florida ucm as-is audit
TRANSCRIPT
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State of Florida
Agency for Workforce Innovation
Unemployment Compensation ProjectPhase 2
As-Is Business Process - Audit
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Document Control
Revision History
Date Version Description Author
9/30/09 0.01 Initial draft Pete Peterson/Tad
McDonald
10/20/09 0.07 Incorporate QA feedback Pete Peterson/Tad
McDonald
10/23/2009 0.10 Incorporate Workshop feedback Pete Peterson/Tad
McDonald
11/4/2009 0.11 Incorporate Initial Deliverable Review Comments Pete Peterson/Tad
McDonald
11/5/2009 1.00 Final Version Pete Peterson/Tad
McDonald
Quality Review History
Date Reviewer Comments
10/19/2009 Lori Nolen Comments provided on printed copy
11/3/2009 Audit Staff Comments provided on printed copy
11/5/2009 Denise Birch Deliverable Approved
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Table of Contents
0 PURPOSE AND OBJECTIVES OF THE AUDIT CORE PROCESS ............................. 1
0.1 BEGINNING AND ENDING POINTS ..................................................................................................................... 20.2 AUDIT DIAGRAM .............................................................................................................................................. 30.3 AUDIT ACTIVITIES ........................................................................................................................................... 4
1 PURPOSE AND OBJECTIVES OF THE AUDITBUSINESS ACCURACYMEASUREMENT (BAM) SUB-PROCESS ............................................................................... 6
1.1 BEGINNING AND ENDING POINTS ..................................................................................................................... 61.2 AUDITBUSINESS ACCURACY MEASUREMENT (BAM)DIAGRAM ................................................................. 71.3 AUDIT -BAMACTIVITIES ............................................................................................................................. 10
1.4 AUDITBAMPROCESS ATTRIBUTES ............................................................................................................ 121.4.1 Elapsed Time ....................................................................................................................................... 121.4.2 Paper Documentation ........... ........... .......... ........... .......... ........... .......... .......... ........... .......... ........... ....... 121.4.3 Business System Data Entry & Data Transfer .......... .......... ........... .......... ........... .......... .......... ........... .. 151.4.4 Communication .................................................................................................................................... 161.4.5 Opportunities ....................................................................................................................................... 18
2 PURPOSE AND OBJECTIVES OF THE AUDIT - BTQ QUARTERLY REPORTING
SUB-PROCESS ........................................................................................................................... 20
2.1 BEGINNING AND ENDING POINTS ................................................................................................................... 202.2 AUDIT -BENEFIT TIMELINESS QUALITY (BTQ)QUARTERLY REPORTING DIAGRAM .................................. 212.3 AUDITBTQQUARTERLY REPORTING ACTIVITIES ................................................................................... 23
2.4 AUDITBTQQUARTERLY REPORTING PROCESS ATTRIBUTES .................................................................. 242.4.1 Elapsed Time ....................................................................................................................................... 242.4.2 Paper Documentation ........... ........... .......... ........... .......... ........... .......... .......... ........... .......... ........... ....... 252.4.3 Business System Data Entry & Data Transfer .......... .......... ........... .......... ........... .......... .......... ........... .. 262.4.4 Communication .................................................................................................................................... 272.4.5 Opportunities ....................................................................................................................................... 27
3 PURPOSE AND OBJECTIVES OF THE AUDITBTQ NON-MONETARY
REVIEWS SUB-PROCESS ....................................................................................................... 29
3.1 BEGINNING AND ENDING POINTS ................................................................................................................... 293.2 AUDITBTQNON-MONETARY REVIEWS DIAGRAM .................................................................................. 303.3 AUDITBTQNON-MONETARY REVIEWS ACTIVITIES ............................................................................... 31
3.4 AUDITBTQNON-MONETARY REVIEWS PROCESS ATTRIBUTES .............................................................. 323.4.1 Elapsed Time ....................................................................................................................................... 323.4.2 Paper Documentation ........... ........... .......... ........... .......... ........... .......... .......... ........... .......... ........... ....... 323.4.3 Business System Data Entry & Data Transfer .......... .......... ........... .......... ........... .......... .......... ........... .. 333.4.4 Communication .................................................................................................................................... 343.4.5 Opportunities ....................................................................................................................................... 35
4 PURPOSE AND OBJECTIVES OF THE AUDITBTQDATA VALIDATION
SUB-PROCESS ........................................................................................................................... 36
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4.1 BEGINNING AND ENDING POINTS ................................................................................................................... 364.2 AUDITBTQDATA VALIDATION DIAGRAM .............................................................................................. 374.3 AUDITBTQDATA VALIDATION ACTIVITIES ............................................................................................ 384.4 AUDITBTQDATA VALIDATION PROCESS ATTRIBUTES ........................................................................... 39
4.4.1 Elapsed Time ....................................................................................................................................... 394.4.2 Paper Documentation ........... ........... .......... ........... .......... ........... .......... .......... ........... .......... ........... ....... 404.4.3 Business System Data Entry & Data Transfer .......... .......... ........... .......... ........... .......... .......... ........... .. 404.4.4 Communication .................................................................................................................................... 414.4.5 Opportunities ....................................................................................................................................... 41
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0 PURPOSE AND OBJECTIVES OF THE AUDIT CORE
PROCESS
The Audit core process is comprised of four distinct sub-processes: Benefit Accuracy Measurement
(BAM), Benefit Timeliness and Quality (BTQ)Quarterly Reporting, BTQNon-Monetary Reviews,and BTQData Validation.
Benefit Accuracy Measurement (BAM)
BAM is a federally mandated program providing the basis for assessing the accuracy of Unemployment
Insurance payments made to claimants and the accuracy of benefits denied to claimants. BAM is also adiagnostic tool for Federal and State workforce agency staff members to assist in error identification andcausal analysis. BAM supports the Agencys desire to implement corrective actions and to track theeffectiveness of those remedial actions.
The objectives of the Benefit Accuracy Measurement program are to:
Assess the accuracy of Unemployment Insurance payments
Assess improvements in program accuracy and integrity
Encourage more efficient administration of the Unemployment Insurance program
A weekly, representative sample of UI payments and disqualifying ineligibility determinations are drawn(from the U.S. Department of Labor UI State Menu system), investigated, and audited intensively todetermine whether they were properly administered to claimants and whether the claimants were properly
paid or appropriately denied. Up to ten cases each for paid and denial determinations are randomlyselected for audit. The normal annual caseload is 480 paid claims and 450 denied determinations. Thespecific number of required audits may be changed by the U.S. Department of Labor depending upon
prevailing conditions (i.e., during periods of high unemployment, the Federal government may reduce the
number of audits to allow an agency to re-assign human resources to other tasks such as claimadjudication).
Benefit Timeliness Quality (BTQ)Quarterly Reporting
The determination of a claimants eligibility for unemployment insurance (UI) benefits is a critical UIprogram function. When issues arise that may affect a claimants past, present, or future benefits, the
adjudicator is responsible for determining the claimants eligibility for those benefits. Suchdeterminations may also affect an employers liability for benefit charges, depending on the type of issuesadjudicated. The adjudicators work impacts the rights of both claimants and employers. The BTQ unit
is responsible to report quarterly to the U.S. Department of Labor (DOL) for nonmonetary claims.
Benefit Timeliness Quality (BTQ)Non-Monetary Reviews
UC has instituted an internal quality review process under the auspices of the BTQ unit to performperiodic assessments of adjudicators in each Adjudication Hub. The information gathered through the
reviews provides insight to existing or potential issues that may be causing difficulties in particularadjudication areas (e.g., separation issues). Managers can use that information to take corrective actionwhich may include arranging for remedial training, modifying policies and procedures, and/or suggestingchanges to the automated system(s) to address less than satisfactory performance.
Benefit Timeliness Quality (BTQ)Data Validation
The comprehensive Federal data validation program is necessary to ensure the accuracy of
Unemployment Insurance Required Reports (UIRR) data. UIRR data are used for economic statistics, toallocate UI administrative funding based on state workload, to measure state claimant eligibility criteria
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and performance in providing benefits, and to account for fund utilization. It is therefore essential thatstates report UIRR data accurately and uniformly. States report to DOL on a monthly and quarterly basis
under the Unemployment Insurance Required Reports system.
States are required to validate reported data every third year, except for data elements used to calculate
Government Performance and Results Act (GPRA) measures. GPRA data are validated annually. The
validation year will coincide with the State Quality Service Plan (SQSP) performance year. Validationof any reporting period during the twelve months beginning April 1 and ending March 31 will be
considered part of the validation year. The SQSP is the vehicle through which states submit plans toimplement validation or to revalidate failed items. GPRA and SQSP reporting is covered in a separate
process, Federal Reporting.
Note: Many units within AWI perform audit functions to monitor their performance. The processesdescribed here address specifically BAM and BTQ and are not meant to encompass other audit functionswithin AWI.
The following sections describe the activities associated with the Audit functions in UC.
0.1
BEGINNING AND ENDING POINTS
BAM
Beginning Point:
A list of completed claims is downloaded from the U.S. Department of Labor (DOL) State Menu
system.
Ending Point:
The BAM investigators case file is sent to imaging or a storage facility.
BTQQuarterly Reporting
Beginning Point:
The UC Benefits system generates a random list of claims for review on the first workday of each
quarter.Ending Point:
The BTQ investigators case file is copied to a local, shared network drive.
BTQNon-Monetary Reviews
Beginning Point:
An Adjudication Hub is selected for review.
Ending Point:
The results of the claims reviews are recorded in an internal reporting document.
BTQData Validations
Beginning Point:
A list of necessary populations to be validated is received from the U.S. Department of Labor(DOL) State Menu system.
Ending Point:
The results of the validations are submitted via the U.S. Department of Labor (DOL) State Menusystem.
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0.2 AUDIT DIAGRAM
BAM Unit
Benefit Accuracy Measurement
BTQ Unit
Benefit Timeliness & Quality
Process Start
+
11.01
BAM Weekly
Reviews
Process Ends
Process Start Process Start Process Start
(Data Validation)
+
11.02
Quarterly
Reports
Process Ends
+
11.03
Non-Monetary
Reviews
Process Ends
+
11.04
Data Validation
Process Ends
Exhibit 1Audit Process Flow
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0.3 AUDIT ACTIVITIES
Exhibit 2Audit Activities lists the activities that make up the Audit Core Process. The following is a
description and definition of each of the columns in this table.
Index A number for use in referencing the activity
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.Activity Description The full-text description of that activity
Actors The job or role title of the individuals having a primary role for that activity
Index Activity Label Activity Description Actors
11.01 BAM Weekly
Reviews
Each week (Monday mornings), a supervisor in the BAM unit logs
on to the State Menu system (U.S. DOL application) and
downloads cases for investigation/audit.
Investigators within the BAM Unit audit their assigned cases for
both Paid and Denied claims (they have a maximum of 120 days to
complete their investigations). The investigator enters the results in
the U.S. DOL State Menu system.
Once an investigation/audit is complete, the results are returned to
the BAM unit supervisor for review. The supervisor reviews the
entire case file and the entries in the State Menu system, approves
(or coordinates corrective action with investigators), and closes the
case(s).
Benefit Accuracy
Measurement Unit
11.02 Quarterly Reports A U.S. DOL algorithm is coded within the UC Benefits system to
randomly select, on the first day of each quarter, non-monetary
cases (50 separation, 50 non-separation) for BTQ reporting. The
audit reports are due by the 20 thof the following month.
(Note: The Quarterly Report has not been run for quite a while due
to the re-assignment of BTQ personnel to support the increased UCworkload.)
Reviewers in the BTQ unit examine the cases assigned to them by a
BTQ supervisor, score each according to established guidelines,
and return the results to the unit supervisor for additional
processing.
The results of the BTQ audits are recorded in the U.S. DOL State
Menu system.
Benefit Timeliness &
Quality Unit
11.03 Non-Monetary
Reviews
The BTQ unit conducts periodic audits of the Adjudication Hubs.
A selection of claims (10 cases per adjudicator) is randomly
extracted from the UC Benefits system for a given date range and
assigned to BTQ examiners for review.
Examiners review cases assigned to them and score each according
to established guidelines.
A BTQ unit supervisor compiles the results of the reviews and
communicates the results to the Adjudication Hub supervisors for
further action.
Benefit Timeliness &
Quality Unit
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Index Activity Label Activity Description Actors
11.04 Data Validation A BTQ supervisor accesses the U.S. DOL State Menu system and
downloads validation data requirements established by the U.S.
Department of Labor. Validation and reporting requirements are
divided into populations by DOL and sent to all states in June or
July. The agencys previous performance (Pass/Fail criteria)
influences the validation requirements for content (which
populations to validate) and frequency (usually, a passing score
relieves the agency of reporting for a given population for three
years while a failing score necessitates corrective action, re-
validation, and reporting on a more frequent basis).
The results of the BTQ audits are recorded in the U.S. DOL State
Menu system.
Benefit Timeliness &
Quality Unit
Exhibit 2Audit Activities
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1 PURPOSE AND OBJECTIVES OF THE AUDITBUSINESS
ACCURACY MEASUREMENT (BAM) SUB-PROCESS
The Audit core process is comprised of four distinct sub-processes: Benefit Accuracy Measurement
(BAM), Benefit Timeliness and Quality (BTQ) - Quarterly Reporting, BTQNon-Monetary Reviews,and BTQData Validation.
Benefit Accuracy Measurement (BAM)
BAM is a federally mandated program providing the basis for assessing the accuracy of Unemployment
Insurance payments made to claimants and the accuracy of benefits denied to claimants. BAM is also adiagnostic tool for Federal and State workforce agency staff members to assist in error identification andcausal analysis. BAM supports the Agencys desire to implement corrective actions and to track theeffectiveness of those remedial actions.
The objectives of the Benefit Accuracy Measurement program are to:
Assess the accuracy of Unemployment Insurance payments
Assess improvements in program accuracy and integrity
Encourage more efficient administration of the Unemployment Insurance program
A weekly, representative sample of UI payments and disqualifying ineligibility determinations are drawn(from the U.S. Department of Labor UI State Menu system), investigated, and audited intensively todetermine whether they were properly administered to claimants and whether the claimants were properly
paid or appropriately denied. Up to ten cases each for paid and denial determinations are randomlyselected for audit. The normal annual caseload is 480 paid claims and 450 denied determinations. Thespecific number of required audits may be changed by the U.S. Department of Labor depending upon
prevailing conditions (i.e., during periods of high unemployment, the Federal government may reduce the
number of audits to allow an agency to re-assign human resources to other tasks such as claimadjudication).
Note: Many units within AWI perform audit functions to monitor their performance. The processes
described here address specifically BAM and are not meant to encompass other audit functions withinAWI.
The following sections describe the activities associated with the Audit - BAM functions in UC.
1.1
BEGINNING AND ENDING POINTS
BAM
Beginning Point:
A list of completed claims is downloaded from the U.S. Department of Labor (DOL) State Menu
system.
Ending Point:
The BAM investigators case file is sent to imaging or a storage facility.
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1.2 AUDITBUSINESS ACCURACY MEASUREMENT (BAM)DIAGRAM
Supervisor
11.01.01Download Cases
InvestigatorUS Department of
Labor
State Menu System
11.01.02 Assign
Investigator
State Menu System
11.01.04 Generate
Code Sheets
Winscape
11.01.06 Update
Investigator OpenCase Document
Word
11.01.07 Save
Open Case
Document to
Investigator folder
Local S: Drive
11.01.05 Move
Case files to
Investigator folder
Local S: Drive
11.01.08 Request
Weekly
Certifications
UC
11.01.03 Run
Script
UI Sun (Putty)
Print Job Request
Process Start
Continued on
Following Page
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EmployerInvestigatorSupervisor
11.01.09 Retrieve
Open Case
Assignments
Local S: Drive
11.01.11 Retrieve
Pre-Investigation
Documents
(Claimant) UC, Imaging,
SunTax,
Employ Florida
11.01.13
Assemble
Investigation Case
Folder
11.01.15
Investigate Case
Word
11.01.10 Print
Code Sheets
11.01.14 Send
Employer Wage
Verification Form
& Claimant
Questionnaire
Claimant
Mail/Email/Fax
Wage Verification Form
Mail/Fax/Email
Questionnaire
Phone/Mail /Fax/Emai l Phone/Mai l/Fax/Emai l
Other AWI Units
If Determination Error
Request
Redetermination
If Possible Fraud
Notify
Benefit Payment Control
Notify
Appeals Clerks Office
If Under Appeal11.01.16 Inform
Other Areas
BD15V Weekly Certifications
11.01.12 Retrieve
Pre-InvestigationDocuments
(Employer)
SunTax
State Menu System
Continued from
Previous Page
Continued on
Following Page
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Supervisor Investigator
11.01.21 Review
Case
11.01.22 Make
Corrections
11.01.17 Complete
Code Sheet
11.01.18 Update
Code Sheet Data
11.01.20 Return
Case Folder
State Menu System
11.01.19 Close
Case
State Menu System
11.01.23 Close
Case
State Menu System
11.01.25 Store File
(3 Years)
If Paid Case
11.01.26 Send File
to Imaging
If Denied Case
Process Ends
Incorrect
Continued from
Previous Page
Investigator
If Improper Payment11.01.24 Review
Case
Interoffice
Memo
Interoffice
Memo
Exhibit 3Audit - BAM Process Flow
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1.3 AUDIT -BAMACTIVITIES
Exhibit 4Audit - BAM Activities lists the activities that make up the AuditBAM sub-process. The
following is a description and definition of each of the columns in this table.
Index A number for use in referencing the activity
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.Activity Description The full-text description of that activity
Actors The job or role title of the individuals having a primary role for that activity
Index Activity Label Activity Description Actors
11.01.01 Download Cases The U.S. Department of Labor (DOL) provides a random selection
of Paid (PCA) and Denied (DCA) claims for state audit. Each
week (Monday mornings), a supervisor in the BAM unit logs on to
the State Menu system (U.S. DOL application) and downloads
cases for investigation/audit. (Note: the cases are automatically
converted.)
US Department of
Labor (DOL)
Supervisor
11.01.02 Assign Investigator The supervisor selects Case Assignment from the State Menu
selection screen and assigns each case to a specific investigator
(investigators are identified with a unique number). The process is
completed for Paid (PCA) cases and repeated for Denied (DCA)
cases.
Supervisor
11.01.03 Run Script The supervisor logs onto the uisfl2 (UI Sun) system and runs a
preloaded script to prepare the coding sheets to be used for the
case reviews.
Supervisor
11.01.04 Generate Code
Sheets
Each investigation has its own code sheet to record the results of
the examination. The BAM supervisor generates the code sheets
using the Winscape application.
Supervisor
11.01.05 Move Case files to
Investigator folder
Each investigator is assigned a folder on the network S: drive. The
coding sheets for the cases assigned to each investigator are placed
in their S: drive folder.
Supervisor
11.01.06 Update InvestigatorOpen Case
Document
The supervisor maintains a Word document containing the caseassignments for each investigator.
Supervisor
11.01.07 Save Open Case
Document to
Investigator Folder
The Word document created by the Supervisor is placed in each
investigators S: drive folder.
Supervisor
11.01.08 Request Weekly
Certifications
For Paid (PCA) cases, the Supervisor runs a print request to create
Weekly Certifications from the UC Benefits system.
Supervisor
11.01.09 Retrieve Open Case
Assignments
The investigator accesses the network S: drive folder to locate the
cases assigned (Word document placed there by the Supervisor).
Investigator
11.01.10 Print Code Sheets The code sheets are printed from the State Menu system. Investigator
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
Using a variety of systems at the investigators disposal (UC,
Imaging, SunTax, Employ Florida), the investigator gathers
information to support the case examination. In addition, the
printed output from the BD15V transaction is returned to the
investigator (the print job runs overnight).
Investigator
11.01.12 Retrieve Pre-
Investigation
Documents
(Employer)
The investigator retrieves employer-related information from the
SunTax system.
Investigator
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Index Activity Label Activity Description Actors
11.01.13 Assemble
Investigation Case
Folder
The investigator follows a common case folder assembly process
to standardize the content and order of documents in the case
investigation folder (one folder is prepared for each case).
Investigator
11.01.14 Send Employer
Wage Verification
Form & Claimant
Questionnaire
The investigator sends a questionnaire to claimants, asking them to
supply information about their particular claim. At the same time,
employers are asked to verify the information about wages using
the Wage Verification form.
(Note: Claimants are informed the failure of responding to the
questionnaire may result in the suspension of benefit payments (if
any are being currently paid). If the Claimant does not respond,
further payments, if any, are suspended. Once a response is
provided, payments, if any, are resumed. No such leverage is
available regarding employers.
Investigators
11.01.15 Investigate Case Investigators review all the information at their disposal to
investigate the cases assigned to them. They may have to
communicate with claimants and employers on an ad-hoc basis to
clarify existing information or to gather additional information.
Investigator
11.01.16 Inform Other Areas If, during the course of an investigation, it is found that a
determination error may have been made, investigators may
request redetermination from the Wage Determination unit. If the
case being investigated is under appeal, the Clerks Office in
Appeals is notified. If the possibility of fraud exists, the Benefit
Payment Control (BPC) unit is informed. The results of the
redetermination and/or fraud investigation are returned to the
Investigator.
Investigator
11.01.17 Complete Code
Sheet
For each assigned case, the investigator completes a separate code
sheet that represents the results of the investigation.
Investigator
11.01.18 Update Code Sheet
Data
The investigator transfers the information from the paper code
sheet to the State Menu system.
Investigator
11.01.19 Close Case After the code sheet data is input to the State Menu system, the
investigator closes the case and prepares the case folder to be
given back to the BAM supervisor.
Investigator
11.01.20 Return Case Folder After review for completeness and accuracy, the investigator
returns the case folder(s) to the BAM supervisor.
Investigator
11.01.21 Review Case The Supervisor reviews the case information and, in an iterative
process, directs the investigator to make necessary corrections to
the case.
Supervisor
11.01.22 Make Corrections When notified by the BAM supervisor, the investigator makes
modifications to the case.
Investigator
11.01.23 Close Case Once the case investigation is complete to the satisfaction of the
BAM supervisor, the case is closed in the State Menu system. If an
Improper Payment has been made, the Supervisor will prepare amemorandum for the Administrators review.
Supervisor
11.01.24 Review Case The Administrator will review the case. If the improper payment
was made in violation of law or policy, a memorandum will be
prepared summarizing the results of the investigation and sent to
the Adjudication Hub Supervisor and/or AWI Management for
appropriate action.
Administrator
11.01.25 Store File (3 Years) Completed cases are archived. Paid cases are retained for three
years in hard copy.
Supervisor
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Index Activity Label Activity Description Actors
11.01.26 Send File to
Imaging
Denied payment cases are sent to imaging for capture and
retention.
Supervisor
Exhibit 4Audit - BAM Activities
1.4
AUDIT
BAMPROCESS ATTRIBUTES
The following sections define and describe sub-process specifics for elapsed time, paper documentation,business system use, communications, and process improvements. The information is arranged in thisway to support analysis of these activities, both individually and collectively.
1.4.1
Elapsed Time
Exhibit 5Audit - BAM Activity Elapsed Time lists the time required to complete each of the activities
that make up the AuditBAM sub-process. The times are estimated except where noted. The followingis a description and definition of each of the columns in this table.
Index A number for use in referencing the activity.
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.Process Time The hands-on time it takes to complete the activity (does not include mail, transport, or time
spent waiting for another activity to complete).
Cycle Time The total elapsed time from the beginning of the activity until it is complete, inclusive of all delays
from transport, mail, other processes, and work load.
Time Goals / Limits Any time limits or goals, from any sourceinternal or externalpertaining to this activity.
Limit/ Goal Source The source of the limit or goal listed above (Florida Statutes, AWI policy, etc.)
Speed Bumps Specific, recurring difficulties that slow the progress of this activity.
Index Activity
Label
Process
Time
Cycle
Time
Limit or Goal Time Limit or
Goal
Source
Speed Bumps
11.01 BAM 4-6 hours
per file
120 Days All investigations must be
completed within 120 days.
ETA 395
Handbook
published by
Department
of Labor.
Gathering
documentation from
multiple systems.
Obtaining responses
from Claimant &
Employer.
11.01.11 Retrieve Pre-
Investigation
Documents
Overnight Overnight Official reproductions of
certain documents must be
requested and printed during
an overnight process.
AWI Staff The overnight print
process, while
generally
cumbersome, does
not create a
significant delay in
the BAM process.
Exhibit 5
Audit - BAM Activity Elapsed Time
1.4.2 Paper Documentation
Exhibit 6Audit - BAM Paper Documentation lists the paper documents required to complete each of
the activities that make up the AuditBAM sub-process. The reference column refers to the originatorand title of policy, procedure, or instruction that contains the form or specifies the content of thedocument. More than one document may be required to carry out a single activity, so each is listed. The
following is a description and definition of each of the columns in this table.
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Index A number for use in referencing the activity.
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Document Title Short title, form number or other designation for the document.
Document
Description
General description of the document contents and purpose.
Reference or Source Originator and title of the source instruction or policy.
Index Activity Label Document Title Document Description Reference
or Source
11.01.06 Update
Investigator Open
Case Document
Investigator Open
Case Document
Word Document used to track all open cases for
each Investigator
BAM
Supervisor
11.01.08 Request Weekly
Certifications
BD15V Weekly Claim Certification Report (for Key Week).
Printed from the UC System.
AWI
Investigator
11.01.10 Print Code Sheets Code Sheet Printout from the State Menu System. Completed by
hand. (4 VersionsPaid Claims, Separation Denial,
Monetary Denial, Non-Separation Denial)
AWI
Investigator
11.01.11 Retrieve Pre-
InvestigationDocuments
(Claimant)
BI08 UC/SunTax Wage Crossmatch. Printed from the UC
System.
AWI
Investigator
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
BD11 Wage Transcript & Determination. Printed from the
UC System.
AWI
Investigator
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
BH01 Claim History. Printed from the UC System. AWI
Investigator
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
BF01 Overpayment History. Printed from the UC System. AWI
Investigator
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
BQ01 Determination History. Printed from the UC
System.
AWI
Investigator
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
Claim Form Printed from the EIS (Imaging System) AWI
Investigator
11.01.11 Retrieve Pre-
Investigation
Documents(Claimant)
Wage Items Screen
Print
Printed from the Department of Revenue SunTax
System.
AWI
Investigator
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
SIDI Out of State Wages Summary Report. Printed from
the UC System.
AWI
Investigator
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Index Activity Label Document Title Document Description Reference
or Source
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
IBIQ Out of State Wages Detail Report. Printed from the
UC System.
AWI
Investigator
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
Job Registration
History
Printed from the EmployFlorida System. AWI
Investigator
11.01.12 Retrieve Pre-
Investigation
Documents
(Employer)
Employer Report Retrieved from the Department of Revenue SunTax
System. Screen print of the Detail 1 and Detail 2
tabs.
AWI
Investigator
11.01.13 Assemble
Investigation Case
Folder
Investigation Activity
Log
Blank template (Word). Completed by hand. AWI
Investigator
11.01.13 Assemble
Investigation CaseFolder
Case Checklist Blank template (Word). Completed by hand. AWI
Investigator
11.01.14 Send Wage
Verification Form
& Claimant
Questionnaires
Claimant
Questionnaire
Document used to gather information from the
Claimant to be used during the Audit Investigation
(4 Versions - Paid Claims, Separation Denial,
Monetary Denial, Non-Separation Denial). Attached
to a Cover Letter generated from a Word Template.
AWI
Investigator
11.01.14 Send Wage
Verification Form
& Claimant
Questionnaires
Information for the
Claimant on the
Unemployment
Compensation Benefit
Accuracy
Measurement
Program (LES UCR
Bulletin 1 (Rev. 6/00)
Pamphlet inserted with the Claimant Questionnaire
containing information regarding the BAM
program.
AWI
Investigator
11.01.14 Send Wage
Verification Form
& Claimant
Questionnaires
Wage Verification
Form
Document used to gather information from the
Employer to be used during the Audit Investigation.
Consists of two parts - Claimant Wage Verification,
Quarterly Earnings Amounts. Attached to a Cover
Letter generated from a Word Template.
AWI
Investigator
11.01.15 Investigate Case School Verification
Form
Document sent to the School that Claimant was
attending during key week. Attached to a Cover
Letter generated from a Word Template.
AWI
Investigator
11.01.15 Investigate Case (Private) Employment
Agency Verification
Document sent to a private employment agency to
validate Claimant's job search history. Attached to a
Cover Letter generated from a Word Template.
AWI
Investigator
11.01.15 Investigate Case Work Search
VerificationRegular
Employer
Document sent to a potential employer to validate
Claimant's job search history. Attached to a Cover
Letter generated from a Word Template.
AWI
Investigator
11.01.15 Investigate Case Work Search
Verification - Labor
Organization
Document sent to a union or labor organization to
validate Claimant's job search history. Attached to a
Cover Letter generated from a Word Template.
AWI
Investigator
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Index Activity Label Document Title Document Description Reference
or Source
11.01.16 Inform Other
Areas
MemoRequest for
Monetary
Redetermination
Word Template. Completed to request a
redetermination based on the results of the
investigation. (Note: The results of the
redetermination are returned to the BAM
Investigator)
AWI
Investigator
11.01.17 Complete Code
Sheet
Summary of
Investigation
Document used to present summary investigation
information to BAM Supervisor. Investigation (4
Versions - Paid Claims, Separation Denial,
Monetary Denial, Non-Monetary Non-Separation
Denial).
AWI
Investigator
11.01.18 Update Code Sheet
Data
Data Collection
Instrument (DCI)
Report
Printout from the State Menu System after data
entry is completed. (4 VersionsPaid Claims,
Separation Denial, Monetary Denial, Non-
Separation Denial)
AWI
Investigator
Exhibit 6Audit - BAM Paper Documentation
1.4.3
Business System Data Entry & Data TransferExhibit 7Audit - BAM Data Entry & Data Transfer lists the business systems that are employeddirectly (touched) or indirectly (data transfer) in the course of the AuditBAM sub-process. Thefollowing is a description and definition of each of the columns in this table.
Index A number for use in referencing the activity.
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Business System The name or designation of the system touched (if any).
Purpose or Intent The business objective accomplished by using the system or systems.
Mode Choose one; entry is made by a person, transfers are from system to system.
Index Activity Label Business System Program or Intent Mode
11.01.03 Run Script UI Sun System (Putty) Command Line Program - Convertsdownloaded cases to a format to be used for
Winscape
Transfer
11.01.04 Generate Code
Sheets
Winscape Command Line Program - Creates Code Sheets
for all selected cases for review. Output is a
series of Word documents
Transfer
11.01.08 Request Weekly
Certifications
UC BD15V - By SSN/Date
Weekly Claim Certification Report (for Key
Work)
Inquiry
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
UC Retrieve by SSN:
(BI08) UC/SunTax Wage Crossmatch
(BD11) Wage Transcript & Determination
(BH01) Claim History
(BF01) Overpayment History
(BQ01) Determination History
Inquiry
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
EIS (Imaging) Input SSN on the Search Screen. Results are
displayed and the Original Claim Form is
printed.
Inquiry
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Index Activity Label Business System Program or Intent Mode
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
SunTax Input SSN on the Search Screen.
Select and print the Wage Items Screen (By
Employer for Base Period & Following)
Inquiry
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
UC Retrieve by SSN
(SIDI) Out of State Wages (Search)
If results are found, input SSN and State to
retrieve:
(IBIQ) Out of State Wages (Detail)
Inquiry
11.01.11 Retrieve Pre-
Investigation
Documents
(Claimant)
EmployFlorida Input SSN on the Assist Screen. Print the Job
Registration History
Inquiry
11.01.12 Retrieve Pre-
Investigation
Documents
(Employer)
SunTax Input the Employer # on the Search Screen.
Print the:
Detail 1 Tab (Basic Demographics)
Detail 2 Tab (Tax Rate/NAICS Code)
Inquiry
Exhibit 7
Audit - BAM Data Entry & Data Transfer
1.4.4 Communication
Exhibit 8Audit - BAM lists the messages, such as the US mail, emails, phone calls and any othercorrespondence, regularly used in the normal courseof the AuditBAM sub-process. Messages are sentto convey required documentation, inform recipients about the status of an activity, to trigger the start orend of other activities, to grant or withdraw authorization, etc. This section only concerns messages sentduring normal (as intended) operations. There may be more than one message associated with any
activity in this process. The following is a description and definition of each of the columns in this table.
Index A number for use in referencing the activity.
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Message Type US mail, email, phone call, etc.Message Sender The organization or role of the message sender.
Message Purpose The intended purpose for sending the message.
Message Recipient The organization or role of the intended recipient.
Occasion Event or action that triggers the requirement to send the message
Index Activity Label Message
Type
Sender Message
Purpose
Message
Recipient
Occasion
11.01.14 Send Wage
Verification
Form & Claimant
Questionnaires
Mail Investigator Claimant
Questionnaire
Claimant During the
Investigation into a
determination.
11.01.14 Send Wage
Verification
Form & Claimant
Questionnaires
Mail/Fax Investigator Wage
Verification
Form
Employer During the
Investigation into a
determination.
11.01.15 Investigate Case Phone/Mail/Fa
x/Email
Investigator To gather
additional
information as
necessary.
Claimant/Emplo
yer
During the
Investigation into a
determination.
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Index Activity Label Message
Type
Sender Message
Purpose
Message
Recipient
Occasion
11.01.15 Investigate Case Mail/Fax Investigator To gather
additional
information as
necessary.
School During the
Investigation into a
determination.
11.01.15 Investigate Case Mail/Fax Investigator To gather
additional
information as
necessary.
Private Job
Search Firm
During the
Investigation into a
determination.
11.01.15 Investigate Case Mail/Fax Investigator To gather
additional
information as
necessary.
Potential
Employer
During the
Investigation into a
determination.
11.01.15 Investigate Case Mail/Fax Investigator To gather
additional
information as
necessary.
Labor
Organization
During the
Investigation into a
determination.
11.01.16 Inform OtherAreas (as
necessary)
Email/Phone/Interoffice
Investigator RequestRedetermination
(Note: The
results of the
redetermination
are returned to
the BAM
Investigator)
AdjudicationHub
If the file appears tocontain a
determination error.
11.01.16 Inform Other
Areas (as
necessary)
Email/Phone/
Interoffice
Investigator Notify Appeals
of a
Redetermination
Appeals Unit If the file appears to
contain a
determination error.
11.01.16 Inform Other
Areas (as
necessary)
Email/Phone/
Interoffice
Investigator Notify BPC of
possible fraud
for further
investigation.
(Note: The
results of the
investigation are
returned to the
BAM
Investigator)
BPC Unit If the file appears to
evidence of
fraudulent activity.
11.01.23 Close Case Interoffice Supervisor Notify the
Administrator of
a possible
improper
payment made
in violation of
law or policy.
Administrator When a possible
improper payment is
detected.
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Index Activity Label Message
Type
Sender Message
Purpose
Message
Recipient
Occasion
11.01.24 Review Case Interoffice Administrator Notify the
Adjudication
Hub Supervisor
and/or AWI
Management of
the improper
payment for
appropriate
corrective
action.
Adjudication
Hub Supervisor/
AWI
Management
When an improper
payment is detected
in violation of law or
policy.
Exhibit 8Audit - BAM Communication
1.4.5 Opportunities
The purpose of this section is to capture improvement suggestions that may have a positive effect ontechnical, functional, or physical components of the Audit - BAM activities.
Over the course of our interviews and observations, we identified a number of possible processimprovement opportunities (long and short term). The following tables contain descriptions (ProblemStatement) of what may be negatively affecting current operations and corresponding potential solutions(Recommendation) to address the issues. In some cases, additional analysis is required tounderstand
fully the impact of the problems and/or recommendations.
The following is a description and definition of each of the columns in this table.
Origin The area of the improvement such as: Central Office, Hub, etc.
Problem
Statement
Description of the problem or opportunity identified.
Recommendation Description of the proposed recommendation, including expected result.
Value Added Description of the expected value received if the recommendation to the problem statement is
identified.
Short Term Opportunities for Improvement
Origin Problem Statement Recommendation Value Added
11.01.11
11.01.12
There are a large number of reports that
are gathered as part of the BAM
process. For the most part, each report
must be requested individually.
Provide a single transaction
for investigators to
automatically generate the UC
reports required to support
audit activities.
Significant time savings.
11.01.14 There appears to be a problem getting
employers to respond to inquiries in a
timely fashion which results in delays
for the investigation process.
Identifying better/easier
methods (e.g., online) for
employer feedback may help
to simplify the process for
employers.
Needs further investigation.
Quicker employer responses will
decrease the time necessary to
complete audit activities.
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11.01.25 Paid case investigation results are not
imaged like the Denied cases.
Paid cases are a lot larger (many more
pages of documents because Paid cases
involve claimants and employers;
denied cases usually only involve
claimants) and there arent time or
resources available to prepare the case
folders for imaging.
We believe further
investigation is required to
develop workable solutions
leading to the capture of Paid
cases in the imaging system.
Capturing images of the Paid cases
would lead to relieve the need to
maintain paper archives and could
provide a faster, easier method for
retrieval.
Exhibit 9Short Term Opportunities for Improvement
Long Term Opportunities for Improvement
Origin Problem Statement Recommendation Value Added
Exhibit 10Long Term Opportunities for Improvement
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2 PURPOSE AND OBJECTIVES OF THE AUDIT - BTQ
QUARTERLY REPORTING SUB-PROCESS
The Audit core process is comprised of four distinct sub-processes: Benefit Accuracy Measurement
(BAM), Benefit Timeliness and Quality (BTQ)Quarterly Reporting, BTQNon-Monetary Reviews,and BTQData Validation. The following section describes the BTQQuarterly Reporting related
activities.
Benefit Timeliness Quality (BTQ)Quarterly Reporting
The determination of a claimants eligibility for unemployment insurance (UI) benefits is a critical UIprogram function. When issues arise that may affect a claimants past, present, or future benefits, theadjudicator is responsible for determining the claimants eligibility for those benefits. Suchdeterminations may also affect an employers liability for benefit charges, depending on the type of issuesadjudicated. The adjudicators work impacts the rights of both claimants and employers. The BTQ unit
is responsible to report quarterly to the U.S. Department of Labor (DOL) for nonmonetary claims.
Note: Many units within AWI perform audit functions to monitor their performance. The processes
described here address specifically BAM and BTQ and are not meant to encompass other audit functionswithin AWI.
The following sections describe the activities associated with the Audit - BTQ functions in UC.
2.1
BEGINNING AND ENDING POINTS
BTQQuarterly Reporting
Beginning Point:
The UC Benefits system generates a random list of claims for review on the first workday of each
quarter.
Ending Point:The BTQ investigators case file is copied to a local, shared network drive.
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2.2 AUDIT -BENEFIT TIMELINESS QUALITY (BTQ)QUARTERLY REPORTING
DIAGRAM
Supervisor Reviewer AWI Print Shop
11.02.05 InsertData
Collection
Instrument
If First Review
11.02.06 Review &
Score File
11.02.01 Select
SSNs for Review
11.02.02 Assign
Reviewer
11.02.03 Setup
Folder & Label
Word
Interoffice
11.02.04 Retrieve
Pre-Review
Documents
UC, Imaging,
FLUID, AENR
If Second Review
UC
Adjudication Hub
If Determination Error
Request
Redetermination
Process Start
Continued on
Following Page
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SupervisorReviewerAdjudication Hub
11.02.11 Complete
Internal Report
11.02.09 Complete
ETA 9056
Reviewers
Agree?
State Menu System
No
11.02.07 Insert
Data
Collection
Instrument
11.02.08 Review &Score File
Yes
If Failing Score
Interoffice to
Hub Supervisor
11.02.10 Archive
File
Excel
Process Ends
Continued from
Previous Page
Exhibit 11Audit - BTQ - Quarterly Reporting Process Flow
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2.3 AUDITBTQQUARTERLY REPORTING ACTIVITIES
Exhibit 12AuditBTQQuarterly Reporting Activities lists the activities that make up the Audit
BTQQuarterly Reporting sub-process. The following is a description and definition of each of thecolumns in this table.
Index A number for use in referencing the activityActivity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Activity Description The full-text description of that activity
Actors The job or role title of the individuals having a primary role for that activity
Index Activity Label Activity Description Actors
11.02.01 Select SSNs for
Review
The UC Benefits system has coded within it a U.S. Department of
Labor (DOL) algorithm which automatically selects random claims
for review (50 Separations, 50 Non-Separations). For quarterly
reporting, the process is executed on the first workday of each
quarter (January, April, July, and October) and creates printouts
for each claim.
UCB45Wage Determination(s)
BH01History
The output is routed to the BTQ Supervisor via interoffice mail
and the Quarterly Reports are due by the 20 thday of the month
following the quarter (e.g., Quarterly Report review reviews for
Jan-Mar are run on April 1 and the results are due back to DOL by
May 20).
AWI Print Shop
11.02.02 Assign Reviewer The BTQ supervisor assigns a reviewer for each case. The cases
are separated by type (50 Separations and 50 Non-Separations).
The supervisor gives 50 of one type to one reviewer and 50 of the
other type to a different reviewer. Later, in this process, the
reviewers exchange cases and re-score each others work.
Supervisor
11.02.03 Setup Folder &
Label
The reviewer sets up a separate folder for each assigned case and
labels the folder.
Reviewer
11.02.04 Retrieve Pre-
Review Documents
The reviewer queries multiple systems to retrieve the information
necessary to complete the assessment.
Reviewer
11.02.05 Insert Data
Collection
Instrument
A blank data collection instrument (scoring sheet) is inserted into
the case folder by each reviewer.
Reviewer
11.02.06 Review & Score
File
The results of each review are scored in accordance with the ET
Handbook 301 (the scoring is indicated on the data collection
instrument for each scoring category).
Once all 50 assigned cases of one type are reviewed by one
examiner, the reviewers exchange the folders and score the cases
again. If there are any disagreements in the scoring, the cases are
submitted to a supervisor to be scored a third time.
If it appears a determination error was committed and is in
violation of law and policy, the case is referred to the Adjudication
Hub for redetermination.
Reviewer
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Index Activity Label Activity Description Actors
11.02.07 Insert Data
Collection
Instrument
If the initial reviewers do not agree about the score for a given
case, the case is scored by the BTQ supervisor using the same
process.
A blank data collection instrument (scoring sheet) is inserted into
the case folder.
Supervisor
11.02.08 Review & Score
File
The case is reviewed and scored in accordance with the ET
Handbook 301 as indicated on the data collection instrument.
Supervisor
11.02.09 Complete ETA
9056
Once all cases are scored, the results are input to the State Menu
system by completing the ETA 9056.
If a case receives a failing score, a memo and a copy of the case is
sent to the Adjudication Hub supervisor to whom the initial case
adjudicator reports.
Reviewer
11.02.10 Archive File The review files are stored in local archives for two years. Reviewer
11.02.11 Complete Internal
Report
An internal report (created in Excel), containing the results of the
reviews, is stored on the network Program Evaluation drive.
Supervisor
Exhibit 12AuditBTQQuarterly Reporting Activities
2.4
AUDITBTQQUARTERLY REPORTING PROCESS ATTRIBUTES
The following sections define and describe sub-process specifics for elapsed time, paper documentation,
business system use, communications, and process improvements. The information is arranged in thisway to support analysis of these activities, both individually and collectively.
2.4.1 Elapsed Time
Exhibit 13AuditBTQQuarterly Reporting Elapsed Time lists the time required to complete each of
the activities that make up the AuditBTQQuarterly Reporting sub-process. The times are estimatedexcept where noted. The following is a description and definition of each of the columns in this table.
Index A number for use in referencing the activity.
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Process Time The hands-on time it takes to complete the activity (does not include mail, transport, or time
spent waiting for another activity to complete).
Cycle Time The total elapsed time from the beginning of the activity until it is complete, inclusive of all delays
from transport, mail, other processes, and work load.
Time Goals / Limits Any time limits or goals, from any sourceinternal or externalpertaining to this activity.
Limit/ Goal Source The source of the limit or goal listed above (Florida Statutes, AWI policy, etc.)
Speed Bumps Specific, recurring difficulties that slow the progress of this activity.
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Index Activity
Label
Process
Time
Cycle
Time
Limit or Goal Time Limit or
Goal
Source
Speed Bumps
11.02 Quarterly
Reports
1.5-2 hrs
per file.
50 days Process Begins on the first
working day of Quarter.
Results due on the 20thof the
month following.
ETA 301
Handbook
published by
Department
of Labor.
Gathering
information from
multiple systems.
Information
occasionally not
present in system
requiring manual
intervention.
Exhibit 13AuditBTQQuarterly Reporting Elapsed Time
2.4.2 Paper Documentation
Exhibit 14AuditBTQ Paper Documentation lists the paper documents required to complete each ofthe activities that make up the AuditBTQQuarterly Reporting sub-process. The reference column
refers to the originator and title of policy, procedure, or instruction that contains the form or specifies the
content of the document. More than one document may be required to carry out a single activity, so eachis listed. The following is a description and definition of each of the columns in this table.
Index A number for use in referencing the activity.
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Document Title Short title, form number or other designation for the document.
Document
Description
General description of the document contents and purpose.
Reference or Source Originator and title of the source instruction or policy.
Index Activity Label Document Title Document Description Reference
or Source
11.02.01 Select SSNs for
Review
UBMSEPBSA20 Report produced from the UC system identifying
the 50 Separation Issues scheduled for review.Includes official reproductions of the UCB-45 for
each issue.
AWI
Reviewer
11.02.01 Select SSNs for
Review
UBMSEP2390 Report produced from the UC system containing the
BH01 (Claims History) for each issue identified in
the report above.
AWI
Reviewer
11.02.01 Select SSNs for
Review
UBMNSEPBSA20 Report produced from the UC system identifying
the 50 Non-Separation Issues scheduled for review.
Includes official reproductions of the UCB-45 for
each issue.
AWI
Reviewer
11.02.01 Select SSNs for
Review
UBMNSEP2390 Report produced from the UC system containing the
BH01 (Claims History) for each issue identified in
the report above.
AWI
Reviewer
11.02.03 Setup Folder &
Label
Label Word Template Label used to identify review file. AWI
Reviewer
11.02.04 Retrieve Pre-
Review
Documents
BQ01 Determination History. Printed from the UC
System.
AWI
Reviewer
11.02.04 Retrieve Pre-
Review
Documents
Automated Non-
Monetary Worksheet
Adjudication Worksheet retrieved from the EIS
(Imaging) System. Accompanied by any other
documents imaged during the Adjudication Process.
AWI
Reviewer
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Index Activity Label Document Title Document Description Reference
or Source
11.02.05 Insert Data
Collection
Instrument
Blank Word Template Document used to record information about file and
to record Reviewers comments and score.
Completed by hand.
AWI
Reviewer
11.02.07 Insert Data
Collection
Instrument
Blank Word Template Document used to record information about file and
to record Reviewers comments and score.
Completed by hand.
AWI
Reviewer
11.02.09 Complete ETA
9056
ETA 9056
Nonmonetary
Determinations
Quality Report (OMB
1205-0359)
Printout from the DOL State Menu System showing
the results of the review process. Attached to the
case file.
AWI
Reviewer
11.02.11 Complete Internal
Report
Summary Report Summary report of all 100 issues reviewed as part
of the cycle. Entered into Excel and stored on a
central share drive.
AWI
Reviewer
Exhibit 14AuditBTQ Paper Documentation
2.4.3
Business System Data Entry & Data TransferExhibit 15AuditBTQQuarterly Reporting Data Entry & Data Transfer lists the business systemsthat are employed directly (touched) or indirectly (data transfer) in the course of the Audit BTQQuarterly Reporting sub-process. The following is a description and definition of each of the columns in
this table.
Index A number for use in referencing the activity.
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Business System The name or designation of the system touched (if any).
Purpose or Intent The business objective accomplished by using the system or systems.
Mode Choose one; entry is made by a person, transfers are from system to system.
Index Activity Label Business System Program or Intent Mode11.02.01 Select SSNs for
Review
UC Selects 100 issues (50 Separation, 50 Non-
Separation Claims) for review. Also triggers
the printout of the UBMSEPBSA20,
UBMSEP1430, UBMNSEPBSA20, and
UBMNSEP1430 reports.
Inquiry
11.02.04 Retrieve Pre-
Review
Documents
UC Retrieve By SSN
(BQ01) Determination History
Inquiry
11.02.04 Retrieve Pre-
Review
Documents
EIS (Imaging) Input SSN. Select and print the
Adjudication Fact Finding File. If the Fact
Finding File does not contain the UCB-412, the
UCB-412 should be printed as well.
Inquiry
11.02.04 Retrieve Pre-
Review
Documents
FLUID Input SSN on the Search Screen. Results are
displayed and the appropriate Claim is selected
and printed. Used only if the Fact Finding File
does not already contain a copy.
Inquiry
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Index Activity Label Business System Program or Intent Mode
11.02.04 Retrieve Pre-
Review
Documents
AENR Input SSN on the Search Screen. Results are
displayed and the appropriate Employer
Verification is selected and printed. Used only
if the Fact Finding File does not already
contain a copy.
Inquiry
Exhibit 15
Audit
BTQ
Quarterly Reporting Data Entry & Data Transfer
2.4.4 Communication
Exhibit 16AuditBTQQuarterly Reporting Communication lists the messages, such as the US mail,emails, phone calls and any other correspondence, regularly used in the normal courseof the Audit
BTQQuarterly Reporting sub-process. Messages are sent to convey required documentation, informrecipients about the status of an activity, to trigger the start or end of other activities, to grant or withdrawauthorization, etc. This section only concerns messages sent during normal (as intended) operations.There may be more than one message associated with any activity in this process. The following is a
description and definition of each of the columns in this table.
Index A number for use in referencing the activity.
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Message Type US mail, email, phone call, etc.
Message Sender The organization or role of the message sender.
Message Purpose The intended purpose for sending the message.
Message Recipient The organization or role of the intended recipient.
Occasion Event or action that triggers the requirement to send the message
Index Activity Label Message
Type
Sender Message
Purpose
Message
Recipient
Occasion
11.02.01 Select SSNs for
Review
Interoffice AWI Print
Shop
Provide copies of
UBMSEPBSA20,
UBMSEP1430,
UBMNSEPBSA20, and
UBMNSEP1430
reports.
Supervisor First working day
of each Quarter.
Starts the review
process.
11.02.06 Review & Score
File
Interoffice Reviewer Request
redetermination
of a particular
claim based on
facts uncovered
during the
review.
Adjudication
Hub
When errors are
found in the initial
claim adjudication.
11.02.09 Complete ETA
9056
Interoffice Reviewer Inform
Adjudicator
Supervisor of a
failing score
(Training
opportunity)
Adjudication
Hub
If a case file has a
failing score.
Exhibit 16AuditBTQQuarterly Reporting Communication
2.4.5 Opportunities
The purpose of this section is to capture improvement suggestions that may have a positive effect on
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technical, functional, or physical components of the AuditBTQ Quarterly reporting activities.
Over the course of our interviews and observations, we identified a number of possible process
improvement opportunities (long and short term). The following tables contain descriptions (ProblemStatement) of what may be negatively affecting current operations and corresponding potential solutions
(Recommendation) to address the issues. In some cases, additional analysis is required to understand
fully the impact of the problems and/or recommendations.
The following is a description and definition of each of the columns in this table.
Origin The area of the improvement such as: Central Office, Hub, etc.
Problem
Statement
Description of the problem or opportunity identified.
Recommendation Description of the proposed recommendation, including expected result.
Value Added Description of the expected value received if the recommendation to the problem statement is
identified.
Short Term Opportunities for Improvement
Origin Problem Statement Recommendation Value Added11.02.01 Quarterly audits are not being run at this
time (due to workload constraints) but
the mainframe reports are still being
created (1,000+ pages).
Ideally, an option should be
provided to turn off the
reports unless they are needed
once reporting commences in
the future.
Paper savings as well as a
reduction in overall workload
(printing, dissemination,
shredding).
Exhibit 17Short Term Opportunities for Improvement
Long Term Opportunities for Improvement
Origin Problem Statement Recommendation Value Added
The UC Benefits system has coded
within it a U.S. Department of Labor
(DOL) algorithm which automatically
selects random claims for review (50
Separations, 50 Non-Separations).
The algorithm in the future
system should be
administrator controlled to
obviate the need to modify
code within the system.
Ideally, the interface between
the DOLs State Menu system
and the new UC system will
be automated and preclude the
need for UC staff to perform
the manual download/upload
processes.
No need for IT resources to
implement code changes in
response to USDOL audit
requirements.
Exhibit 18Long Term Opportunities for Improvement
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3 PURPOSE AND OBJECTIVES OF THE AUDITBTQ NON-
MONETARY REVIEWS SUB-PROCESS
The Audit core process is comprised of four distinct sub-processes: Benefit Accuracy Measurement
(BAM), Benefit Timeliness and Quality (BTQ)Quarterly Reporting, BTQNon-Monetary Reviews,and BTQData Validation. The following sections describe the BTQ Non-Monetary related activities.
Benefit Timeliness Quality (BTQ)Non-Monetary Reviews
UC has instituted an internal quality review process under the auspices of the BTQ unit to perform
periodic assessments of adjudicators in each Adjudication Hub. The information gathered through thereviews provides insight to existing or potential issues that may be causing difficulties in particularadjudication areas (e.g., separation issues). Managers can use that information to take corrective actionwhich may include arranging for remedial training, modifying policies and procedures, and/or suggestingchanges to the automated system(s) to address less than satisfactory performance.
Note: Many units within AWI perform audit functions to monitor their performance. The processesdescribed here address specifically BAM and BTQ and are not meant to encompass other audit functions
within AWI.
The following sections describe the activities associated with the Audit - BTQ Non-Monetary Reviewsfunctions in UC.
3.1
BEGINNING AND ENDING POINTS
BTQ
Beginning Point:
An Adjudication Hub is selected for review.
Ending Point:
The results of the claims reviews are recorded in an internal reporting document.
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3.2 AUDITBTQNON-MONETARY REVIEWS DIAGRAM
Supervisor Reviewer Adjudicator Supervisor
11.03.05 Insert
Data
Collection
Instrument
11.03.06 Review &
Score File
11.03.01 Run
Process
for Selected
Time Period
11.03.02 Assign
Reviewer 11.03.04 Retrieve
Pre-Review
Documents
UC, Imaging,FLUID, AENR
UC
Process Start
11.03.07 Complete
Summary Scoring
Report for
Adjudicator
Excel
11.03.03 Select 10
SSNs for Review
For Each SSN
For Each Adjudicator
11.03.08 Complete
Summary Scoring
Report for Hub
Process Ends
Word/Excel
Interoffice
Hub Score
Report
Exhibit 193.2 Audit BTQNon-Monetary Reviews Process Flow
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3.3 AUDITBTQNON-MONETARY REVIEWS ACTIVITIES
Exhibit 20AuditBTQNon-Monetary Reviews Activities lists the activities that make up the Audit
BTQNon-Monetary Reviews sub-process. The following is a description and definition of each ofthe columns in this table.
Index A number for use in referencing the activityActivity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Activity Description The full-text description of that activity
Actors The job or role title of the individuals having a primary role for that activity
Index Activity Label Activity Description Actors
11.03.01 Run Process for
Selected Time
Period
The BTQ unit conducts periodic audits of the Adjudication Hubs.
The supervisor begins the process by requesting a SAR Report of
all closed cases for a specified time period (usually a week) for a
particular adjudicator. This process is repeated for each
adjudicator to be audited.
Note: This process is very similar to the Quarterly Review outlined
above and is used to support internal quality reviews.
Supervisor
11.03.02 Assign Reviewer The BTQ supervisor assigns reviewers to complete the audits. Supervisor
11.03.03 Select 10 SSNs for
Review
The reviewer selects 10 social security numbers (determinations
for particular claimants) from the SAR Report and goes through an
iterative process to review all 10 cases.
Note: The reviewer attempts to select more Separation cases than
Non-Separation cases (Separation cases, in general, have a higher
error rate).
Reviewer
11.03.04 Retrieve Pre-
Review Documents
The reviewer queries numerous systems to gather the information
necessary to complete the examination.
Reviewer
11.03.05 Insert Data
CollectionInstrument
The information is written into the data collection instrument. Reviewer
11.03.06 Review & Score
File
The collection instrument is reviewed and scored. At the end of
the process, a copy of the scoring sheet, for each adjudicator, will
be provided to the Adjudication Hub supervisor.
Reviewer
11.03.07 Complete Summary
Scoring Report for
Adjudicator
The Reviewer creates a summary report (Excel file) for each
adjudicator and stores the results on the Program Eval Drive (a
designated network drive). At the end of the process, the reports
will also be provided to the Adjudicators supervisor.
Reviewer
11.03.08 Complete Summary
Scoring Report for
Hub
The supervisor prepares a summary report for the entire
Adjudication Hub (summary scores for each adjudicator and
overall statistics for the Hub) and a cover letter (memorandum)
and mails the package to the Adjudication Hub supervisor along
with the individual scoring sheets and summary scoring reports for
each adjudicator.
The supervisor also updates the state-wide adjudication hub review
results.
All reports are stored on the Program Eval drive.
Supervisor
Exhibit 20AuditBTQNon-Monetary Reviews Activities
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3.4 AUDITBTQNON-MONETARY REVIEWS PROCESS ATTRIBUTES
The following sections define and describe sub-process specifics for elapsed time, paper documentation,
business system use, communications, and process improvements. The information is arranged in thisway to support analysis of these activities, both individually and collectively.
3.4.1
Elapsed Time
Exhibit 21AuditBTQNon-Monetary Reviews Activity Elapsed Time lists the time required tocomplete each of the activities that make up the AuditBTQNon-Monetary Reviews sub-process. Thetimes are estimated except where noted. The following is a description and definition of each of thecolumns in this table.
Index A number for use in referencing the activity.
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Process Time The hands-on time it takes to complete the activity (does not include mail, transport, or time
spent waiting for another activity to complete).
Cycle Time The total elapsed time from the beginning of the activity until it is complete, inclusive of all delays
from transport, mail, other processes, and work load.
Time Goals / Limits Any time limits or goals, from any sourceinternal or externalpertaining to this activity.
Limit/ Goal Source The source of the limit or goal listed above (Florida Statutes, AWI policy, etc.)
Speed Bumps Specific, recurring difficulties that slow the progress of this activity.
Index Activity
Label
Process
Time
Cycle
Time
Limit or Goal Time Limit or
Goal
Source
Speed Bumps
11.03 Non-Monetary
Reviews
11.5 hrs
per file.
Varies
based on
size of
Hub.
Policy is for one to two Hubs
to be evaluated each Quarter.
Internal
Policy
Gathering
information from
multiple systems.
Information
occasionally not
present in systemrequiring manual
intervention.
Exhibit 21AuditBTQNon-Monetary Reviews Activity Elapsed Time
3.4.2 Paper Documentation
Exhibit 22AuditBTQNon-Monetary Reviews Paper Documentation lists the paper documentsrequired to complete each of the activities that make up AuditBTQNon-Monetary Reviews sub-
process. The reference column refers to the originator and title of policy, procedure, or instruction thatcontains the form or specifies the content of the document. More than one document may be required to
carry out a single activity, so each is listed. The following is a description and definition of each of thecolumns in this table.
Index A number for use in referencing the activity.
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Document Title Short title, form number or other designation for the document.
Document
Description
General description of the document contents and purpose.
Reference or Source Originator and title of the source instruction or policy.
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Index Activity Label Document Title Document Description Reference
or Source
11.03.01 Run Process for
Selected Time
Period
UBDNONMW1420 List of closed adjudications within a selected time
period for a given adjudicator.
BTQ
Supervisor
11.03.04 Select SSNs for
Review
BH01 Claims History. Printed from the UC System. AWI
Reviewer
11.03.04 Select SSNs for
Review
UCB45 Claim Determination. Printed from the UC System. AWI
Reviewer
11.03.04 Retrieve Pre-
Review
Documents
BQ01 Determination History. Printed from the UC
System.
AWI
Reviewer
11.03.04 Retrieve Pre-
Review
Documents
Automated Non-
Monetary Worksheet
Adjudication Worksheet retrieved from the EIS
(Imaging) System. Accompanied by any other
documents imaged during the Adjudication Process.
AWI
Reviewer
11.03.05 Insert Data
Collection
Instrument
Blank Word Template Document used to record information about file and
to record Reviewer's comments and score.
Completed by hand.
AWI
Reviewer
11.03.07 CompleteSummary Scoring
Report for
Adjudicator
Excel Template Report of all cases reviewed for a particularadjudicator with score and comments.
AWIReviewer
11.03.08 Complete
Summary Scoring
Report for Hub
(incl. Memo) &
State
Excel Chart Template Report of all cases reviewed for a Hub. BTQ
Supervisor
11.03.08 Complete
Summary Scoring
Report for Hub
(incl. Memo) &
State
Word Template Memo used as a cover sheet for the Adjudication
Hub Scoring Report
BTQ
Supervisor
11.03.08 Complete
Summary Scoring
Report for Hub
(incl. Memo) &
State
Excel Chart Template Report of all cases reviewed for the State BTQ
Supervisor
Exhibit 22AuditBTQNon-Monetary Reviews Paper Documentation
3.4.3
Business System Data Entry & Data Transfer
Exhibit 23AuditBTQNon-Monetary Reviews Data Entry & Data Transfer lists the businesssystems that are employed directly (touched) or indirectly (data transfer) in the course of the AuditBTQ
Non-Monetary Reviews sub-process. The following is a description and definition of each of the
columns in this table.
Index A number for use in referencing the activity.
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Business System The name or designation of the system touched (if any).
Purpose or Intent The business objective accomplished by using the system or systems.
Mode Choose one; entry is made by a person, transfers are from system to system.
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Index Activity Label Business System Program or Intent Mode
11.03.01 Run Process for
Selected Time
Period
UC Input an Adjudicator Name and a Time period:
(UBDNONMW1420) List of closed
adjudications within the input time period for
the adjudicator.
BTQ
Supervisor
11.03.04 Retrieve Pre-
Review
Documents
UC Retrieve by SSN:
(BQ01) Determination History
(UCB45) Wage Determinations
(BH01) Claim History
Inquiry
11.03.04 Retrieve Pre-
Review
Documents
EIS (Imaging) Input SSN. Select and print the
Adjudication Fact Finding File. If the Fact
Finding File does not contain the UCB-412,
the UCB-412 should be printed as well.
Inquiry
11.03.04 Retrieve Pre-
Review
Documents
FLUID Input SSN on the Search Screen. Results are
displayed and the appropriate Claim is selected
and printed. Used only if the Fact Finding File
does not already contain a copy.
Inquiry
11.03.04 Retrieve Pre-
ReviewDocuments
AENR Input SSN on the Search Screen. Results are
displayed and the appropriate EmployerVerification is selected and printed. Used only
if the Fact Finding File does not already
contain a copy.
Inquiry
Exhibit 23AuditBTQNon-Monetary Reviews Data Entry & Data Transfer
3.4.4 Communication
Exhibit 24AuditBTQNon-Monetary Reviews Communication lists the messages, such as the USmail, emails, phone calls and any other correspondence, regularly used in the normal courseof the Audit
BTQNon-Monetary Reviews sub-process. Messages are sent to convey required documentation,inform recipients about the status of an activity, to trigger the start or end of other activities, to grant orwithdraw authorization, etc. This section only concerns messages sent during normal (as intended)
operations. There may be more than one message associated with any activity in this process. Thefollowing is a description and definition of each of the columns in this table.
Index A number for use in referencing the activity.
Activity Label A short name for that activity that is used to represent it in the detailed workflow diagram.
Message Type US mail, email, phone call, etc.
Message Sender The organization or role of the message sender.
Message Purpose The intended purpose for sending the message.
Message Recipient The organization or role of the intended recipient.
Occasion Event or action that triggers the requirement to send the message
Index Activity Label Message
Type
Sender Message
Purpose
Message
Recipient
Occasion
11.03.08 Complete
Summary
Scoring Report
for Hub (incl.
Memo) & State
Interoffice BTQ
Supervisor
Provide
Adjudicator
Supervisor with
all scoring
documentation.
Adjudication
Supervisor
After any Hub
review has been
completed.
Exhibit 24AuditBTQNon-Monetary Reviews Communication
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3.4.5 Opportunities
The purpose of this section is to capture improvement suggestions that may have a positive effect ontechnical, functional, or physical components of the AuditBTQ Non-Monetary Review activities.
Over the course of our interviews and observations, we identified a number of possible process
improvement opportunities (long and short term). The following tables contain descriptions (ProblemStatement) of what may be negatively affecting current operations and corresponding potential solutions(Recommendation) to address the issues. In some cases,