continued Claims and Payment: Explanation and Enablers (cont.)Steps 5-8 represent the certification process for issue-free claims where the preferred answers are provided

5 Process: If the claimant has provided the preferred answers to the eligibility validation questions (step 4), they are automatically approved and routed for payment


6 Process: Make payment. The claimant’s payment is automatically approved by the system, and generated via the mechanism they selected at the initial claims process.

The payment options that will be available to claimants (and may be used to offset refunds) may include direct deposit, UI debit card and check, but may be limited to two options as debit cards and checks meet the same customer need – payments for those without bank accounts.

Technology: Workflow system

7 Process: Receive payment. The claimant receives payment via the payment mechanism they selected. In some cases he/she may be notified that the payment has been allocated against a refund owed.

Technology: None.

8 Process: Notification to claimant is generated automatically. This notification should include the amount of the payment, the date, the next certification date and options, and information on how to access reemployment services, and other workforce services as appropriate.

Note: it was suggested that the certification frequency should remain 2 weeks, but the new system will be flexible enough to handle different certification schedules.

Technology: Automatic notification system, workflow


Continued Claims and Payment: Explanation and Enablers (cont.)Steps 9-16 represent the certification process when issues are present, and certification occurs during business hours (7 AM to 7 PM)

9 Process: Suspend certification. If a claimant provides “non-preferred answers” to the eligibility questions, he/ she will be provided the opportunity to confirm his/her answer choice (to minimize possibility that information was improperly entered). If he/she confirms the non-preferred answer, the certification is “suspended” and he/she will be notified.

Within standard business hours, this claim will be immediately routed to a UI representative (step 10); outside of business hours, they will be notified and provided with their contact options (step 17) and what that means.


10 Process: Immediately route to representative.If a claim is suspended during business hours (step 9) or if a claimant selects the option of contacting the agency at step 19, the claimant will be routed directly to an appropriate UI representative.

If a representative is able to clarify a claimant’s questions or correct an error, the claimant can be routed back to the automated, claims-without-agents continued claims process (step 5).

For suspended certification during business hours, a claimant certifying by phone will be transferred to the appropriate representative. Claimants certifying via the web during business hours could be provided the option of using a “instant messenger” system whereby the representative could interview them in real-time, via the web.

Note: if a claimant web certifying chose not to use the instant messenger option, they would be routed to step 17 whereby they would be able to elect that a UI representative call them back.

Technology: Workflow, call routing, instant messenger


Continued Claims and Payment: Explanation and Enablers (cont.)11 Process: The UI representative will decide whether the certification “problem” is a one or a two party

issue. If a two party issue (i.e. an issue involving the employer), the fact finding is scheduled as soon as possible (step 15). If a single party issue, the UI representative would immediately address the certification issue (step 12).

Technology: Automated scheduling, expert system, workflow

12 Process: One party issue – assess if eligible. The UI representative proceeds to determine whether the claimant is eligible, enters the result in the system, and proceeds to step 13 (ineligible) or 5 (eligible).

Note: the workload impact of the ‘assisted certification’ model as described here is unknown.

Technology: Expert system, workflow

13 Process: Determine as ineligible. If the claimant failed to meet the certification criteria, he/she is identified as being ineligible by the representative, who immediately enters the result in the system.


14 Process: Deny. If ineligible, the claimant is denied benefits and immediately notified (see step 8). If there has been an overpayment, the claim will set up for overpayment (step 22).

Technology: Workflow, automatic notification system

15 Process: Schedule fact-finding. If the claimant’s certification issue is identified as a two-party issue (i.e., it involves the employer for any reason), the representative must schedule a fact-finding as soon as possible – while maintaining due process – and provide the claimant with “next step” information.

Technology: Automated scheduling, workflow, automated notification

16 Process: Route to adjudication. The case then re-enters the adjudication process.



Continued Claims and Payment: Explanation and Enablers (cont.)Steps 17-22 represent the certification process when issues are present, and certification occurs outside of business hours (7 AM to 7 PM). (These process steps are relevant only for web and phone certification – as in-person certification will be naturally limited to business hours.)

17 Process: If the claimant encounters a problem (when attempting to certify for benefits outside business hours, the claimant is informed of his/her options: (1) to contact NJDOL UI again during business hours (via local number, or by re-accessing the web site) (step 19), or (2) request that the agency calls him/her back the next day (step 21).

Technology: Enablers include the workflow system and case management.

18 Process: Claimant selects preferred option (claimant or agency initiated follow-up).

Technology: None.

19 Process: Claimant to initiate contact. If claimant selects to call UI, he/she is directed do so within a given time period (The time period discussed within the workshops was 48 hours, however this merits further analysis.) in order to be routed directly to a representative, who is able to easily access the record of their attempted certification and quickly address any remaining issues. If the web is the preferred method of certification, a claimant can re-access the certification web site.

The claim then rejoins the ‘issue arises with certification – in business hours’ process (step 10).

Technology: Workflow.


Continued Claims and Payment: Explanation and Enablers (cont.)20 Process: Send reminder. If claimant does not contact within 48 hours (or the default time frame), the

system will automatically generate and send a letter or email stating that the claim will not be reopened until the claimant takes further actions.

[Note: the process by which claimants reenter system after the lag period elapsed was not discussed]

Technology: Automated notification, workflow system

21 Process: If claimant chooses to have UI call him/her, the claimant confirms their preferred contact details (provided during the initial claims process) and provides their preferred contact dates and times. These are routed to the next available UI representative


22 Process: Establish overpayment. If there has been an overpayment, the claim will be routed to Collections.



Continued Claims and Payment: Business Design Principles Contact to certify by phone or web (95%), other 5% certify manually or on paper At each certification, amount of payment per week and remaining balance will be provided through the

case file Allow 48 hour “fix period” before sending out letter informing didn’t certify correctly If call is received within business hours, customers should be able to get through in less than 5 minutes Extend business hours, to no more than 12 hours / 5 days Enable claimants to reconfirm certification answers Full tracking / audit trail; including where representative changes claimant responses for certification Claimant option of card vs. auto payment vs. check Different certification models (to be enabled on same system, e.g. DDU) “Workflow” transfers actions (and tracks progress) across all units in UI If certification issues arise out-of-hours, workflow creates call-back assignments OR leave action to

claimant to get resolved Assume someone manages workload queues across resources Customers should be able to find out status of claim via IVR (e.g. is issued x resolved?) As much as practical, get real time data Perform cross-match during continued claims as often as cross-match data is updated and available


PREVENTING OVERPAYMENTS

Introduction to Preventing Overpayments Process Preventing Overpayments Process

– This section presents the new preventing overpayments process, in the following order:

• Diagram depicting the relationship of the Preventing Overpayments process to the Intake and Adjudication and Continued Claims processes


• Process map




Note: the Preventing Overpayments Process applies both to new and to continued claims.

Preventing Overpayments . . .

Continued Claims: Conceptual Process Diagram

Claimant Division of Unemployment Insurance


5. Approve continuedclaim (automatic)

1. Contact UI


answers

Preferredanswers



7. Receivepayment




Two-party issue

One-partyissue

Yes

Don'tknow

No


whole)

14. Deny


options






suspended


10.Immediately

route to agent

20. Sendreminder

(automatic)

Call within 48 hrs


(automatic)




Agentcorrectserrors

22. Establishoverpayment

Continued Claims & Payment Process – SNAPSHOT

Intake & Adjudication Process – SNAPSHOT

Introduction: Relationship to Other Processes


The preventing overpayments

process occurs concurrently with

these process steps

INPUTS OUTPUTS

Preventing Overpayments – High-Level View of the Process

Preventing Overpayments Process

Verify identity• Social security number, address• Other security identifier• Citizenship status (INS)• Homeland security cross-match• Employee addressesVerify qualifying information• Cross-matches: New hire, state

vendor, corporate officer, current claimant, Dept of Corrections, death certificates, bankruptcy

Collate available eligibility information• Pension information• Wage records• Separation information (if provided)• Social security wage data• Cross-matches: state tax, child

support, workers’ compensation, special (injury) compensation

• Outstanding debt (intra- or interstate)• ECF history (incl. previous claim data)

• Ineligible claims identified and denied before and after first payment

• Denial notification, to include rights information and other workforce service information

• Investigation


Preventing fraud and overpayments: conceptual process diagram

Agency

Core process steps: intakeor continued claims

EmployerClaimant

2.Validateeligibility

1a.Choose to filea claim

5. UI agenthandles issue

6. Routed toBPC for

investigation

8. Provideinformation


14. Receivenotification

11. Notifyclaimant

3. Cross-check flag?

7. BPCinvestigates

10. Resolve asineligible

12. Send forcriminal

investigation

13. Processcollection

1b.Choose tocertify

4a. Continue withintake and

adjudication process

4b. Continue withcontinued claims

process

9. Resolve aseligible



Agency


OutsideagencyEmployerClaimant



All claims

5. Routed toUI agent

6. Routed toprofessional

investigator andsend notification

8. Provideinformation8. Provide

information

11. Sendnotification(automatic)

3. Cross-check flag

7. Professionalinvestigates

10. Benefitsdenied

12. Send forpossible criminal

investigation


1b.Choose tocertify

4. Continue withintake or continued

claims process

9. Benefitsallowed

UI agent resolves issue



If two-party issue, or where employer will be credited




UI agent cannot resolve issue

Preventing Overpayments: What’s New

1

3

2

4

Preventing Overpayments: New and Enhanced Functionality

The emphasis on preventing overpayments is new for NJDOL UI. The benefits of preventing overpayments reduces the number of possible issues and narrows the focus to those issues truly requiring attention

Preventing overpayments, as well as investigations will become even more integrated with day-to-day UI operations.

The number and type of cross-checks done early in the process will be expanded, and will be done on the most recent data available (real-time data may not be available).

If a cross-check flag is raised, the process of filing a claim or certifying will continue

Flagged cross-checks will be addressed by appropriately trained UI representatives, to quickly resolve basic issues, and determine those issues that require handling by a professional investigator. Appropriately trained representatives should be able to resolve issues concerning such things as incorrect addresses and names. If the UI representative is able to handle the issue, they will do so and allow the claimant to continue filing their initial claim or certifying their continued claim. If they cannot address the issue, they will route it (via workflow) to a professional investigator for additional investigation. The claim filing process will continue even while an investigation is ongoing also.

Claimants may be notified about an investigation as early as possible. This notification will be generated automatically and will acknowledge all previous communications from NJ DOL UI and explain the nature of the inquiry. (This is expected to have a significant deterrent effect on ineligible claimants.)


1

2

3

4

Preventing Overpayments: Explanation and Enablers1 Process: When a claimant chooses to file a new claim (or reopen an existing claim), he/she will be able

to do so via phone or web – and will have the choice to file unassisted (a claim-without-agents), or with the assistance of a UI representative. (See triage, intake-to-adjudication, and continued claims processes for details)

Technology: No additional enablers required.

2 Process: Validate eligibility. This is a key step of the claim filing process, done behind the scenes. Upon entry of a social security number (SSN), the system will cross-check that SSN and other claimant information against a range of other government databases to

Verify the identity of the claimant

Identify whether the claimant qualifies for UI (gathering information required for any UI program at this stage)

Gather available eligibility information (new hire cross-match, immigrant status, etc.)

The preventing overpayments inputs and outputs diagram (presented earlier – with the large arrows) depicts the full list of potential cross-matches. Any cross-checks must be done against the latest version of the databases possible.

Technology: New technology enablers include up-to-date databases of information against which the SSN of every claimant can be run, workflow, (validation crosschecks), CRM system (electronic case file), and intelligent systems


Preventing Overpayments: Explanation and Enablers (cont.)3 Process: If a cross-check result is positive during intake or certification, the case will be transferred to a

UI-claims-skilled representative for investigation/resolution. (The claimant will be notified that an investigation has been initiated, and this notification will acknowledge any previous communications sent to the claimant.)

Procedures will be needed to define:

Which cross-match issues should be directed immediately to a professional investigator? (It is likely that these will be the more serious issues.)

Which cross-match issues should be directed immediately to a UI-skilled resource? (These may include questions about claimant key data: name, date of birth, social security number, address, and possibly others)

(Note: the workshop participants discussed a different process whereby the expert system would identify those issues that required full investigation and that some cross-flag issues would be directly routed to a professional investigator.)

The process steps in the case of a positive cross-match for each data source should take into account factors such as the reliability and sensitivity of the data source.

Technology: Workflow systems, automatic notification, CRM system (electronic case file)

4 Process: Continue with initial claim (or certification process). Unless an appropriately trained UI representative interacts with the claimant to resolve a cross-flag issue, the initial investigation process will continue parallel to the claim filing or certifying, and be transparent to the claimant (See the intake to adjudication and continued claims processes for details).

Technology: No additional technology enablers required.


Preventing Overpayments: Explanation and Enablers (cont.)5 Process: Routed to UI representative. Flagged cross-match issues are routed directly to an available

and appropriately trained representative for resolution.

If the representative is able to resolve the issue, the claimant is returned to the initial claim filing process. (Representatives will likely be able to address incorrect SSN, name spelling, address problems, etc)

[Note: workshop did not determine if this would mean transferring claimants back to the IVR]

If the representative identifies that the issue is potentially more complex or serious, he/she will be able to send it to a professional investigator for further investigation and return the claimant back to the initial claim filing process

Technology: Workflow, expert system, CRM system (electronic case file)

6 Process: Routed to professional investigator for investigation. The “flagged” cross-matches that cannot be resolved simply by a UI representative should be automatically included into the workload for investigations. Because they will need to be investigated before the first payment is made (for optimal results), these work items should also be flagged with a deadline date.

Technology: Workflow, CRM system (electronic case file)

7 Process: Professional investigator investigates. The detailed investigation process is not yet developed [as of 4/23 – we are meeting with BPC to review and redesign the investigations process]. For all investigations pertaining to an initial claim, an automatic reminder should be set ‘a few days’ before the first payment deadline – reminding the representative to review the possibility of suspending the claim’s eligibility for further investigation (and also as a reminder of the work item!) (The investigation process is briefly discussed in the following section of this document.)

Technology: Likely to include expert system, automatic scheduling and notification


Preventing Overpayments: Explanation and Enablers (cont.)8 Process: Provide information. Claimants and employers will provide required information for

investigation process (which remains to be defined).

Technology: Workflow, CRM (electronic case file), potentially imaging solutions

9 Process: Resolve as eligible. If the investigation resolves that the claimant is eligible, the finding is logged and investigation closed.

Technology: Workflow, CRM (electronic case file)

10 Process: Resolve as ineligible. If the claimant is found to be ineligible, the finding is logged on the system


11 Process: Deny claim. Once the claim is formally denied…

If before first payment, the claim is denied and the claimant notified (including all usual extra information) and provided next step information (e.g. how to file an appeal)

If after first payment, the claim is denied, the claimant notified and the collection process automatically triggered (See financial processes section.)

Claimant will receive appeal rights, employment services information etc in the same way as if determined ineligible in the usual way.

Technology: Workflow, CRM (electronic case file), automated scheduling

12 Process: Send for potential criminal prosecution (where appropriate). This is likely to be an exceptional outcome of the preventing overpayments process.



Preventing Overpayments: Explanation and Enablers (cont.)13 Process: Process collection. A collection process will be automatically triggered if a payment has been

made prior to denial (See financial processes section for details)


14 Process: Claimant will be notified of any change of status to his/her claim, via the preferred method he/she indicated early in the process. Importantly, any notification sent to the claimant regarding an overpayment prevention investigation will acknowledge any previous communication from the Division.

Technology: Automated notification, workflow, CRM (electronic case file)


Preventing Overpayments: Business Design Principles

Preventing overpayments focuses on ensuring that only eligible claimants receive payment . However, the agency will err on the side of paying claims: only where there is sufficient evidence that the claim is invalid (or ineligible) will a claim be denied or payment stopped.

The process steps in the case of a “flagged” cross-match for each data source should take into account factors such as the reliability and sensitivity of the data source.


INVESTIGATING OVERPAYMENTS

IntroductionContents This section presents the process-specific business design principles for investigating overpayments.

Note: Initially, the investigation process was planned for review by BPC in the Spring of 2003 as part of the

BARTS II requirements. However, for completeness and at the request of the UI Director , we have scheduled an extra workshop session to cover investigations; this session falls outside the deadline for delivery of this deliverable to the Quality Review Board (April 25). We will include the redesigned process in the following iteration, allowing for review outside the formal cycle.

Investigating Overpayments . . .

Investigating Overpayments: Business Design Principles

Investigators should be responsible for - and enabled to – take an investigation from start to finish (including triggering the collections process)

Claim agents and/or adjudicators may assume additional validation actions in response to cross-match flags Telephone fact-finding should be used where possible in investigations, recognizing the need at times for in-person fact-

finding Ongoing training to keep up with patterns of fraud/overpayments Solution must meet all the general IT principles – flexible, scalable, reliable etc – and must be maintain-able internally Need to be able to auto-prioritize cases: where the claimant is currently claiming, allegations etc Need to link investigations cases (taken from BARTS or equivalent) to the full claim history stored on the full UI system Need flag to BPC when wage record is changed, for any cases under investigation Investigations process should include setting up refunds (collections) All correspondence should be electronic where possible It should be as easy as possible for our customers to send data into the agency (e.g., employers sending in B98

information)

Detailed principles Would like wages to be separated from other earnings on WR30 (outside UI control) Consider having return addresses on letters personalized to investigators – so information can be acted upon

immediately (where email not appropriate) Need to become pro-active in response to potential IT vulnerabilities – maybe in partnership with OIT/DIT Correspondence during investigations should include a specific contact route for investigations queries Replacement system must overcome current constraints such as accurate FEINs and limited characters per field


Ideas and quick wins Use the new hire directory to trace people – as a debtor locator for wage garnishments (refunds) etc Provide Adobe Acrobat reader to collections team, so they can read the list of bankruptcies Have an annual amnesty on debt interest – thereby encouraging full payment of principles Have an outside company (e.g., a bank) present on identity theft and how to guard against it Present at employer seminars again, to remind them about BPC processes Improve the B98 form

– Date terminated not same as last day of work


INPUTS OUTPUTS

Investigating Overpayments – High-Level View of the Process

Investigating Overpayments Process

• Referral during intake & adjudication process

• Allegation (hotline & other sources)• Historical cross-matches

• Collections process• Criminal prosecution• Civil prosecution• Case closes


Agency


EmployerClaimant



5. UI agenthandles issue

6. Routed toBPC for

investigation




11. Notifyclaimant

3. Cross-check flag?

7. BPCinvestigates

10. Resolve asineligible

12. Send forcriminal

investigation


1b.Choose tocertify

4a. Continue withintake and

adjudication process

4b. Continue withcontinued claims

process

9. Resolve aseligible


Investigating fraud and overpayments: conceptual process diagram

1. Input or referral2. Send

request forinformation

Agency ClaimantEmployer


electronic transfer(preferred) or paper

4. Receiveinformation electronic transfer (preferred) or paper

5. Enter datareceived on paper

into system

6. Assign caseautomatically

7. Collate casefile (centrally)

8. Send caseto investigator

9. Review casefile

10. Validate &test information

11. Notify claimant&request evidence as

needed


13. Receiveinformation

14. Claimantrequests fact-

finding


16. Fact-finding

17. Make decision& set up refund

18. Close case 19. Send forprosecution

within 30 days

16. Fact-finding


Investigating Overpayments: What’s New

1

32 4

5

6

7


Investigating Overpayments: New and Enhanced Functionality

Requests for information on potential overpayment and fraud cases will be sent out to employers electronically – and returned electronically - where possible. Large employers and employer agents should be provided means of responding in bulk, rather than on a case-by-case basis – to increase the percentage of responses.

Cases will be assigned to investigators automatically, based on a number of rules – for example, by skill-set / location / individuals’ workloads.

Case file collation will be a much faster process, as all information will be attached to the claimant and employer electronic case files.

Investigation cases will therefore be transferred to investigators electronically also. All investigators will also have access to the core UI system remotely.

Where a fact-finding is required, the claimant will be able to schedule the session him/her –self via the phone or web. They will also be able to do so through the triage function: the investigations fact-finding schedule will be accessible to all. The agency may put parameters on the options available (e.g., within 3 weeks).

The majority of fact-findings will be conducted via the phone, unless there is a specific reason why an in-person interview is required.

Investigators will be responsible for setting up refunds where that is the outcome of the investigation. This will be a simpler process step, supported by the system. There will be NO rekeying.

1

2

3

4

5

6

7


Investigating Overpayments: Explanation and Enablers

1 Process: Input or referral. The triggers for the investigations process are (a) referrals from the preventative cross-matches run during initial claims and continued claims, (b) allegations – via the hotline or any other source and (c) ‘historical’ cross-match results where recent claims history is reviewed for patterns.Technology: All triggers will be automatic, as a result of the cross-check edits component of the UI system.

2 Process: Send request for information. Where possible, this will be done electronically. An immediate request for confirmation and review of previously submitted information will be sent to the relevant employers. (This is currently the B98).

Option: send out these requests in batch, to help employers manage their side of the workflow. This might be particularly helpful for large employers and employer agentsOption: the format of information requests should be tailored by type of employer/employer agent. E.g., web form for single cases / accept bulk wage record information from larger companies?Option: co-ordinate correspondence sent, with that sent by UI/DI – so employers do not receive more than one request for the same information

The request for information must be worded as simply as possible, to minimize employer queries.Technology: Email, secure file transfer, workflow, eforms, web, CRM (electronic case file)

3 Process: Send information. See 2, aboveTechnology: See 2, above

4 Process: Receive information. Information received back from employers will be accepted directly into the system. Technology: See 2, above

5 Process: Enter data received on paper into the system. To continue to cater for less technical employers, where information is submitted on paper, this will need to be entered into the system using imaging software.Technology: Imaging, workflow, CRM (electronic case file)


Investigating Overpayments: Explanation and Enablers

6 Process: Assign case automatically. As soon as ‘B98’ information has been received into the system, the case will be automatically assigned to an investigator. Assigning a case will take into account a number of factors, including workload of each investigator, their skills and their location.


7 Process: Collate case file (centrally). The investigations case file will contain some extra information to the standard claims file. It will also be stored on the system. Access to the investigations case file may need to be limited. The collation process will therefore become a validation of the electronic information.


8 Process: Send case to an investigator. The case file will be transferred automatically to the investigator for action.


9 Process: Review case file. The investigator will review the file and the actions needed. To avoid duplication, for example investigators cross-checking addresses, the case file will be online and key information updated in real-time.

Technology: Workflow, CRM (electronic case files)

10 Process: Validate and test information. The key activities of an investigation will vary from case to case – may include interviewing employers, co-workers and research.

Technology: Variable, CRM (electronic case file)

11 Process: Notify claimant and request evidence as needed. The claimant is presented with the evidence trail and is allowed 30 days to respond. Depending on the preferences of each claimant, he/she may be notified by email

Technology: Imaging, workflow, CRM (electronic case file)


12 Process: Provide information (possible). The claimant may submit extra evidence to the investigator in the course of the investigation.Technology: email possible

13 Process: Receive information. The claimant will have the option of submitting extra evidence on paper or electronically.Technology: email, imaging, workflow, CRM (electronic case file)

14 Process: Claimant requests fact-finding. After notification, the claimant has thirty days to request a fact-finding.Technology: CRM (electronic case file)

15 Process: Schedule fact-finding. The claimant will be able to schedule the fact-finding interview him/her –self, via the phone or the web. Alternatively, he/she may do so through a triage representative who will also have access to the schedule(s). The agency may put parameters on the options available (e.g., within 3 weeks). Technology: Workflow, scheduling software, IVR, web

16 Process: Fact-finding. The vast majority of fact-finding interviews will be held on the telephone, unless a specific reason for in-person interview is identified. Notes from the fact-finding should be entered directly into the system.Technology: Phone system, eforms, CRM (electronic case file), workflow

17 Process: Make decision and set up refund. The investigator will make his/her decision and enter that into the computer. The decision type will automatically trigger notification, the content of the letter to be sent and the next actions (e.g., set up a refund). Depending on the preferences of each claimant, he/she may be notified by email. The refund will be set up automatically from the decision. The investigator will be responsible and will be assisted supported by automated calculations and workflow. Once the refund is set-up, ownership will transfer to the Collections unit.Technology: Workflow, CRM (electronic case file)

Investigating Overpayments: Explanation and EnablersInvestigating Overpayments . . .

18 Process: Close case. Where there is no case to answer, the case will be closed by the investigator and a history of the investigation maintained on the system.

Technology: CRM (electronic case file), data warehouse

19 Process: Send for prosecution. Where a case of extensive fraud/overpayment is established, the case can be transferred to the Attorney General’s office for further investigation (whether criminal or civil). The transfer will be in a format appropriate to the AG’s office.

Technology: CRM (electronic case file)

20 Process: Receive notification. The claimant will receive notice of the outcome of the investigation, by his/her preferred communications method.

Technology: N/A

Investigating Overpayments: Explanation and EnablersInvestigating Overpayments . . .

Current Challenges to Investigations Incorrect addresses for employers and claimants Volume of B98s returned by employers is low Information returned by employers is often incorrect. They fill out the B98 poorly. E.g.,

– Wrong pay weeks

– Wrong SSN

– Incorrectly show when the money was earned (often show when money paid, not earned) System is not flexible in understanding names (e.g., search for Reilly and if someone is called O’Reilly,

doesn’t come up) No verification in BARTS on correct address or social security number Can’t expunge history – e.g., if someone has suffered identity theft Don’t know if we are picking up on tell-tale signs of identity theft (patterns etc) Employer responses are only submitted on paper currently Employers can’t send batch returns Staff can’t correct data entry problems in real time – all batch processing in the BARTS system Incomplete case information (files) provided to the field investigators – such as payroll, case assembly -

meaning they conduct their own preparation (rework) Field investigators don’t have online access to full case history – only the BARTS extract, which covers a

maximum of four quarters. There is no synchronization or link with the full claim history on LOOPS Common cases involve off the books employment, fictitious employers, imposters, corporate officer

claiming and identity theft We don’t yet fully understand the new Federal standards (and the new regulation on equity and good

conscience) and implications for what we focus on


Current Challenges to Investigations (Cont.) Investigators don’t complete the process (don’t set up refunds) BPC and all UI activity is low priority for employers but we rely on them for most of our information:

responding to BPC is purely altruistic – no immediate return Employers are constantly calling regarding the B98 form, with a large number of basic questions being

asked

Preventing overpayments Don’t prepare for future threats, have forward thinking. For example, new technologies mean more and

varied opportunities for prevention and for types of fraud. Not doing anything about them Adjudication centers aren’t responsive to BPC referrals

Debt management, collections Don’t have full information on the history behind debts we have to collect. Difficult to respond to customer

concerns. Knowing about bankruptcies in order to trigger appropriate action; proof of claim, suspension of collection

activities Political intervention undermining debt decisions Don’t use many collections methods used in wider industry…. E.g.,

– Cold calling (legal issues?)

– Pro-active debt collection through agencies (may require legislation as they demand a % of the principle)

Don’t allow credit card payments of debts Don’t allow ‘direct debit’ style payment of debts by claimants


APPEALS

Introduction to Appeals This section presents the new appeals processes, in the following order:

– Appeals Tribunal


• Process map



– Board of Review


• Process map



– Underlying business principles

Appeals . . .

Appeals Tribunal jurisdiction

AT Appeals: Conceptual Process Diagram

Appealing Party Division of Unemployment Insurance Other InterestedParties

1. Requestsreconsideration

5. Receivenotification &information


7. Party/Advocaterequests case info

9. Hold hearing

12. Automatednotification

13. Remand back toUI for re-adjudication

2. UI review ofdetermination

6. Provide (accessto) case

information ifrequested


11. UI automatednext steps

10. Make decision

8. Schedulehearing

3. Re-determination by UI

4. Case pre-review

INPUTS OUTPUTS

AT Appeals – High-Level View of the Process

AT Appeals Process• Party requests

reconsideration• Any party (or party’s

advocate) requests case information

• All parties notified and provided information

• Routed to UI for:• Re-determination • Re-adjudication• Notification of

decision to originating Adjudication Center

Appeals . . .

Appeals . . .

AT Appeals: What’s New

Appeals Tribunal jurisdiction

AT Appeals: Conceptual Process Diagram

Appealing Party Division of Unemployment Insurance Other InterestedParties

1. Requestsreconsideration




9. Hold hearing

12. Automatednotification

13. Remand back toUI for re-adjudication

2. UI review ofdetermination

6. Provide (accessto) case

information ifrequested



10. Make decision

8. Schedulehearing

3. Re-determination by UI

4. Case pre-review

1

23

4

5

* All steps that involve a change to the claim, customer or employer information update the Electronic Case File

An online case law library will be made available to all parties within and external to the agency Parties will be able to request a reconsideration via phone, taking advantage of voice-to-text software

(as well as via the web or by mail – as currently) Case information will be stored on the system and therefore will be easily accessible to AT staff and

also to parties via their electronic case files, for example to see the status of an appeal Parties will be able to submit preferred hearing dates via the phone or web Hearing times can be scheduled automatically, requiring only approval from AT Scheduling will need to accommodate class action and other multiple-party hearings Potential for some decision-support modules to support hearings

Automatic application of the decision by the UI system, entered by the Appeals Examiner. This removes the need for cases to be referred back to adjudication centers for re-entry into the UI system. The next step(s) of the process will be triggered automatically. (For example, setting up a claimant’s skeleton refund and including the requirement to contact UI Debt Management in the notification letter to the claimant).

AT Appeals: New and Enhanced Functionality

1

2

3

4

5

Appeals . . .

AT Appeals: Explanation and Enablers1 Process: Parties will be able to request a reconsideration (and initiate an appeal) by email/web form,

fax, letter or telephone with detailed reason and information about (a) when NOT available for hearings and (b) language preferences … as well as key data – name, address etc.

Customers should be made fully aware of the steps taken following a request for reconsideration: namely, that the agency will take the opportunity to review the determination before sending the case through to the Appeals Tribunal.

Technology: Voice-to-text software to enable phone requests for appeal to be transcribed. Workflow system to transfer the work item to Appeals Tribunal, ECF for updates

2 Process: UI review of determination. To avoid unnecessary workload at the Appeals Tribunal, the agency will consistently conduct a reconsideration of the determination made, before the Appeals Tribunal begins case preparation. This will filter out appeals caused by agency error or late submission of salient information. For development purposes, this review will, where possible, be conducted by the same office/unit that provided the original determination but not by the same adjudicator.

Technology: Workflow will send the review task to the appropriate office. The electronic case file (ECF) will include all information used in the fact-finding as well as any other information that was submitted after the determination date.

3 Process: Re-determination by UI. Where the determination has been reviewed and the original determination changed, a re-determination will be applied by the Division of UI. All appropriate parties will be automatically notified of the re-determination. It will be the parties’ responsibility to appeal a re-determination.

Where there is no re-determination, the responsible adjudication center will immediately file an appeal on behalf of the party that protested the determination.

Technology: Automatic notification of parties following a re-determination. ECF for updates

Appeals . . .

AT Appeals: Explanation and Enablers (cont.)4 Process: Case pre-review and notification of parties. If the agency reconfirms the original determination,

the appeal is submitted formally to the Appeal Tribunal. The pre-review unit of the Tribunal then prepares the case and identifies and notifies all interested parties that the appeal has been received by the Tribunal.

Technology: Automatic notification of parties and workflow to transfer the appeal. ECF for updates

5 Process: Parties receive notification and information. Information sent includes confirmation of receipt of appeal, verbatim copy of the appeal filing (including reasons), appeal rights information and – for current claimants – instructions on how to continue claiming. The docket number of the appeal should also be included so that parties can track the appeal’s status via their ECFs.

[This combines what is currently two separate packages – one from the AT and one from the adjudication center – into a single mailing]

Option: allow claimants the option of whether to continue to claim during appeal

Option: provide hearing date at this stage? May require a policy change

Technology: Automatic notification (and details of package sent stored on ECF for all parties)

6 Process: If appropriate, case information can be attached to the electronic case files of the parties involved in the appeal. This will require allocation of security ‘tags’ to case information to differentiate access. Where access to case information via ECF is not possible or desirable, the Appeals Tribunal will be able to collate materials requested under a subpoena quickly as all information will be stored on the system

Technology: Electronic case file, integrated phone and web systems

7 Process: To prepare for the hearing, parties may request / subpoena case information. At any time, they should be able to access their electronic case files to identify salient information about their appeal – e.g., hearing date, status etc (using the docket number to identify the right appeal). If they wish to access this information via a representative, this option will also be available

Technology: Electronic case file, integrated phone and web systems

Appeals . . .

8 Process: Scheduling the appeal hearing. With early notification of appeal, parties will be given the option of submitting preferred dates for the hearing. If they choose to submit preferred dates, that information will be automatically submitted into the automated scheduling system.

The Tribunal will maintain the flexibility to schedule hearings as far in advance as deemed appropriate. The scheduling system will be able to recommend dates meeting the defined parameters, for approval by an AT agent. Notification of all parties can then be sent out automatically, once the pre-review team has approved the date and time of the hearing (based on all parameters, including time required etc).

Technology: Automatic scheduling and notification of parties, then workflow to transfer the case information to the appropriate Appeals Examiner

9 Process: Hold hearing. All hearings will be digitally recorded and then attached to the appropriate electronic case files. (The AT has an existing target to conduct 95% of all hearings by telephone).

There is potential for application of some decision-support modules for Appeals Examiners – for example, prompting appropriate questions as per lead case recommendations.

In the long-term, the AT may also consider use of video- and web- conferencing technologies to complement telephone hearings.

Technology: Digital recording, ECF and workflow.

10 Process: Decision is made after the hearing, based solely on evidence provided at that forum. Decision is entered directly into the system by the Appeals Examiner either (a) typed in or (b) via voice-recognition software. The Appeals Examiner, supported by an easy-to-use monetary calculation tool, will also be responsible for entering monetary parameters and approving a monetary re-determination, if appropriate.

Some cases may also require more than a single hearing.

Technology: Voice-recognition software, expert monetary system and ECF.

Appeals . . .

AT Appeals: Explanation and Enablers (cont.)

11 Process: Once the decision is made, the system will automatically trigger the required agency actions (authorized by the Deputy) in response to the decision parameters entered by the Appeals Examiner. These actions will be in ‘suspend’ for two days to allow a senior adjudication examiner to view the decision and actions, before the actions are triggered.

Automated actions following an AT decision

may include payment / set-up of a refund / benefit non-charging credit and associated notifications on behalf of the Deputy

will include automatic notification to the originating adjudication center that the decision has affirmed, modified or reversed the determination, for training purposes

Technology: ECF, expert system, workflow.

12 Process: The AT’s notification of decision will be automatically generated, once the examiner has confirmed the decision in the system. Parties will receive notifications via their preferred methods (with an automatic alternative method triggered if an email is returned as undeliverable). Decision should be shown at top of first page, with explanation following (rather than at the end of several pages). Package sent should include next steps instructions to each party, dependent on the situation.

Option: where AT notification and agency notifications are required at the same time – for example, when a refund is established automatically – these could be sent together,

saving on mailing costs

Technology: ECF, automatic notification, workflow.

13 Process: Remand back to UI. In cases where the Appeals Tribunal decides that the appeal was caused by agency omission, or that the case requires further investigation, it can be remanded back to UI. The remand will trigger immediate inclusion of the work item in the appropriate office’s work queue.

Technology: Voice-recognition software, ECF and workflow

* A case may be withdrawn, vacated or dismissed for many reasons. These outcomes are not shown on the conceptual design only for simplicity.

Appeals . . .

AT Appeals: Explanation and Enablers (cont.)

INPUTS OUTPUTS

BoR Appeals – High-Level View of the Process

BoR Appeals Process

• Party appeals to Board of Review (becomes appellant)

• All parties notified • All parties provided

information (if needed)• Routed to UI for:

• Re-determination • Remanded back to

Appeals Tribunal

Appeals . . .

Board of Review jurisdiction

Board of Review Appeals: Conceptual Process Diagram

Appealing Party Division of UI Other InterestedParties

2. File with Board ofReview

3. Send notice tointerested parties

5. Make decision andnotify

1. Rejects ATdecision and

appeals

9. Remand backto Appeals

Tribunal

4. Receive andreview information


7. Automatedredetermination &

notification6. Automatednotification of

decision







5. Make decision


appeals


Tribunal



6. Automatednotification of

decision


BoR Appeals: New and Enhanced Functionality

1

2

3

4

Appeals . . .

BoR Appeals: New and Enhanced Functionality All steps that involve a change to the claim, customer or employer information update the Electronic

Case File Parties will be able to initiate a Board of Review appeal via email, fax, Internet, and via the phone

using voice-to-text software. (Note: the extent to which phone filing and the use of digital signatures for appeals are constrained by law or policy must be clarified.)

Workflow will enable draft decisions to be circulated for review or it can be done on a virtual discussion board, centrally

All case information will be stored on the UI system and will be accessible to the Board Automatic application of the decision by the UI system, entered by the Board Member. This removes

the need for cases to be referred back to adjudication centers for re-entry into the UI system – and therefore speeds up notification of parties

Transfer of a case back to NJDOL UI or to the Appeals Tribunal will be automatic and will automatically trigger the next step of the process

Appeals . . .

1

2

3

4

Note: Much of the functionality described above is, or is expected to be, delivered in ACES.

BoR Appeals: Explanation and Enablers1 Process: Parties will be able to initiate a BoR appeal by email, fax, letter, internet or telephone

Technology: Voice-to-text software to enable phone requests for appeal to be transcribed. Workflow system to transfer the work item to Appeals Tribunal

2 Process: File with Board of Review. The case is automatically transferred to the Board’s jurisdiction. The Board then allocates the case to an Appellate Specialist.

(Appellate Specialists are also responsible for

Dissemination of any precedent-making case law

Management of multi-party and ‘lead’ cases)

Technology: Workflow and security controls (to change the access rights as jurisdiction transfers)

3 Process: Board sends notice of receipt of appeal to all interested parties via their preferred correspondence method (indicated at earlier appeal stage or before).

Technology: Automatic notification The electronic case file (ECF) will include all information used in the fact-finding as well as any other information that was submitted after the determination date.

4 Process: Notice of receipt package should include rights information, transcript of reason(s) for the appeal, (instructions on continued certification for the claimant) etc.

Technology: Automatic notification of parties

Appeals . . .

BoR Appeals: Explanation and Enablers (cont)5 Process: The process steps to make a decision can involve:

Review of the appeal by a specialist, who prepares a written statement/ draft decision

Review of the written statement/draft decision by Board members

Discussion of the case at a weekly Board meeting

A hearing (If a hearing is scheduled, then the system automatically is updated and sends notification)

Board approval of the draft decision

Workflow will transfer cases around the Board, with flags for action. Elapsed time should also be shown. All workload must be visible to the Secretary.

Technology: Workflow, a virtual discussion board to facilitate remote review and approval of cases, digital recording for hearings.

6 Process: Automated notification of Board decision to all parties, including reasons for decision. This should be easy to understand and include a copy of the applicable section of the UI law, to inform parties who may not appreciate that they have appealed without real legal grounds.

Conceptually, the re-determination itself will be conducted by the UI-owned system in response to parameters entered by the Board. The re-determination will include automatic notification of the parties.

Technology: Automatic notification of parties of the decision, via method preferred by the parties

Appeals . . .

BoR Appeals: Explanation and Enablers (cont)8 Process: The next steps for UI will be triggered automatically as appropriate – including payment / set-

up of a refund / benefit non-charging credit / notification (for all).

Technology: ECF, automatic notification, workflow.

9 Process: In cases where the Board of Review decides that the higher authority appeal was caused by an error at the Appeals Tribunal, the remand back to the AT will trigger immediate inclusion of the work item in the Tribunal’s work queue.

Technology: Voice-recognition software, ECF and workflow

Appeals . . .

Appeals Processes: Business Design Principles 95% of AT hearings by phone [AT-defined target] Different tracking and actions for Leading Cases Build in ability to use tracking for training and MI (e.g. number of appeals based on decisions per

adjudicator, per adjudication center and so on)

Appeals . . .

POLICY AND PROCEDURES

Introduction to this sectionContents

This section presents the new policy and procedures processes, in the following order:

Developing and communicating procedures

– High-level view of the process: inputs and outputs

– Summary of what’s new: annotated process map

– Process map with detailed explanatory notes


Monitoring procedures & remedial action

– High-level view of the process: inputs and outputs

– Summary of what’s new: annotated process map

– Process map with detailed explanatory notes


Developing and communicating policy – discussion

Policy and procedures . . .

Develop

Monitor

Communicate

Remedial Action

INPUTS OUTPUTS

Developing & Communicating

Procedures Process






5. Make decision andnotify


appeals


Tribunal



7. Automatedredetermination &

notification6. Automatednotification of

decision


High-level view of Developing & Communicating Procedures: Inputs and Outputs

• Internal agency initiative• External stakeholder initiative• Legislative mandate• Feedback from front-line staff

• New/updated procedure posted on internal website

• Synopsis emailed to all impacted staff

• Implemented technical/operational changes to enable the new procedure

• Defined compliance measures and monitoring plan



Policy and procedure development: Conceptual Process Diagram

Legislative & policycommunity Bureau of P,S&S Rest of Agency

1. Good idea ormandate

17. Make systems / op'lchanges acc to plan

9. Input

3. Funnelled toBureau of PP&S 2. Good idea

5. Initial analysis ofoperations impact

6. Gather initialinput from

interested parties

7. Consolidateanalysis

4. Triage: prioritizechanges, test vs.

objectives

8. Draft procedure& roll-out plan

10. Circulate forclearance(comment)

Iterateif needed

13. Distributesynopsis

16. Conductinformation

meetings / training15. Run Help Desk

14. Hold staffmeeting to discuss

16. Attend training

6. Initial feasibilityinput

6. Provide positioninput

11. Developimplementationplan in parallel

12. Approve new /changed

procedure

9. Input9. Input frominterested parties

What’s New: Developing & Communicating Procedures

1

2

3

4

5

What’s New: Developing & Communicating Procedures Stakeholders across the Department will be able to view and post comments and questions about

first draft procedures on a virtual discussion board Stakeholders across the Department will be able to view and post comments and questions about

second draft procedures on a virtual discussion board. [For some policies, the timescales will be too tight before implementation to do this effectively. However, the aim to allow for proper consultation wherever possible].

Systems and operations implementation projects triggered by policy or procedure change will be formally recognized as projects and subject to project controls and reporting

A policy and procedure help desk will respond to questions from the field about appropriate courses of action in difficult circumstances

For significant changes, the policy and procedures group will run information / training sessions across the State


1

2

3

4

5

Explanation and Enablers: Developing and Communicating Procedures1 Process: New policies and procedures (or changes) can be initiated outside the agency by any

stakeholder. Legislative mandates in particular.

Technology: Virtual suggestions box on the Departmental website

2 Process: New policies and procedures (or changes) can be initiated easily inside the agency from any source. The workshop suggested encouraging recommendations from the field through a well-advertised virtual suggestions box or similar.

Technology: Virtual suggestions box on the internal website

3 Process: All ideas with a potential procedural implication should be directed to and logged by the Bureau

Technology: Database to manage the list of items for review

4 Process: Policy/procedural ideas should be managed as a portfolio – with the most important ones prioritized. Factors used to determine priority should include contribution to the agency’s strategic objectives and legislative backing

Technology: Database to manage the list of items for review

5 Process: The policy and procedures group will conduct an initial analysis of the proposed change on operations – creating a ‘straw model’ for later comments to build upon. The initial analysis should cover process, organization, technology, data implications. At this stage, the group will also identify all affected parties.

Technology: Data warehouse and “What if” analysis of policy/procedure impacts


Explanation and Enablers: Developing and Communicating Procedures6 Process: An initial round of consultation will be conducted via an online message-board or discussion

function, so that all comments are available for review by all interested parties. Key agency functions will be required to assess the feasibility and impact of the change from their perspective (applications / network / technical architecture / adjudication etc). As appropriate, external stakeholder input will also be solicited at this stage

Technology: Virtual discussion board and/or communication capability (email) or web posting to get comments on the draft

7 Process: The policy and procedure group will consolidate the input – identifying and resolving significant overlaps and gaps.

Technology: Database to manage and consolidate inputs

8 Process: The group will then develop the draft procedure, success measures and monitoring plan. A first cut implementation plan should also be developed: depending on the subject, the responsibility for developing the plan may lie outside the policy and procedures group (although they will continue to input).

Technology: Database to manage the development process and actions

9 Process:The second round of input on the draft procedure will again be facilitated by an online discussion function – and be time boxed.

Technology: Virtual discussion board

10 Process: Clearance will require different levels of approval dependent on the scope of the change. To facilitate faster approvals, workflow can be used to prompt actions.

Technology: Workflow process to manage approvals


Explanation and Enablers: Developing and Communicating Procedures11 Process: In parallel with formal sign off (and even before) the agency teams listed in the draft plan will

be augmenting and improving the implementation plan for the new procedure. Where a procedure requires more activity than development and communication to the field, it will be deemed a project – and subject to project lifecycle and controls.

Technology: Possibly project planning software

12 Process: For all but the most contentious of issues, approval should be delegated to an appropriate manager, for example, the Head of the Bureau.

Technology: Workflow process to manage approvals

13 Process: All procedure changes will be communicated to the field through an easy-to-understand synopsis, emailed to all appropriate staff. The email will contain a link to the full text of the new procedure. Additionally, business rules/expert system guides will be updated to reflect the new approach.

The synopsis will include an explanation of why the change is being made (beyond ‘required by State legislature’ or similar) and an explanation of how the change will help to achieve agency objectives

Technology: Virtual discussion board and/or communication capability (email) or web posting, rules engine, expert system software

14 Process: Agency managers will be held accountable for their staff understanding and following procedure. All staff will be encouraged to provide feedback on the success or challenges of any change, so that adjustments can be made

Technology: Virtual discussion board, management information (to enable managers to assess impacts)

15 Process: a policy/procedure help-desk will respond to any member of staff questions about correct policy/procedure at any time during business hours. The help-desk should be staffed by respected, experienced people who will need to understand both the policy/procedure and the operational context.

Technology: Helpdesk phone number, database to log issues and help identify patterns


Explanation and Enablers: Developing and Communicating Procedures16 Process: For larger changes, the policy and procedures group will be even more pro-active in

communicating the change, potentially including meetings/training across the State as well as providing assistance to managers in explaining the implications to staff.

Technology: N/A

17 Process: Operational and technology changes to make the policy/procedure change work should be implemented in parallel, as part of the same project.

Technology: See step 13


* Ideally, all procedure development will be done before a policy comes into place; however, this is not always possible - for example, the recent TUC-A experience. In these cases, the faster distribution methods should assist in rapid action. Key recommendations included here – such as a project approach to implementation – should always be followed, whatever the timescales.

Developing & Communicating Procedures, Process-Specific Business Design PrinciplesAll policy & procedures Policy and procedures are a pillar of ongoing operations performance management and improvement Policies and procedures should always support agency objectives and compliance must be monitored, to

provide a level baseline for performance improvement Policy and procedures team(s) should work as consultants to UI operations, with a focus on maintaining

and enhancing performance Treat policies and procedures in a hierarchy (1) legislative mandates, (2) non-mandated policies with

significant operational impact (3) others

Developing policy and procedures Where possible, all affected parties should be consulted – with a reciprocal duty to provide comments

rapidly Legislatively-mandated policy changes can be implemented with less consultation activity Project management lifecycle and tools should be used to manage the development and implementation

of new procedures (in particular, for co-ordination when technical and other operational changes must be delivered in parallel)

All new procedures should be assessed by a ‘User Needs Assessment Group’ Final approval should be delegated for most policies/procedures, and should always be within 3 days Monitoring compliance to new policies and procedures should be a shared responsibility between

operations managers and the central group; the monitoring plan should be developed alongside the procedure

Communicating policy and procedures Provide front-line staff with salient information – such as a ‘quick hit’ synopsis - don’t overwhelm them

with too much detail. Also make clear the reasons and sources for new policies and procedures Easy-to-access central repository of policies and procedures should be available for all


INPUTS OUTPUTS

Monitoring Procedures and Remedial Action

Process

High-level view of Monitoring Procedures and Remedial Action: Inputs and Outputs

• Scheduled effectiveness assessment

• Feedback on new procedures from the field

• Increased training on the procedure

• Clarified communications• Revision(s) to the

procedure and re-issuance

Policy and procedure monitoring & remedial action: Conceptual Process Diagram

Rest of Agency

2. Feedback onprocedure

8. Link back topolicy

(re)development

6. Trigger successassessment


Bureau of P,S&SLegislative, policycommunity

If widespread problem

1. Scheduledeffectivenessassessment

4. Local resolutionof issue

5. Regionalresolution of issue

If issuecan be resolvedby operations

9. Define remedialaction options &

measures

10. Agree actionswith operations

mgmt

11. Agree remedialactions &measures

7. Assess success

12. Implementactions



Policy and procedure monitoring & remedial action: Conceptual Process Diagram

Rest of Agency


8. Link back topolicy

(re)development

6. Trigger successassessment


Bureau of P,S&SLegislative, policycommunity

If widespread problem

1. Scheduledeffectivenessassessment

4. Local resolutionof issue

5. Regionalresolution of issue

If issuecan be resolvedby operations

9. Define remedialaction options &

measures

10. Agree actionswith operations

mgmt

11. Agree remedialactions &measures

7. Assess success



1

2

3

What’s New: Monitoring Procedures & Remedial Action


What’s New: Monitoring Procedures & Remedial Action

A monitoring plan for new policies and procedures will be developed before implementation

Stakeholders across the Department will be encouraged to view and post feedback on the impact of new policies and procedures on a virtual discussion board

A formal review will assess the success of policies and procedures and identify improvement actions, which may include training, further communications, revisiting sections of policies/procedures and further research


1

2

3

Explanation and Enablers: Monitoring Procedures and Remedial Action (cont.)1 Process: Operations managers are responsible for the successful implementation of policies and

procedures. To support that effort, success/effectiveness assessments by the central policy and procedures group will be scheduled as part of the monitoring plan drafted in parallel with the policy/procedure. They will be conducted as early as practicable to identify if the measure is having the desired effect and contribution to overall objectives.

Technology: Data warehouse and query tools, for performance analysis

2 Process: Feedback on the impact of any new/changed procedure from external stakeholders may trigger a success assessment.

Technology: Virtual suggestions box on the Departmental website

3 Process: Feedback on the impact of any new/changed procedure from within the agency may trigger a success assessment


4/5 Process: Internal feedback on policy and procedure may highlight operational issues in a particular area, such as incorrect application of a new policy: these should be addressed at the appropriate level – local or regional.


6 Process: Success assessments will be triggered by automatic reminders from the workflow system

Technology: Workflow, Data warehouse and query tools, for performance analysis


Explanation and Enablers: Monitoring Procedures and Remedial Action (cont.)7 Process: Assess success: operations managers are responsible for the effective implementation of

policy and procedure. To support their efforts, the policy and procedures group may conduct an impact assessment of the implemented change, as defined in the monitoring plan. This may involve data analysis, site visits and gathering input from Operations staff and managers to understand what’s happening on the ground. The scale of the monitoring activity will depend on the complexity of the procedure(s) implemented – but will always rely on spot checking.


8 Process: For serious ‘failures’ there may be a need to return immediately to the drafting stage to revise the policy/procedure.

Technology: Data warehouse and “What if” analysis of policy/procedure impacts

9 Process: Success assessment will include pro-active recommendations to resolve the performance issues identified (if any) as well as success measures for the recommended actions.


10/11

Process: Actions will be jointly agreed by the policy and procedures group and operations management.

Technology: Workflow to facilitate the approvals process

12/13

Process: Actions to ensure the policy / procedure achieves its objectives may be required by all areas of the agency.

Technology: N/A


Monitoring Procedures & Remedial Action, Process-Specific Business Design PrinciplesAll policy & procedures Policy and procedures are a pillar of ongoing operations performance management and improvement Policies and procedures should always support agency objectives and compliance must be monitored, to

provide a level baseline for performance improvement Policy and procedures team(s) should work as consultants to UI operations, with a focus on maintaining

and enhancing performance Treat policies and procedures in a hierarchy (1) legislative mandates, (2) new/changed policies with

significant operational impact (3) others

Monitoring Ensuring policies and procedures are followed is important to creating a baseline for performance

improvements Policies and procedures should be reviewed as early as practicable for success Managers should be held responsible for communicating and enforcing policies and procedures; staff

should be held accountable for applying policies and procedures A central group can spot-check compliance to procedures and help managers improve compliance – but

should not be held responsible for delivering it

Remedial action Policy and procedures team(s) should work as consultants to UI operations, with a focus on maintaining

and enhancing performance Policy and procedures should be measured in terms of

– contribution to overall agency objectives

– communication – was it implemented well?


A Note on Policy Development…High-level policy development is outside the scope of agency operations and is therefore not discussed in detail in this document.

Policy development is unlikely to involve formalized consultation of agency staff in the same way as for procedures. However, dissemination of policy can take advantage of many of the mechanisms discussed in this chapter for procedures. For example: Same communication methods can be used – email groups; internal website post board Same policy –operations managers group could jointly review implementation


FINANCIAL PROCESSES

Financial Processes Underpin All Benefit ProgramsFinancial processes underpin the effective delivery of unemployment and disability benefits. Accurate financial management is a MUST for the future integrity of the service.

This section addresses the following financial processes: Payments Federal Income Tax Collections Garnishments Check Reconciliation Reconciliation/Variation/Reporting Employer Credit Audit Trail Offsets Waivers Write-Offs

Note: this section was developed during a few short, intense break-out sessions. Some ideas were raised that were not sufficiently discussed to be listed as principles. Rather than losing these ideas, however, they are retained in the chapter as options and questions – to be investigated more fully in detailed design.

Financial Processes . . .

The Scope of Financial Processes for UI Modernization

Payables(benefit

payments out)

Receivables(Employer

Accounts – out of scope)

FIT

Off-sets

Waivers

Write-offs

Garnishments

Employer Credit

Disbursement reconciliation

Reconciliation / variation reporting

Collections

AUDIT TRAIL


Overall PrinciplesSeveral key principles emerged during the course of the Financial Processes sessions. They are: Ensure responsible fiscal management There must be a single source of financial information UI should be viewed as a benefit system and as an insurance program Maintain integrity of the financial system as part of the overall system System date, transaction date, and effective date are recorded for all activities, and are underpinned by

clear timing rules Every transaction stands alone, is given a transaction number, and is never overwritten Standard accounting principles must be applied (Generally Accepted Accounting Principles) All transactions should be viewable from a detail and summary (or ‘roll-up’) perspective Employer Accounts should automatically flag employer issues to UI System and processes should be flexible enough to change payment interval relatively easily


PaymentsDefinition Payment (of claim) = Charges (inclusive of general fund charges) to Employer - Deductions

Principles System will cover standard benefit payments model. Also, may need to accommodate

– TRA health benefit coverage (IRS should be providing this service in the long term)

– DUA payments Must ensure that sufficient audit trail is in place for Electronic Fund Transfer (EFT) payments to enable

criminal prosecutions

– This may attract the need for special tools for investigation

Option for how this should work in the future and first-cut implementation issues Checks

– Option A weekly benefit checks

• Issues are postage costs (although covered by USDOL), managing check stock

• Pros – Find bad addresses more rapidly

• Cons – level of effort, stolen checks, cash flow, cost of re-deposits (Increased frequency of payment increased processing costs)

– Option B bi-weekly benefit checks – as currently done

• Least upheaval from current approach

– System and processes should be flexible enough to change payment interval relatively easily

– Check format - No tear on the MICR line, combined instructions and check, more room for messages, plain language, clear readable instructions


Payments (cont.)• Direct Deposit

– Requirements for EFT

• ABA Routing Number

• Bank Account Number

• Checking or Savings Account

• Assumption: pre-notification of route to recipient’s account not needed

– Issue: currently fraud prosecutions rely on the signature endorsing a check as the evidence trail. This will be lost in a pure epayment model

• IDEA: Send out form – or obtain from internet – for signature guarantee from bank as another downstream fraud prevention measure?

– Issue: claimants may forget the benefit amounts they are receiving, because it is no longer in ‘black and white’ in front of them

• IDEA: When sending next certification reminder, provide latest deposit information? Lump sum for claimants facing a fixed lay-off period?

– A simpler model, that would reduce the administrative burden for this subset of claims UI debit cards

– Idea is to assess and potentially copy the model used by Welfare, based on the assumption that a significant proportion of UI claimants do not hold bank accounts

– Issue: will the Bank issue cards, or will that become a DOL responsibility?


Payments (cont.)Underlying principles Reimbursement checks will be managed wholly within DOL, with Treasury oversight via the daily

reconciliation report. (This is being implemented in Spring 2003).

– On returned checks

• Write re-deposit on back of check (send claimant instructions)

• Scan in re-deposit instead of re-keying (reason code must be captured)

– Treasury extends the date

– Send replacement check (idea: show “void after 90 days on check”) When applicable, an overpayment automatically sets up and pays an underpayment On underpayments, withhold FIT Online, self-service viewing and printing of 1099

– Issue: will a mail or email verification notice still be required for every claimant?

– Note: this has proved very popular in other states… Stop payments

– Journal entry back to UC fund required

All new payment options require significant further investigation and a full cost/benefit analysis What are the costs of each option and combination? Procurement strategy?


Federal Income Tax (FIT)How this should work in the future and what’s needed On phone or internet, claimant elects to make deduction and system deducts electronically Use internet or phone to allow claimant to change withholding status Automatically deduct FIT on “make-up” payments if FIT elected Tax Liability: UI personnel must explain clearly that FIT withholding cannot be returned to claimant. Tax

contributions are immediately turned over to the IRS. The claimant has the opportunity to recover these funds (in whole or part) when they file their annual income tax form(s)

Option Carryover question on deduction on new claims


Collections – of OverpaymentsPrinciples Agreements on payments should be logged and tracked on system Principal and fees must be paid in full Customers can choose payment method: credit cards should be accepted Debtors can overpay, but not underpay (according to month-by-month schedule) Automatic flag of defaults (like missed payments) based on business rules Where customers call and make alternative payback schedule arrangements, UI representative needs to

explain that the arrangement will require renewal every 6 months in order to avoid a judgment filing - which will grab UI benefit payments, state tax / homestead/soil refunds

No interest is charged until account file is in judgment Automatically generate monthly bills or send link to secure website for information Put all relevant data on a single screen for refund situations Have a user-friendly system - no code language Obtain link with Federal criminal prosecution system to learn when claimant makes refund payment to

Federal probation office (This link is in place with state probation office.)


Collections – Summary MapProcessing collections: conceptual process diagram

AgencyDebtor Customer

Overpaymentdetermination

made

Customernotified

Paymentschedulegenerated

Advise onoptions and

agree scheduleCustomernotified

Customer makespayment

Systemupdated

Customernotified

Customer contacts Agencyto change schedule

Customer does notmake payment acc

to schedule

Paymentschedulegenerated

Automaticconfirmation of

receipt

Access Staterefunds, incl

tax

File civil case

Customernotified

Monthly billcycle revised

Monthly billcycle

established


Collections – of OverpaymentsHow this should work in the future and what’s needed Any change of address needs to update claimant information Should be able to contact claimant by phone Interface UI to DI for address information, plus use DMV, new hire file, US and NJ Income tax Cross-match to other agency data bases Link claimant’s debts to future UI benefits in one history

– All debt information should be accessible (and viewable in a summary roll-up format), in the same way as information on outgoing payments

Issues Where should system of record be located? Withdraw money owed from direct deposit accounts? At what point should debt be written off, but data retained in case person ‘resurfaces’ and opportunity to

collect balance exists? Policy issue: currently BPC can capture full amount of benefit check for collections – even when there is

an existing UI-claimant agreement. As a result, the claimant may become eligible for welfare. The policy implications of this should be studied.

– Option: continue with agreed payment schedule, if customer is making payments regularly?


Child Support GarnishmentsPrinciples All data should be attached to the electronic case file and therefore viewable to UI and to the claimant, potentially

including the court order All adjustments should take account of garnishments and other offsets.

– System should be able to garnish even if set up as an underpayment Must build in systems assurance checks (duplication, omission) Need timing rules – to ensure that system & effective (processing) date are the same All data should be viewable at detailed and summary levels – and roll-up must work! Maintain system and data integrity Exception processes are needed (e.g., refunds) Must be compatible with TDI

How this should work in the future and what’s needed Child support is the primary driver Need a daily list of garnishments, by program - recapped in a weekly summary (roll-up) Automatically recalculate garnishment when weekly benefit changes End product must be useable by DHS

Future process File transfer between UI and ASCES system; amounts are reconciled (QC) Sent to DHS who confirms the totals and provides instructions to DOL regarding total and breakdown by county DOL wires funds to the New Jersey Administrative Office of the Courts Money wired to judiciaries (in and out of state) – on information received from the Dept. of Human Services


Child Support Garnishments (cont.)Issues/constraints Set-up of garnishment is reliant on correct court order The structure is fixed … report is sent to DHS, and then wired to the New Jersey Administrative Office of

the Courts Limitations on amount that can be garnished – need to be built in as business rules No ability to recall wires after payment is made


Disbursement ReconciliationPrinciples System must allow for whatever mechanism UI and the claimants choose (direct deposit, debit card,

checks, etc.) There should be daily reconciliation of charges to payments out and payments cashed Reconciliation should occur as money is disbursed and when checks are cashed Maintain ability to re-run checks and to be able to start mid-run Reconcile check stock daily TARGET: No unresolved reconciliation issues

How should this work in future On a daily basis, reconcile disbursements (charges to payments out) Reconcile as check goes out the door and when cashed (done at Treasury) All forms and checks should be generated directly from the system When receive a returned check, trigger bad address indicator so as to stop further checks to the address

Issues/constraints Reconciliation may not work when money is sent to the wrong bank account, to a closed bank account,

when checks are sent to the wrong address, or checks are not cashed in a timely manner

– Permitting direct deposit as a transfer mechanisms increases the need for electronic reconciliation of distributions, but will make reconciliation easier and more accurate

– Reconciliation issues MUST be resolved. Deadline for honoring checks (i.e. time limit on receiving benefits paid while still eligible) is currently

inconsistent across the agency. This is a legal/policy issue for quick resolution.


Disbursement Reconciliation - ReportingPrinciples Charges to employers must reconcile to payments (enabling accurate experience rating) Refunds: cash collected must equal cash in system Standard accounting principles must be applied (Generally Accepted Accounting Principles) Timing is a major issue … capture effective & system dates Need to have an intelligent “snapshots” of accounts at a point in time

– But should include any later changes to that effective date data (prior to the cut off date) = later audit trail should highlight these items

– Should be available to employer accounts (will affect experience rating and B187 reports) Reconcile across UI and employer tax systems Capture system overrides in audit trail


Employer CreditsPrinciples Provide employers with the ability to view charging data, via Employer Accounts’ portal, and other

channels (via their electronic case files) Enable Employer Accounts to update experience rating (up or down) as soon as employer protest is

upheld – or after notification and 10-day appeal period has elapsed (in real-time, or at least daily) Employer Accounts should automatically flag employer issues to UI and send information

Issues/constraints Policy question: should employers be credited when claimant checks were not cashed or were returned?

– Option: credit could be triggered when check is escheated back to the Fund?

– Option: set up as underpayment for a specific amount of time (20-day protest period, 2 year statue of limitations on employer)

• Note: establishing underpayments would need to be policed closely

• Related policy issue: revisit statute of limitations and consider making consistent for employers and claimants


Offsets, Waivers and Write-offsOffsets Offsets are deductions from claimant benefit based on uncollected refunds

Principles Benefits can only offset other benefits Same process as collections, but during a claim A waiver does not equal an official write-off Claimant refund might be spread over time, but employer credit hits immediately Variations (options): if claimant becomes permanently disabled or dies, eligible party can request waiver.

Requires management approval

Issues/constraints Must maintain hierarchy of what is impacted first (Issue: hierarchy should be clarified)

– Need collections policy clarified (see “Collections” page for further information)

Waivers of offsets / write-offs

Triggers Death, permanent disability

Principles Do not revisit waivers No settlements Accurate & reconcilable Reports (summaries) needed for accounts


Write-offs (of Refund)Principles Write-offs only occur in refund Structure of refunds must support write-off process Treasury has final approval

– Must comply with Treasury requirements (circular as well as unspoken requirements)

• Detail of all records

• Example: separation principal/interest by program

– Therefore consider providing Treasury with system access Enable easy pulling of random samples requested as part of Treasury audit

– Automatic check of compliance?

– After Treasury approval of samples, write-off items can be removed from UI Financials. Ensure that there is an indicator in the system that there is a write-off (with effective date)

Reduce receivables allowance for uncollected monies

Issues/constraints After a waiver, what happens if the person re-files a claim. Are there conditions under which they can

collect (i.e., not death / permanent disability)?

Key Result Outstanding receivables that have never been approved for write-off may be resolved (with a one-time

write-off)

– Issues: migration and aged debt recording


Financial Processes Enabler: Financial Audit TrailThe fundamental underpinning enabler for accurate financial management is a comprehensive and reliable

audit trail. The audit trail enabler is discussed elsewhere in this report and is reprised here to emphasize its importance to financial integrity.

Principles Ability to trace each and every individual transaction (no whiteout!)

– Including system date, transaction date, identity of who made a change, what changed, reason for change

Clear governance of who can make changes, approval structures, linking of information to claimant and employer, etc.

Provide both a summary view, and the ability to drill-down Exception reporting as standard Control access to information and monitor (improper use of internal information for personal purposes) Offline and online balances must reconcile (allows early ID of problems) Must comply with Treasury requirements Need to be able to transfer data into Excel format for analysis

Issues/constraints What are the records management, data capture, and retention rules that NJ applies to “online” records?

– These must be built into the design

– Should current standard of five years’ accessible history (then archiving) continue?

– Should key data be available for longer than other ECF elements? Security


INTERNAL CONTROLS

Internal controls are a management function – and we need to decide the level of risk we are wiling to accept

Audit trail and monitoring

• Strong audit trail : every transaction must be auditable, traceable

• One system, one data source for accounting and case management – makes system more transparent

- coordinated, reconcilable data

- claimant info rolled up into accounting information

- audit record of every single transaction

- ability to generate queries easily, as necessary

• Manual interventions may always be needed (if less so) so, when this done

- Ensure there is a strong audit trail of these changes

- Provide system guides and internal logic to show that if ‘a’ changes, ‘b’ must be altered too – to ensure consistency

Access profiles

• should be based on future rights and responsibilities (more of them); some like payments will be sensitive and therefore limited

• Supervisors should be able to change the access profiles – within a range – for their teams

• A central system security function continues to be needed to oversee access

• Managers at all levels should use the tracking mechanism to cross-check at times – with adequate supervision, supported by system alerts

Internal Controls . . .

Internal Controls: Design Principles

Payments• Ideally, the system’s security and audit trail should be sufficient so that a single UI representative can be

allowed to handle a claim, end to end? The management decision is the cost/benefit balance

- Potentially, there is no need to segregate claims taking from payment authorization with a strong audit trail

• The system must therefore have a monitoring function which flags suspicious / fraud patterns

Access• Customer access must be secure, as private information will be held on it

• Web entry into system – security must be equal to other entry points

Internal Controls: Design Principles (cont.)

Internal Controls . . .

PROCESS ENABLERS

Underpinning Enablers for the New ProcessesIntroduction: In the following pages we describe the business and technology enablers for the new processes. Enablers are tools or approaches that make possible the principles and objectives.

Enablers . . .

Business enablers Triage Conducive workplace Training Sufficient resources Development Performance management Self service Online law and procedures library Interpretation facility

Technology enablers CRM software Electronic case file Workflow System cross-checks (expanded) Audit trail Automated notifications Rules engine Voice-to-text software Intelligent systems Customer virtual suggestion box Internal virtual suggestion box Instant messenger / chat room Local phone numbers Unified database Integration of phone and web systems Data warehousing and query tools

Business Enablers This section specifically discusses the business enablers needed to support the new UI Modernization processes. We describe enablers that are new (e.g. triage) and enablers that extend existing capabilities (e.g. conducive workplace) – all of which were emphasized by workshop participants as crucial for UI Modernization to succeed. We do not review existing enablers - such as effective management control, vision etc – but assume that these will continue.

TRIAGE: Triage is the quick assessment of customer (claimant or employer) needs as they come into contact with UI, so that they can be accurately assisted and and routed to services that will address these needs. Triage may be a simple automated phone response, or where a customer has a more complex need, a UI representative can help diagnose the problem and help the customer access the service(s) he/she may need. Importantly, triage should apply to claimants who access the agency via phone, web or in-person. Triage comes in three forms as shown in the diagram below.

As part of the triage capability, we will be able to transfer customers seamlessly and immediately to key workforce partners via the phone or internet (Workforce New Jersey in the first phase, other services in later stages)

CONDUCIVE WORKPLACE: For workers to provide the appropriate level of customer service in the new UI, they need workplaces that enable them to perform their jobs. In some cases this involves reviewing whether groups need to have some amount of isolation (e.g. adjudicators). In other situations, it means having closer proximity to people providing other related services (e.g. triage at the One Stops). Providing a conducive workplace also implies that our staff has the right tools, as discussed throughout the workshops. The Division has already shown its commitment to a conducive workplace with its recent roll-out of new PCs.











Workforce partner service

Enablers . . .

Business Enablers (cont.)TRAINING: One of the key enablers needing extension is training and development. For UI Modernization to work, the staff will need accurate, timely, measurable, refreshed, and cross -training. For accuracy, the training has to take into account current process and procedures, reflect how a processes works, and how the process fits into the entire UI workflow. For timeliness, the training needs to occur ‘just in time’ (at the point where the trainee is ready to use the new processes – not months before or after starting the job). For measurable, the Division, trainee and supervisors need to know that the training was effective - and if not, the causes for failure so that they can be remedied. For refresher training, trainers, supervisors and trainees need to identify when retraining is needed (if for no other reason that the processes or procedures have changed). As UI Modernization goes forward, UI employees will have opportunities to work in positions with more responsibilities across DOL and require cross training to handle these responsibilities.

SUFFICIENT RESOURCES: The number of staff, skills sets and knowledge available to NJDOL UI has decreased in recent years. The planned processes and system will help ease some of this workload but will not in themselves resolve the resource issues that have come to light.

Sufficient resources means having the right number of people, with the right skills, at the right time and in the right place. To achieve this, ideas have been discussed in the workshops around training (see above), recruitment and retention, transition planning increasing the flexibility of career paths throughout the Department of Labor (see below) and resource balancing across the field. These ideas need to be expanded upon to ensure that sufficient resources are an enabler upon which UI Modernization can rely.

DEVELOPMENT: In parallel with training and flexible job assignments, NJDOL UI has made a commitment to build meaningful career paths for staff and for those aiming for management. The career path should include on-the-job training, mentoring and crucially it should ensure that people are exposed to many aspects of the Division’s work. Potentially, career paths may include time in our partner agencies too. Ambitions discussed in the workshops were (a) to help retain staff and reduce frustration and (b) to ensure staff is increasingly able to work across the organization.

Reviewing career paths for people currently working in One Stops, RCCs and Adjudication Centers are agreed to be of particular importance because specialization here, while welcomed, has led to less exposure to other functions.

Enablers . . .

Business Enablers (cont.)PERFORMANCE MANAGEMENT: Successful implementation of this blueprint does not mark the end of process and performance enhancement. To succeed, the Division of UI has recognized the importance of continuous improvement. Performance management, as the enabler for the principle of continuous improvement, can be understood in two dimensions: personal and Division-wide.

At the personal level, the future holds an increased attention to Training (see above) Transparent performance measurement (everyone having the ability to review their own individual

performance against normative measures and against group / team objectives) Everyone participating in recommending and delivering performance/process enhancements (tapping

the wealth of expertise of all our staff)

In this way, staff will be able to see their contribution to Division objectives and will be provided training and support quickly, where needed.

At the Division level, a group will be dedicated to monitoring policy, procedures and performance and working with Operations managers to address problem areas. By acting as internal consultants to Operations, this performance management group will keep focus on continuous performance improvement.

SELF SERVICE: Self service is rapidly becoming one of the predominant enablers in State government (e.g. drivers license renewal through the internet) and in private industry (e.g. pouring your own soda at Burger King).

For UI Modernization, self service means allowing our customers access to information - see the electronic case file description later in this chapter - and providing customers with the tools to get their questions answered, via the phone and internet. By achieving a high rate of self service, our front-line staff will be able to concentrate on helping those customers that truly need assistance.

Enablers . . .

Business Enablers (cont.)ONLINE LAW & PROCEDURES LIBRARY: An easy-to-search online library of case law (leading cases in particular) and of policy and procedures will be crucial to enable employees of the Division of UI to be able to Stay up-to-date in terms of changing case law Self-train Run easy cross-checks when dealing with an area of the business with which they may not be familiar

INTERPRETATION FACILITY: Where customers are not fluent in either English or Spanish, UI staff will continue to need access to language interpretation services that can be used primarily for over-the-phone and in-person situations but potentially also for web services.

Enablers . . .

Technology EnablersIntroduction: This section reviews the technology enablers needed to support the business processes. In this section we only describe technology enablers that are new (CRM, data warehousing, etc.) and those enablers that extend existing capabilities (voice–to-text on the IVR system). The UI modernization effort will continue to use and need a number of existing technology enablers including: IVR, database technology, Wide Area Network (WAN), system monitoring software, etc.

The first of these new or extended enablers is Customer Relationship Management software

CUSTOMER RELATIONSHIP MANAGEMENT (CRM): CRM software is typically a packaged suite that will allow the Division a more accurate and streamlined way to provide customer service. In most packages CRM provides the capability to gather and access information about customers histories, preferences, complaints, and other data so they can better understand what customers want now and anticipate what customers will want in the future.

These features include: All customer data and history in one place (see electronic case file) Controlling the work flow (see workflow module) Auditing all transactions (see audit trail)• Faster response to customer inquiries • Increased efficiency through automation • Deeper understanding of customers • Increased service opportunities • Identifying customers groups and trends (see data warehousing and query)• Receiving customer feedback that leads to new and improved products or services • Obtaining information that can be shared with business partners.

Enablers . . .

Technology Enablers (cont.)ELECTRONIC CASE FILE (ECF): The ECF is a component of the Customer Relationship Management system and holds in a single database, all pertinent information related to a claimant or a company. Information is recorded on entry of initial claim and on any subsequent action. Case information is available to the claimant and employer through phone access and the internet. All ECF information is available to UI representatives. The ECF will also allow limited updates to profile information to the claimant and employer, depending on the status of the claim.

Claimant information includes: Key information: Name, address, SSN (including preferences – e.g., preference for being contacted

via email address over mailing address) Claim(s) information: All data related to a claim – benefit amount, when filed, where claim is in the

process, fact finding, hearing information, certification dates, impacts of deductions and garnishments, repayment schedules, repayment balances, etc.

Employer information includes: Profile Information: Name Address, Federal ID number, Claim related information: Active and historical claims against that employer, associated contributions,

relief of charges, claim-related fact findings and appeals information

Enablers . . .

Technology Enablers (cont.)WORKFLOW MODULE: As a separate piece of software or as a component module of the CRM, the system will provide workflow capability, moving work items from person to person in ‘conveyor belt’ style. It: Allows UI personnel to follow the process path of a claim (through the full process cycle) Enables UI personnel (and the customer, via the ECF) to view the status of the claim Enables UI personnel to identify the UI representative working on a particular aspect of the claim Enables scheduling of events (e.g., fact findings) Enables routing of activities (e.g., routing a claim to someone with a particular expertise, or reroute

claim activities when someone is on vacation) Enables process reviews (by reviewing efforts needed to complete a process step)

EXPANDED SYSTEM CROSSCHECKS: To enable preventing overpayments, rework, and limit opportunities of fraud at the initial claim entry and at various stages of the claim life cycle, the system will perform periodic cross checks against relevant data. These checks will include: Verifying identity: SSN, INS, Homeland Security (?), and others Verifying qualifying information: inter-state new hire directory, Department of Corrections, UI current

claims, etc. Eligibility impacts: wage data, child support garnishments

Problems are flagged as early as possible in the cycle and depending on the claim step will require action by the claimant, adjudicator or by a professional investigator.

Enablers . . .

Technology Enablers (cont.)AUDIT TRAIL / CRADLE-TO-GRAVE TRACKING OF CLAIM: As part of the workflow ,CRM and UI baseline components, the system will record an audit trail of all transactions. At a minimum, this audit trail needs to capture the transaction author and time created. At a maximum, the audit trail might capture and record the actions taken during an online session (e.g. the claimant looked at FAQs regarding claim benefits, and then entered the initial claim screen).

AUTOMATIC, SYSTEM-GENERATED NOTIFICATIONS: The system will automatically generate the following types of notifications: Online pop-up windows that remind the UI representative (or claimant, or employer) of a specific

action, follow through, next step, or policy information Email or online notification that a claim has moved into their work queue and needs specific attention

(this is tied to the workflow capability mentioned earlier) Email or postal mail notification – determination package, notice of appeal, etc

RULES ENGINE: In the UI system as in any other business application there is a requirement to separate the business rules/logic from the rest of the system functions. A rules engine (by codifying these rules) provides the opportunity for the rules to be reused by different system modules. This simplifies system maintenance and more easily handles subsequent changes in the business logic

INTELLIGENT SYSTEM(S): This software because of its tie into the UI, workflow and specifically the rules engine software knows when to create/pop-up notifications, directs the workflow, directs the UI representative to likely next steps and flags certain problems for further actions.

VOICE-TO-TEXT SOFTWARE: This software (used on phone conversants) converts claimants’ or employers’ voice responses (answers or questions) into a digital data format that is stored in the same fashion as data entered through the internet. This enables the phone system to provide similar capabilities as the internet.

Enablers . . .

Technology Enablers (cont.)CUSTOMER VIRTUAL SUGGESTION BOX: The virtual suggestion box is a online capability that allows customers the ability to enter and provide feedback on the UI experience. This voluntary feature would be available through the phone tree or internet site at the end of a transaction sequence. In a future phase, the internet site could display a screen citing suggestions and subsequent follow-ups.

INTERNAL VIRTUAL SUGGESTION BOX: This tool will enable staff to provide continuous performance improvements suggestions through a virtual suggestion box. Author can provide their name or remain anonymous. Suggestions that are suggested will go on the supervisor and policy and procedure groups for review and development. As part of the divisions communication plan, suggestions, implementations, and authors will get recognized. The division has already committed to this enabler through the current “quick wins” process

INSTANT MESSENGER / CHAT ROOM: The instant messenger/chat room capability is available to customers specifically through the web. Using these technical capabilities, the customers could have a real-time conversation (most probably around an inquiry) with a UI representative.

LOCAL PHONE NUMBER: Many of our clients spend excessive monies trying to connect with UI because of long distance phone charges. Providing one local phone number per One Stop Center ( enabled by voice-over-IP), would remove that cost from the customer at minimal extra cost to the division. Once connected to the local line, the UI phone system would route the call to the next available representative (wherever he/she is in New Jersey).

Interstate claimants only will be able to access NJDOL UI services via a 1-800 number.

UNIFIED DATABASE: A unified database is a single repository of all UI information. Today’s system architecture holds the same data in multiple data repositories making data reconciliation and problem resolution difficult.

INTEGRATION OF PHONE AND WEB SYSTEMS: The integration of phone and web systems comes through a number of other enablers (e.g. voice-to-text and unified database enabler). This integration enables the Electronic Case File – providing a comprehensive view of the claimant or employer

Enablers . . .

Technology Enablers (cont.)DATA WAREHOUSING AND QUERY TOOLS: The data warehouse holds much of the same data that is held in the production database. It is configured and optimized for real time data queries (these queries are developed using discrete tools, specifically designed for real time reporting). Managers will use the data warehouse and query tools to: Review system performance Produce Federal and State metric performance reports Review business policy, procedure and performance

CASE MANAGEMENT: See ECF

REAL-TIME SCHEDULING: See Workflow

IMMEDIATE OR REAL-TIME NOTIFICATION: See Automatic, System Generated Notifications

Enablers . . .

NEW AND CHANGED EXTERNAL PROCESS INTERFACES

New and Changed External Process InterfacesIn this section we discuss new and changed process interfaces between the future UI functions and our partner agencies. An external, process interface is where one process step is conducted by one agency and further process steps are required by a partner agency.

This section will not review

A. Data interfaces (where data is transferred from or to UI for information or research purposes only, not supporting a process step) as these will be addressed as a component of the technical architecture. This includes cross-checks with other systems as well as requesting information from ICON etc.

B. Process interfaces with our core customers – employers and claimants (these are covered in the prior process section of this diagram)

C. Internal process ‘interfaces’. As mentioned at the beginning of this document, UI Modernization covers all the following benefit programs. We do not treat transfers between these programs as interfaces, as they are internal.

• Unemployment insurance

- Standard, in-state benefits

- Interstate unemployment insurance

- Combined wage claims

- Extended benefits

• UCFE

• UCX

• Disability During Unemployment

• Additional Benefits during Training

• Self-Employment Assistance

• Disaster Unemployment Assistance

• Trade Re-adjustment Act assistance

Process Interfaces . . .

Process Interfaces: Partner Agencies Involved

Investigation

Inquiry / Triage




System management

Triage

Entry



Determination

Re-determination



Adjudication

Prevent overpayment

Triage

Entry



Determination

Re-determination



Adjudication

Prevent overpayment

Entry



Determination

Re-determination



Adjudication

Prevent overpayment

Adjudication

Prevent overpayment

Core Process

Temporary Disability Insurance

Employer Accounts


Attorney General

Treasury

Dept of Human ServicesCounty Courts

Bank

One Stop group of partners


New and Changed Process Interfaces

Interface name Inward or Outward?

Purpose / description UI process impacted

External partner involved

Referral* to all One-Stop services at point of inquiry, on web

Out/In Links will be available on the UI site to the web sites of our workforce partners. We will request the same for UI on their sites

Claimant Triage/Inquiry

Workforce New Jersey & all One Stop partners

Referral to all One-Stop services at point of inquiry, on telephone

Out Customer can use FAQs for standard answers and/or get directions to the nearest One Stop office (from the customer’s zip code). If the customer is placed on hold, they will hear a recording detailing re-employment Services

Claimant Triage/Inquiry


Referral from One-Stop partners at point of inquiry

In To be confirmed with One Stop partners. Claimant Triage/Inquiry


Referral to all Workforce New Jersey services at point of denial

Out Standard UI notification will be modified to include information on One-Stop services

Intake to Adjudication


Referral to all Workforce New Jersey services at point of claim invalidity

Out Standard UI notification will be modified to include information on One-Stop services



Referral to all Workforce New Jersey services at notification of claim submission

Out Claim Submittal: In the new UI process, the letter with the claimant’s password and PIN for OSOS are sent out in the same package as the scan card



*In the long-term, our blueprint allows for modernized UI services to include a shared phone and web triage service with our One-Stop partners (to mirror the in-person triage at some One Stop offices now). In the medium-term, however, our focus will be on enabling improvements to transfers to and from our partners.


New and Changed Process InterfacesInterface name Inward or

Outward?Purpose / description UI process

impactedExternal partner involved

Referral to Employer Accounts at point of inquiry, on web

Out/In Integrated employer inquiry web site, providing links to Employer Accounts (and UI) online services.

Employer Triage/Inquiry

Employer Accounts

Referral to Employer Accounts at point of inquiry, on phone

Out Integrated employer inquiry phone tree, which will transfer employers seamlessly to the appropriate unit for the type of question.


Employer Accounts

Referral from Employer Accounts, on phone

In As needed, Employer Accounts staff to have ability to transfer employers back to the integrated phone tree or directly to specific UI units.


Employer Accounts

Transfer of new claims from TDI to DDU/UI

In All disability cases are filtered by State Plan and those probably eligible for DDU will be automatically sent for intake and adjudication by the unit responsible for DDU.


TDI

Transfer of new claims from DDU/UI to TDI

Out Where a claimant’s eligibility status changes, making him/her potentially eligible for other disability benefits, the case will be transferred automatically to TDI.


TDI

Transfer of TDI appeals In The Appeals Tribunal and Board of Review handle all DI appeals. Where TDI agrees it is possible, these should be electronic transfers.

AT and BoR appeals

TDI

Application of TDI appeals decisions

Out It will be possible to communicate DI appeal decisions electronically from both the appeals authorities. TDI to confirm the preferred method.

AT and BoR appeals

TDI

TDI refunds and changes to refunds

In The modernized UI service will continue to cover debt management for all disability programs. Therefore, whenever a refund needs to be established or changed, that information should be fed automatically from the TDI system.

Collections / debt management

TDI


New and Changed Process Interfaces (cont.)Interface name Inward or



Epayments Out When UI moves to electronic funds transfer and direct deposit options for claimant payments, there will be a key process interface with the bank to approve and transfer funds.

Payment Bank

Treasury audit of payment reconciliation

Out Treasury needs to reconcile the bank account daily Payment reconciliation

Treasury

Check replacement approval

Removed! Treasury will not need to approve every replacement check; instead they will rely on daily bank account reconciliation to flag anomalies. [Note: we anticipate the volume of check replacements to reduce considerably also].

Payment (replacement checks)

Treasury

Financial information Out Key transfer: Upload of information (totals and breakdowns) of benefit payments paid, on a daily basis. Also a range of other information

Payment Budget & Accounting

Transfer of fraud cases to Attorney General

Out When cases are ready for transfer to the AG’s office, this can be done electronically, because in the vast majority of cases, all case materials will be stored on the system.

Investigations Attorney General

Child support garnishment request

In Automated submission from DHS’ ACSES system to trigger a garnishment calculation and reconciliation (also automated but cross-checked).

Garnishments (financial process)

Department of Human Services

Child support garnishment payments

Out Funds electronically transferred to the Administrative Office of the Courts

Garnishments (financial process)

Administrative Office of the Courts


New and Changed Process Interfaces (cont.)Interface name Inward or



ABT training institution reporting

In POSSIBLE: Potentially, training institutions that want to report poor attendance at classes by an ABT recipient cannot do so over the web. This could be a simple additional web service. [This idea was not discussed at a workshop – not yet approved].

ABT continued claims and payments

Training institutions

TRA Out POSSIBLE: Payments to health providers. New TRA regulations now provide 65% coverage of health benefits for TRA recipients – to be administered initially by the state agencies.

IRS may need to access UI data to identify eligible claimants.

TRA continued claims and payments

IRS


PROCESS DIFFERENCES, BY BENEFIT PROGRAM

Ensuring the Blueprint Works for All Benefit Programs The high-level processes described in the previous chapter are intended to cover the benefit programs

described below:

1. Unemployment insurance

- Standard, in-state benefits

- Interstate unemployment insurance

- Combined wage claims

- UCFE (prior federal employees seeking unemployment benefits)

- UCX (prior US military employees seeking unemployment benefits)

- All extensions

2. Disability During Unemployment

3. Additional Benefits during Training

4. Self-Employment Assistance

5. Disaster Unemployment Assistance

6. Trade Re-adjustment Act assistance

Benefit program differences…


All These Benefit Programs Share the Same Fundamental Processes…

ABTSEA


In-state UI claims, TUC claims, UCX/UCFE claims, TRA

Adjudication Center

One Stop

Collateral claims

RCC

Interstate claims

Disability during unemployment

Intake

Adjudication

Continued claim & payments

Preventing overpayments

Correspondence handling

Inquiry handling

Appeals

However, Each Program Has Differences That Must Be Allowed for Within the High-level Blueprint

Interstate, New Jersey liable

• Interstate liable will in fact become closer to the standard model: 1-800 number for out-of-state claims will mean that claimants contact New Jersey directly, eliminating cases filed via ICON

Interstate, New Jersey as agent

• Inform claimants of other States’ internet applications or 1-800 numbers will be a part of triage services (most states). ICON transmission functionality needed for states that do not take their own claims. Paper IB1s are still required for all states for which we act as an agent.

Combined wage claims, New Jersey liable

• Feed of new combined claims against New Jersey from ICON will continue to be dictated by the national program: overnight batch process, for foreseeable future.

For cases file via ICON (MA and VI only)

• Feed of new interstate claims against New Jersey from ICON will continue to be dictated by the national program: overnight batch process, for foreseeable future.

• All data sent through from ICON should be directly inserted into a ‘template’ claim [currently some has to be re-keyed in]

• Need to enable faster and more accurate identification of Federal agency codes (for any process)

Combined wage claims, New Jersey as agent

• Automated cross-check of available weeks and wages to request?

Beyond the processes and enablers described earlier in this section, many benefit programs have different requirements – for example different eligibility measures - that will need to be taken into account. We include here a high-level checklist of the different requirements, to give a sense of the variations.

All enablers discussed earlier will be available and used across ALL benefit programs, unless there is a specific legal or regulatory requirement not to do so.


Benefit Program Differences (cont.)UCX, UCFE • Speed and approach to cross-matches with the national databases will continue to

be dictated by the national programs. I.e., for UCX and UCFE claims, validating identity will remain an overnight process, in the foreseeable future.

• UCX: need ability to link copy of claimant’s DD214 (proof of service) to the electronic case file

• UCFE: need ability to link copy of claimant’s SF50 and/or paystubs

Disability during unemployment

• Basis of eligibility is different. Employer coverage checks should be automatic.

• Financial calculations will be unique: DDU and UI benefits together can be worth 150% of standard UI benefits (neither benefit paying more than 100%). Impacts:

• Different basis for calculations

• Claimant case file should be able to reflect impact of DDU and UI claims on the shared eligibility balance

• Need the ability to attach medical approval to the claimant’s electronic case file. Currently, this is always provided as a hard copy form by a doctor and includes his/her signature. This breaks down into the following information requirements:

• The ability to enter physician and medical information including a prognosis date through to which payments will be paid (see below).

• Listing of licensed physicians and status of licenses - suspended, revoked, etc.

• Listing of morbidity codes.

• Tracking of impartial examinations.

• Different certification model: the claimant is deemed eligible until the prognosis date provided by the doctor (to a maximum of eight weeks) or until an impartial exam deems otherwise. At this point, the claim is re-adjudicated.


Additional Benefits during Training

• Continue to manage payments and continued claims certification for ABT. This therefore requires a certification model that allows for change, to cover paper, phone and web certification

• Basis of eligibility is different

• Benefit payment should extend only to the end of the training course, not a standard period

• Grant payment will not be associated with certification (separate payment to training institution)

Self-Employment Assistance

• SEA certification is (currently) mail-based only.

• Basis of eligibility is different as are implications of receiving SEA (for example, no longer eligible for UI or extensions)

• Benefit payment amount is different.

Trade Re-Adjustment Act

• TRA claims will have a different basis of eligibility: based on an approved TRA list

• Claims process will need to accommodate training approval and tracking

• TRA accounting will need to accommodate health insurance payments (if short-term responsibility does not transfer to the IRS)

Disaster Unemployment Assistance

• DUA eligibility will be based on pre-authorized location criteria

• Benefit amounts will be different

• DUA procedures in particular are constantly evolving and must be easy to change rapidly, to enable rapid response to a disaster


Benefit Program Differences (cont.)

REAL-TIME INFORMATION TO TRANSFORM MANAGEMENT RESPONSIVENESS

Real-time, Accessible Management InformationAccurate, timely and meaningful management information (MI) will be a crucial enabler in the way we manage unemployment insurance services in the future. We started to explore the impact and uses for management information during the expert workshop sessions. This section outlines our early principles for how MI should be used and for the design of MI tools.

The new IT system will collect and maintain an exhaustive audit trail of information, which can be used as a platform for analysis to support all management functions. It will be possible for this information to be queried easily by non-technical managers – in the creation of specific reports and real-time (on screen) views of information.

The new tools will enable faster management action:

• Evidence-based planning: we’ll know what’s achievable

• Rapid identification and response when performance problems arise

• Quicker identification of good practice – improvement trends will be more obvious

• Transparent breakdown of workload – by region, office and even by person

Enhanced access to case information will also enable policy and operations modeling

Illustrative only…

Management information…

XXX solutions

XXX solutions

XXX solutions

Process XXX

Real-time MI Enables More Responsive ManagementManagement information will enable

Senior management to Deliver agency objectives Drive continuous improvement (process and procedure) Provide Federally required reports

Field managers to Manage their units (system, people, processes) against agency objectives Manage staff and their development Drive continuous improvement (process and procedure)

All staff to Understand and monitor their own contribution to performance View and feel part of the overall drive towards agency objectives Drive continuous improvement (process and procedure)

Management information will not be used to monitor the minutiae of or to micro-manage staff activity. Instead the focus will be on identifying performance drivers and targeting training and development where most needed.


• Use real-time staff performance information to provide pats on the back; target staff improvement actions (including mentoring & training), in support of the organization’s needs

• Identify training and customer service needs

• Share data with staff real-time

• Better determination of where problems lie and targeting of remedial actions

• E.g., identification of spelling errors that trigger system errors

• Manage more proactively, in a more timely manner

• Increase consistency across the agency (through sharing of same information)

• Identify best practices and share with the rest of the organization

• Plan resources and activities more accurately

• Improve customer focus

• Improve internal communications


Real-time MI will enable Managers to do Many Things Differently…

Our Business Design Principles for MIThe design principles below represent a first-cut list of management information needs. They are split into principles (a) for how management information should be used in the future and (b) for the tools needed.

(a) Design principles for how MI is used MI should be a balance of qualitative and quantitative information

– Must include customer satisfaction as a key indicator Build in remedial action loop: MI is only valuable as a trigger to action Interpretation of MI will require training Management style and approach may be impacted – may need training on how to manage in new

model?

Overall performance measurement… Measure across whole process Balance emphasis on timeliness with concern about quality Generate outcome measurements

– Not just the immediate outcomes (average wait time), but about contribution to overall objectives (how are we doing against )

Recognize the differences in claim types

– E.g., number of employers per claimant can vary significantly by region and by office (although this should reduce significantly when intake and adjudication workload is shared across the State)

Balance the need to achieve overall performance targets with an understanding of local differences. In particular, look at trends in offices’ performance – don’t just compare different regions


(a) Design principles for how MI is used (cont)

Staff and people measurement… Measure contribution to agency objectives at all levels, from front-line staff upwards

– E.g., Allow front-line workers to compare their performance against their peers Enable each manager to

– Measure his/her office’s performance against agency objectives

– Define extra performance metrics, for specific local issues Use information on staff performance carefully (mitigate the big brother aspects) Establish patterns and measure aberrations, - and collect the reasons for why there is an aberration

(b) Design principles for MI tools Reports should be accessible to people across the organization, making performance transparent within

the Division of UI Allow for an “end-to-end” view of each claim and/or customer history

– E.g., How many contacts were made during the course of one claim? Relate all aspects of performance to get a holistic view (thereby taking into account the different

constraints faced by different parts of the organization) Provide the ability to customize reports and views Flexible query capability Provide real-time information as far as possible

Our Business Design Principles for MI (cont.)


Include a proactive alert system that has built-in triggers to flag problems quickly

– for example, failure of a server should be flagged to managers of all services dependent on that server

Enable timely query access to historical data, for trend and policy research Protect data fields from poor quality data entry

– E.g., Currently, people enter 9999 into LOOPS fields for a number of different reasons. Instead, we should ensure that each piece of information can be entered in an appropriate place (no ‘forcing’ the system)

Must move away from system codes and instead use meaningful names/labels Need for standard data naming conventions The new system must be able to capture and provide analysis on output and performance data, using a

variety of workload data. The system should

– Capture performance data at the lowest level (cost center level as well as by claim)

– Measure workload items including, but not limited to, initial claims processes, weeks claimed etc.

– Be able to provide workload data for any new UI programs that may be enacted by the State or the federal government (e.g., TEUC)

– Provide for the ability to determine the length of various processes. (Eg. How long does it take to process an initial claim in the Vineland RCC? etc).

– Provide for the ability to budget workload data by cost center and measure performance against budget.


Our Business Design Principles for MI (cont.)

CREATING THE RIGHT ENVIRONMENT: ORGANIZATION AND CULTURE CHALLENGES

We Must Address Organization & Culture ChallengesAddressing organizational and cultural challenges effectively is crucial to the success of UI Modernization. UI Modernization is being developed in a frustrating and sometimes stressful environment for UI employees that presents clear opportunities for improvement. These are discussed in the baseline description document, and include: Stressful, repetitive tasks in the One Stop and RCC offices Insufficient training beyond inductions Additional pressure on remaining staff following early retirement initiative

In addition, UI Modernization itself represents significant changes to future ways of working: Enhanced processes New system Modernized functions, such as preventative investigations for potential overpayments; performance management and potentially an in-house training service

The discussion on how the organization and culture of the Division of Unemployment Insurance should change is just beginning. This chapter covers: Core UI functions of the future Principles for organization and culture Potential quick wins Next steps

Core Functions of the Future: Overview

Organization and culture…

Management Financial Accounting*

Overpayment Prevention

Triage and InformationIntake Adjudication

Appeals Tribunal

Debt Management

IT Support and Security*

Training and Personnel

Research and Reporting*

Marketing & Communications*

Policies and Procedures Development

Fraud / Overpayments Investigations

Managing certification & payments

DELIVERY functions MONITOR & IMPROVE functions SUPPORT functions

Performance & Risk Management

Claims-without-Agents

Board of Review

* These functions are currently in full or in part provided outside of the Division of UI. They are included here for their importance to delivering UI services.

Core Functions: Description of New Functions

Claims-without-agents

One ambition for UI Modernization is that straightforward or ‘vanilla’ claims can be submitted through the web or an automated phone system, avoiding the need for claimants to queue for representative assistance wherever possible.

This new function will be responsible for ensuring that claims-without-agents are processed efficiently and effectively – and that the service is available and useful to as many claimants as possible.

Triage and information

Services within triage and information will include: managing entry into the UI system

– accessible phone tree

– website system and content management

‘self-serve’ information provision on phone system and web representative-assisted triage at One Stop centers, on the phone and via web

Workforce New Jersey has committed to identifying how UI and Workforce New Jersey can work together to provide this service jointly to our shared customer base.

Managing certification & payments

There is a potential new, consolidated oversight role in managing all continued claims, post-determination. To be investigated further.

The table below details new functions that we anticipate will be needed to deliver UI in the future model, as well as changes to some current functions. These changes are directly aimed at supporting the modernized processes and approach described earlier.


Overpayment prevention

The new preventative model as part of controlling benefit payments could logically be separated out from traditional (post-event) investigations.

Further detail is required to understand how much prevention activity will best be undertaken as part of the claim intake and adjudication process, or in a new overpayment prevention function. The two functions will certainly need to become interlinked further.

Performance and risk management

To enable continuous improvement and inform management decision-making more effectively, an enhanced central function is needed. This function will focus on understanding the drivers of risk and performance and – working to Operations – help improve every aspect of UI service delivery.

The performance and risk management function could contain elements of the current QC, QA/Internal Audit, and BPC.

Training and personnel

There will be a new in-house training function to address the need for UI-specific training and development, both at point of hire and throughout employees’ careers. This new function will be formalizing the training roles already undertaken by some staff in BPS&S and executive teams.

The personnel function will be a dedicated liaison with DOL personnel, responsible for development paths, recruitment, retention and succession planning.

Marketing and communications

Communications directly with UI’s customers – employers, claimants and staff (and our partners) – has been identified as a key area for improvement. The new function will oversee communications during UI processes, and deliver supporting communications services (extra communiqués etc).

IT support and security

Note: the structure of IT services in the future will be defined in parallel with the technical architecture.


Core Functions: Description of New Functions (cont.)

• Consolidate services that customers do not physically access

– Option: physical consolidation (see next page for considerations)

– Option: virtual consolidation – work as a single unit while geographically dispersed

• Co-locate services that customers do physically access with other workforce services, in locations convenient for the customer

• Balance consolidation of back-end services with ability to manage the operations (see next page)

• Effective resource allocation and values should inform organization structure

– Effective resource allocation can be measured by the productivity of the resource model

– The Division’s cultural values should also be central to any organization decisions – for example, our organization should enable great customer service as well as make the organization a fulfilling place to work

• Work to achieve a collaborative, matrix organization with service delivery as the primary function

• Balance a flat organization model with the need for managers’ span-of-control to be reasonable – I.e., not over-stretching managers

• Separate ‘customer service’ functions from ‘policing’ functions, to balance customer service with preservation of Trust Fund

• Operations management structure should reflect labor market regions, to remain close to local issues and local workforce partners

• All benefit programs should be supported by the same management and tools, with less need to distinguish among them operationally

– Option: include as separate units, but under regional manager command

– Option: completely integrate with in-state UI (assumes that processes have been simplified through application of ‘expert systems’)

– DDU should stay in its current position within DDI

Organization & Culture Business Design Principles


Some function-specific principles have also been defined:• Prevention of overpayments is everyone’s responsibility – and should be worked into approaches and training. In particular, the claims intake, adjudication, claims-without-agents, certification and payment and overpayment prevention functions will be impacted by prevention activities.

• Debt Management should be a centralized, separate function.

• Appeals Tribunal and Board of Review both have autonomy in regard to the substance of their decisions, regardless of where organizationally positioned.

• IT support in field should be generally-skilled to cover many support issues; however, they should have full support of and access to specialists who can resolve more complex issues (who would be based centrally)

Ideas for functional re-organization are still in development; the ideas above will continue to be tested.


Organization & Culture Business Design Principles

Enhanced understanding of the business

Rapid response to local demandsEnhanced customer satisfaction

Minimum corporate overheadWider resource pool

Consolidated functions

Dispersed functions

In practice, few organizations are wholly centralized or

decentralized – the fundamental issue is

one of degree

Getting the balance right between agency standards & control and business unit freedom is an ongoing challenge

Cost savings from synergiesImproved alignment with corporate

strategyOptimal utilization of scarce resources

Economies of scale Shared best practices & standardization

Reduced operational risk Improved career paths

Minimum duplication of effort

Balancing the Benefits of Consolidation and Dispersion Will Be an Ongoing Challenge


The workshop participants discussed a number of actions that could be started soon, to demonstrate the Division’s commitment to addressing organizational and cultural issues: Begin providing a single point of contact for employer inquiries

• Begin training on what ‘empowerment’ means and responsibility to identify barriers to service delivery, along with potential solutions, in particular for managers

• Provide a central point of contact for managers to direct ‘ silo barrier problems’ for appropriate referral and tracking

• Begin cross-training exposure – potentially to include short-term placements and more information-sharing where technically possible now

• Begin planning for rewritten job descriptions with SMART* objectives and clear accountabilities – in particular ensuring that job descriptions reflect current requirements

• Train on how to manage with SMART objectives and accountabilities

• Develop tracking for the informal mentoring program to assess how to improve

• Begin thinking through how ‘case management’ could work and training implications

• Develop a view of property leases vs. consolidation and co-location goals

Organization & Culture: Potential Quick Wins


* SMART: Specific, Measurable, Action-orientated, Realistic and Timed

The following risks have been identified, and should be addressed in the strategic plan phase:

• Potential changes to job scopes, unit scopes, and the fit with DOP regulations

• Ensuring Union representatives are continually involved

• Ensuring the initiative is already delivering before the administration’s term is over (so that it will continue)

• Identifying the appropriate skill-sets for the future state

• Addressing the perceived lack of mentoring and training; lack of cross-understanding of other functions and programs; culture of self-interest and not sharing information to protect jobs

• Clarifying accountability and alignment to UI Modernization objectives

• Change and fear as a barrier: consolidation over past few years – recent experience of change has not been good

• Move towards specialization for quality and consistency (and costs)

• Resourcing for the triage and inquiry function

• Need to analyze best ways to introduce flexibility into the work day to cover a longer period of time (e.g., workshops 2 and 8 discussed a 12 hour business day option that could be supported by multiple shifts)

• Prevention of incorrect benefit payments – change in model, integration with claims processing

Organization & Culture: Implementation Risks


Next Steps: Detailing Culture ChangeAn organization’s culture acts like a lens through which all business plans, communications, initiatives and other messages are filtered and interpreted by employees.

While this phase of UI Modernization has focused primarily on process change, the initiative has not lost sight of the importance of effecting culture modernization as well.

Agency Strategy

CULTURE Business

Results

AssumptionsNorms Values

Initiative 1

Initiative 2

“the way we do things round here”


People

Processes

Organization

Technology

• How power is exercised• How leaders behave • What is understood by

success• How careers develop• How people are rewarded

• How technology shapes jobs• How technology can mobilize• How technology can empower• The influence of e-commerce

• How the structure works• How the organization communicates• The influence of working environment• How alliances and partnerships work• How suppliers are treated• Working practices and SOPs

• How work and money flow• How information is reported• How performance is managed• How the business is governed• How quality is achieved

CULTURE

The next phase of organization and culture design will focus on the detailed changes that will re-energize and focus the organization to deliver the objectives UI Modernization. In planning, it’s worth remembering that the elements that form a culture can be used as levers to change it, too.

This process will be as inclusive as the workshops that developed the rest of this blueprint.

Detailing Culture Change: Select the Best Levers


Building the Momentum for Change

Building the Momentum for Change


measurements






change


What UI Modernization means for our stakeholders

Our inclusive approach has

supported our change objectives

Momentum for Change…

WHAT UI MODERNIZATION MEANS TO OUR STAKEHOLDERS

What will UI Modernization mean to…?

Claimants

Partner Agencies

Employers

Staff

Political stakeholders


Extract from the UI Modernization vision statement:

For our claimants, we will help them to focus on reemployment by making the claims process timely, efficient and informative. We will also help them to access related government services by improving

referrals from UI, in partnership with the workforce community.

Example benefits for our claimants:

I have immediate access to the UI Division, by phone, on the Internet, or by visiting a One Stop Career Center, with little or no waiting. I can even speak to a representative immediately if I so desire

The UI agency will treat me as a real person, with a sincere interest in my needs and questions

I will easily understand the initial claim-filing process and get my question answered by phone or by the Internet. If necessary, I can speak to a knowledgeable and skilled representative who will show a sincere interest in answering my questions or solving my problem

I can expect a prompt determination of my claim. If eligible, my claim will be paid promptly by my choice of payment (check, direct deposit, or other expedient means)

If my claim is not allowed, I will promptly know the reasons why and be informed of my rights to request a reconsideration of my claim or appeal the denial. I can use the phone, Internet or a paper form to file an appeal.

My ongoing obligation to report to the agency my continued status can be quickly done by my choice of phone or internet.

From the onset of my contact with the agency, I will get prompt assistance with the various services and programs available that may allow me to become employed again as soon as possible

I have instant access to my claim status either by phone or internet – and will be able to view all and to change some basic information in my own case file

I can expect to contact the agency via a local phone number (at local cost)

For Our Claimants…


Extract from the UI Modernization vision statement:For our employers, we will simplify correspondence and improve our responsiveness. We will treat

employers as partners in the provision of unemployment insurance

Example benefits for our employers:

The agency is easily available by its website or phone and will answer any of my questions or inquiries (providing my cumulative and individual claim status and history)

I will be able to view my company’s unemployment insurance information – claims and charges – online, via a secure internet site

I will have the opportunity to provide the agency with information about mass layoffs and those individuals who may be affected in advance – making the process easier for me and for my employees

I will be able to participate better in UI fact-finding, because I will be able to leave a voicemail for an adjudicator if he/she is out when I call

I will be able to take advantage of a range of correspondence methods, to make interaction with the Division of UI faster

The agency staff with whom I engage will be fair, prompt, knowledgeable, and immediately available

I will be informed of my ongoing UI obligations and responsibilities (via the internet or phone)

I will be able to file an appeal by internet, phone or in writing – whichever is most convenient to me

For Our Employers…


Extract from the UI Modernization vision statement:For our staff, we will empower them to deliver superior service by ensuring a stable work environment,

creating equal opportunities for career growth and providing appropriate tools and training to do the job. We will treat our employees with the same professionalism and respect they are expected to

share with every UI customer.

Example benefits for our staff:We have the ability to inform proposed and existing changes – and hear how my improvement ideas have been acted upon

We have the means of communicating with each other effectively at all levels of the agency

We have a suite of tools that enable us to meet our customers’ needs so that we can provide prompt and efficient customer service

We have a common database and system that provides fully integrated information in real time about employers and claimants

Our time is spent efficiently, doing those things that best meet our customer’s needs

We are involved in preserving the integrity of the UI trust fund

We are able to avoid mistakes, redundancies, and re-work by means of the excellent tools at our disposal, the training we receive, and our commitment to excellence

We have a dedicated training service that helps us to stay up-to-date on delivering UI services

There is a clear career path within the Department that we can aim for

For Our Staff…


Example benefits:

The UI agency is a “shining star” in the array of services offered by the New Jersey State Government

The State receives great feedback from individuals and citizen groups about the outstanding friendliness, courtesy and prompt services offered by the men and women of the UI agency

The UI agency provides an increasingly important role in the economic health of our State and the financial viability of our citizens

The Unemployment Trust Fund is well managed and the integrity of its resources is assured by the attentiveness given by all employed to administer claims

The UI agency provides an increasing pivotal role in the economic development needs of a trained, qualified, and accessible workforce for in-state employers

For Our Political Stakeholders…


Example benefits:

The UI agency is cooperative in providing timely information to other partners

The UI agency recognizes its essential role in the “team” by providing essential economic support and prompt and efficient services to employers and those who are out of work through no fault of their own

We share a common database for individuals or organizations. This database is integrated, accessible, and user friendly

The UI agency promptly cooperates with its partnering agencies (One Stops, Tax, Child Support)

The UI agency functions like a collaborative partner to serve the common needs of the customers we jointly share

For Our Partner Agencies…


OUR INCLUSIVE APPROACH HAS SUPPORTED OUR CHANGE OBJECTIVES


We have taken an inclusive approach to the creation of the business process conceptual design to ensure we have taken advantage of the knowledge residing both within the organization and with our customers. Activities have included:

Gathering insights from our customers Claimant focus groups and interviews Employer focus groups A legal services (claimant advocate) focus group

Reports from these sessions are attached as Appendix A.

Gathering insights from other States The team developed a best practice guide to innovative approaches taken by other State agencies in

the provision of UI services

This report is attached as Appendix C.

Designing the framework and blueprint Eight guided workshop sessions involving over 120 people from across the Department of Labor and its

partners (many in more than one session)

Summary slides from each workshop are available upon request.

Validating the framework and blueprint A final workshop session for 60+ people, communicated and validated the major changes implied by the

business process conceptual design We solicited informal feedback on this report by key experts prior to submission

We have taken an inclusive approach…


The diagram below depicts the key stages in delivering change effectively in any organization. The approach taken to the business process conceptual design phase – in particular the inclusive nature of the workshops – has helped facilitate readiness for change for an important cross-section of the agency.

…which itself has contributed to the change process

The business process conceptual design workshops

have helped to achieve a number of

critical change management goals










Build a compellingcase for change

Engage change leaders at every

level

Win the commitment

of critical stakeholders

Design the business to

deliver what’s important

Drive theprogram

Speed

Benefits

Risk andcomplexity

Sustainability

Outcome

Additionally, our approach has forced the pace of UI Modernization - giving the process extra energy and giving the Division the chance to deliver early wins and to prove it’s serious about

change


However, we need to continue to lay the foundations for a successful transitionWe are still in the early phases of UI Modernization. We have started to build some excitement about future changes and need to maintain a steady momentum in building first awareness and then buy-in to the initiative.



level

Win the commitment




Drive theprogram

Speed

Benefits

Risk andcomplexity

Sustainability

Outcome



level

Win the commitment




Drive theprogram

Speed

Benefits

Risk andcomplexity

Sustainability

Outcome

Support change agents provide assistance

in getting messages out Provide tools Ensure there’s

something to talk about!

Support change agents Provide assistance

in getting messages out Provide tools Ensure there’s

something to talk about!

Maintain buy-in during the planning and detailed design phases: Ensure the detailed

design addresses concerns of front-line staff

Prioritize changes with biggest impacts on day-to-day work

When planning, build in time for user assessment of projects and deliverables


Some ideas for ongoing change management Assess status and effectiveness to date of current change management activities Develop a formal Change Management Plan

– Identify and train ‘change champions’ who already have a following

– Provide change champions with appropriate training and guidance, potentially incorporating these accountabilities into their job descriptions and objectives

– Emphasize continued involvement of all stakeholders at all levels

– Emphasize articulation to all stakeholders how UI Modernization will affect them through communications that are early, often, complete, consistent, candid and two-way

• What’s in it for me?

• How will it impact my job and career?

• Will it really be done or is this just another initiative that will die on the vine? Implement Quick Wins and advertise their achievement to reinforce credibility of the UI Modernization

project Continue the ‘new tradition’ of inclusive discussions across the whole agency, to help eliminate the view

that headquarters is ‘doing it to us’ Remember that change is a journey, not an event and that it will require commitment, time and patience

from the leadership who demonstrate that they are ‘walking the talk’ Celebrate achievement of major milestones


Next Steps

So, We Have a Framework and Blueprint…The Business Process Conceptual Design is a major deliverable in this strategic design phase of UI Modernization.



DesignDesignDesignDesign PlanPlan

Do

PlanPlan

Do

UI Process Review



Deliverables









Implementation RFPs

Manage the change




Do

PlanPlan

Do

UI Process Review



Deliverables









Implementation RFPs

Manage the change

PlanPlan

Do

PlanPlan

Do

UI Process Review



Deliverables








Requirements

Strategic plan

Implementation RFPs

Manage the change

Nov 2002 – Feb 2003

Feb – May 2003

May – July 2003


Define

Next steps…

… What Comes Next?Formally, the next project steps to complete are the Technical Architecture and Interfaces List, and then the Strategic Plan for implementation of UI Modernization.

Next steps…




Do

PlanPlan

Do

UI Process Review



Deliverables









Implementation RFPs

Manage the change




Do

PlanPlan

Do

UI Process Review



Deliverables









Implementation RFPs

Manage the change

PlanPlan

Do

PlanPlan

Do

UI Process Review



Deliverables








Requirements

Strategic plan

Implementation RFPs

Manage the change

Nov 2002 –Feb 2003

Feb – May 2003

May – July 2003


Define




Do

PlanPlan

Do

UI Process Review



Deliverables









Implementation RFPs

Manage the change

PlanPlan

Do

PlanPlan

Do

UI Process Review



Deliverables









Implementation RFPs

Manage the change




Do

PlanPlan

Do

UI Process Review



Deliverables









Implementation RFPs

Manage the change

PlanPlan

Do

PlanPlan

Do

UI Process Review



Deliverables








Requirements

Strategic plan

Implementation RFPs

Manage the change

Nov 2002 –Feb 2003

Feb – May 2003

May – July 2003


Define

1The Technical Architecture and Interfaces deliverables will• Be delivered in parallel• Describe the architecture and functionality required to support the processes described in this business

process conceptual design• Identify the best architecture in terms of

overall cost: benefit

2The Strategic Plan will identify the best change path for UI Modernization, taking into account • The need to deliver the benefits of each project, as it is implemented• Implementation risks such as continuity of service• The impact on staff and customers of each change

By July 2003, UI Modernization will be fully planned out and the Division will be in a position to trigger the first implementation phase.

The Division Is Continuing to Deliver Quick Win ImprovementsMany participants in UI Modernization have suggested ‘quick win’ changes that could be implemented immediately and thereby start improving the work environment immediately.

In order to give these ideas their full due, the Division has created a parallel work stream to the main UI Modernization process, headed up by Jim Boney.

Potential quick wins are assessed in parallel to the Project, with the expectation the cost-effective and appropriate ones will be implemented as soon as is possible, and need not be encumbered by the UI Modernization implementation timeline.

Examples of quick wins include: Posting ranges of social security numbers being serviced by the RCC on a board next to One Stop

courtesy phones, so that claimants do not waste time on the phones only to learn that their SSN is blocked

Communicating to claimants that they do not qualify for a particular UI benefit check more simply and clearly than sending a non-negotiable check

Providing voicemail for certain staff positions, so that they are more accessible for claimants and employers (for example, adjudicators)

Next steps…

We Are Aware of Ongoing Risks and Continue to Mitigate ThemAt this stage of UI Modernization, risks to success center around gaining support for the direction and approach to delivering such large-scale change. The table below outlines our approach to mitigating the top three risks.

Next steps…

Risk

Stakeholders and particularly staff do not support the initiative

Mitigation action

-- an inclusive workshop approach-- ongoing communications activities and change management plan (see slide 217)

Business process conceptual design is questioned for lack of detailed analysis

-- many UI experts from across the Department and wider have been involved in developing and assessing the conceptual design-- where there is a need for detailed implementation analysis, this will start in the strategic plan phase (e.g., cost:benefit of each of the potential payment methods)-- emphasize need to create the strategic framework and blueprint

quickly, so that detailed design issues are resolved in a shared framework

Insufficient consideration of human resources, management and managing change requirements

-- the business process conceptual design has defined broad functions for the future UI-- acknowledgement that further design needs to be done for human resources – this will start immediately and continue through the strategic plan will identify -- continuous open communication with staff on ideas being discussed – emphasizing positive, unthreatening nature of any changes

New Jersey Department of Labor

Documents

ui division

ui customer service

ui modernizationwe

modernization of ui

modern ui system

associated business

executive summarywhy

customer service needs