Unemployment Compensation Project Phase 2

Transcription

1 State of Florida Agency for Workforce Innovation Unemployment Compensation Project Phase 2 System Use Case UC Investigate Week

2 Document Control Revision History Date Version Description Author 02/01/ Initial Draft Pete Peterson 02/04/ Team Revisions Pete Peterson 02/10/ QA Revisions Pete Peterson 04/01/ Final Review Tad McDonald Quality Review History Date Reviewer Comments 02/03/2010 Tad McDonald Internal Review 02/10/2010 Denise Birch/Ron McCranie QA Review 02/23/2010 Aaron Dienger Peer Review 04/01/2010 Tad McDonald Final Quality Review Page 1

3 UC INVESTIGATE WEEK CONTEXT OF USE This Use Case describes when a Benefit Accuracy Measurement (BAM) Investigator audits a payment week for proper determination and payment. SCOPE UCCBIS. LEVEL User Goal. PRIMARY ACTORS Investigator (BAM Staff). STAKEHOLDERS AND INTERESTS AWI UC needs to protect the fiscal integrity of the program by validating that proper procedures are followed in making determinations and needs to comply with Federal reporting requirements. US Department of Labor (USDOL) needs to ensure that state programs are following proper procedures. PRE-CONDITIONS Investigator is authenticated. A Claim Week has been selected for audit. MINIMAL GUARANTEES The system logs Investigator activities. The system stores incomplete information for later completion. SUCCESS GUARANTEES The USDOL Code Sheet is completed. TRIGGERS Investigator chooses to conduct an investigation. Page 2

4 MAIN SUCCESS SCENARIO Investigator audits a Claim Week. 1. Investigator requests completion of Claimant Questionnaire using Generate Correspondence. 2. Investigator requests completion of Employer Wage Verification using Generate Correspondence. 3. Investigator requests information from third-parties (Schools, Employment Agencies, etc.) as necessary using Generate Correspondence. 4. Investigator attaches information gathered from external sources using Intake Correspondence. 5. Investigator reviews the claim Information. 6. Investigator enters code sheet information. 7. The system validates code sheet information. 8. Investigator confirms code sheet information. 9. Investigator submits code sheet information. 10. The system saves code sheet information. 11. Use Case ends. EXTENSIONS (ALTERNATE PATHS) 5a. Incomplete Information: Contact Claimant or Employer In the Main Success Scenario, when the information submitted is insufficient to make a determination on the issue, additional contacts may be necessary. 5a1. Investigator requests additional information from Claimant or Employer using Generate Correspondence. 5a2. The Main Success Scenario is rejoined at Step 5. 5b. Claimant Response Time Exceeded: Suspend Payment In the Main Success Scenario, when the Claimant fails to respond to the Claimant Questionnaire within the specified time frame, payment to the Claimant is suspended. 5b1. Investigator enters an issue on the claim which prevents payments from being issued. 5b2. The system validates the issue. 5b3. Investigator confirms the issue. 5b4. Investigator submits the issue. 5b5. The system saves the issue. 5b6. The system generates notification to the Claimant that payment has been suspended using Generate Correspondence. 5b7. The Main Success Scenario is rejoined at Step 5. 5c. Claimant Response Received: Remove Payment Suspension In the Main Success Scenario, when the Claimant responds to the Claimant Questionnaire and payment has been suspended; Investigator removes the payment suspension. 5c1. Investigator removes the issue from the claim. 5c2. The system generates notification to the Claimant that payment has been restarted using Generate Correspondence. 5c3. The Main Success Scenario is rejoined at Step 5. Page 3

5 5d. Possible Fraud: Request Investigation In the Main Success Scenario, Investigator determines that the information supports a suspicion of fraudulent activity; Investigator requests a fraud investigation from Wage Determination (Employer fraud) or Benefit Payment Control (Claimant fraud). 5d1. Investigator routes the claim to the appropriate Unit. 5d2. The system creates a work item for the appropriate Unit. 5d3. The Unit notifies Investigator about the results of the investigation. 5d4. The Main Success Scenario is rejoined at Step 6. 5e. Incorrect Determination: Request Redetermination In the Main Success Scenario, Investigator determines that the original determination was made in error; Investigator requests a redetermination. 5e1. Investigator routes the claim to the Adjudication Unit. 5e2. The system creates a work item for the Adjudication Unit. 5e3. Adjudication notifies Investigator about the results of the redetermination. 5e4. The Main Success Scenario is rejoined at Step 6. TECHNOLOGY AND DATA VARIATION LIST - RELATED INFORMATION References US DOL ETA Handbook No th Edition (11/17/2009). Related To-Be Processes Audit BAM BAM Weekly Reviews. Page 4