Description
Unemployment (or joblessness) occurs when people are without work and actively seeking work. The unemployment rate is a measure of the prevalence of unemployment and it is calculated as a percentage by dividing the number of unemployed individuals by all individuals currently in the labor force.
State of Florida Agency for Workforce Innovation
Unemployment Compensation Project – Phase 2
To-Be Business Process – Benefit Payment Control (BPC)
Document Control
Revision History
Date
01/27/2010
Version
1.00
Description
Final Deliverable Pete Peterson
Author
Quality Review History
Date
01/26/2010
Reviewer
Robin Nichols/Dianne Parcell Client Review – Approved.
Comments
Page i
Table of Contents
0.
0.1. 0.2. 0.3.
TO-BE PROCESS BENEFIT PAYMENT CONTROL (BPC)........................ 1
OVERVIEW.............................................................................................................................. 1 ASSUMPTIONS ......................................................................................................................... 2 WORKFLOW DIAGRAM ............................................................................................................ 3
1.
1.1. 1.2. 1.3. 1.4. 1.5. 1.6. 1.7.
TO-BE WAGE AUDIT SUB-PROCESS .......................................................... 4
OVERVIEW.............................................................................................................................. 4 WORKFLOW DIAGRAM ............................................................................................................ 5 ACTIVITIES ............................................................................................................................. 7 CORRESPONDENCE ................................................................................................................ 10 PERFORMANCE METRICS ....................................................................................................... 11 BUSINESS RULES ................................................................................................................... 12 TIME CONSTRAINTS .............................................................................................................. 12
2.
2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7.
TO-BE PAYMENT INTAKE SUB-PROCESS .............................................. 14
OVERVIEW............................................................................................................................ 14 WORKFLOW DIAGRAM .......................................................................................................... 15 ACTIVITIES ........................................................................................................................... 16 CORRESPONDENCE ................................................................................................................ 17 PERFORMANCE METRICS ....................................................................................................... 18 BUSINESS RULES ................................................................................................................... 18 TIME CONSTRAINTS .............................................................................................................. 19
3.
3.1. 3.2. 3.3. 3.4. 3.5. 3.6. 3.7.
TO-BE OVERPAYMENT STOP SUB-PROCESS ........................................ 20
OVERVIEW............................................................................................................................ 20 WORKFLOW DIAGRAM .......................................................................................................... 21 ACTIVITIES ........................................................................................................................... 22 CORRESPONDENCE ................................................................................................................ 22 PERFORMANCE METRICS ....................................................................................................... 23 BUSINESS RULES ................................................................................................................... 24 TIME CONSTRAINTS .............................................................................................................. 24
4.
4.1. 4.2. 4.3. 4.4. 4.5. 4.6. 4.7.
TO-BE LOTTERY SUB-PROCESS ............................................................... 25
OVERVIEW............................................................................................................................ 25 WORKFLOW DIAGRAM .......................................................................................................... 26 ACTIVITIES ........................................................................................................................... 27 CORRESPONDENCE ................................................................................................................ 27 PERFORMANCE METRICS ....................................................................................................... 28 BUSINESS RULES ................................................................................................................... 28 TIME CONSTRAINTS .............................................................................................................. 29
5.
5.1. 5.2. 5.3. 5.4. 5.5.
TO-BE NEW HIRE AUDIT SUB-PROCESS ................................................ 30
OVERVIEW............................................................................................................................ 30 WORKFLOW DIAGRAM .......................................................................................................... 31 ACTIVITIES ........................................................................................................................... 32 CORRESPONDENCE ................................................................................................................ 33 PERFORMANCE METRICS ....................................................................................................... 34
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5.6. 5.7.
BUSINESS RULES ................................................................................................................... 35 TIME CONSTRAINTS .............................................................................................................. 35
6.
6.1. 6.2. 6.3. 6.4. 6.5. 6.6. 6.7.
TO-BE MULTI-ADDRESS/PHONE AUDIT SUB-PROCESS ..................... 37
OVERVIEW............................................................................................................................ 37 WORKFLOW DIAGRAM .......................................................................................................... 38 ACTIVITIES ........................................................................................................................... 39 CORRESPONDENCE ................................................................................................................ 40 PERFORMANCE METRICS ....................................................................................................... 41 BUSINESS RULES ................................................................................................................... 41 TIME CONSTRAINTS .............................................................................................................. 42
7.
7.1. 7.2. 7.3. 7.4. 7.5. 7.6. 7.7.
TO-BE WAIVER SUB-PROCESS.................................................................. 43
OVERVIEW............................................................................................................................ 43 WORKFLOW DIAGRAM .......................................................................................................... 44 ACTIVITIES ........................................................................................................................... 45 CORRESPONDENCE ................................................................................................................ 45 PERFORMANCE METRICS ....................................................................................................... 46 BUSINESS RULES ................................................................................................................... 46 TIME CONSTRAINTS .............................................................................................................. 47
8.
8.1. 8.2. 8.3. 8.4. 8.5. 8.6. 8.7.
TO-BE INTERSTATE OVERPAYMENTS (IRORA) SUB-PROCESS ....... 48
OVERVIEW............................................................................................................................ 48 WORKFLOW DIAGRAM .......................................................................................................... 49 ACTIVITIES ........................................................................................................................... 50 CORRESPONDENCE ................................................................................................................ 51 PERFORMANCE METRICS ....................................................................................................... 52 BUSINESS RULES ................................................................................................................... 53 TIME CONSTRAINTS .............................................................................................................. 53
9.
9.1. 9.2. 9.3. 9.4. 9.5. 9.6. 9.7.
TO-BE OVERPAYMENT WRITE-OFF SUB-PROCESS ............................ 54
OVERVIEW............................................................................................................................ 54 WORKFLOW DIAGRAM .......................................................................................................... 55 ACTIVITIES ........................................................................................................................... 56 CORRESPONDENCE ................................................................................................................ 56 PERFORMANCE METRICS ....................................................................................................... 57 BUSINESS RULES ................................................................................................................... 57 TIME CONSTRAINTS .............................................................................................................. 58
10.
10.1. 10.2. 10.3. 10.4. 10.5. 10.6. 10.7.
TO-BE DEATH AUDIT SUB-PROCESS ....................................................... 59
OVERVIEW............................................................................................................................ 59 WORKFLOW DIAGRAM .......................................................................................................... 60 ACTIVITIES ........................................................................................................................... 61 CORRESPONDENCE ................................................................................................................ 62 PERFORMANCE METRICS ....................................................................................................... 63 BUSINESS RULES ................................................................................................................... 63 TIME CONSTRAINTS .............................................................................................................. 63
11.
TO-BE INVESTIGATIONS SUB-PROCESS ................................................ 65
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11.1. 11.2. 11.3. 11.4. 11.5. 11.6. 11.7.
OVERVIEW............................................................................................................................ 65 WORKFLOW DIAGRAM .......................................................................................................... 66 ACTIVITIES ........................................................................................................................... 67 CORRESPONDENCE ................................................................................................................ 68 PERFORMANCE METRICS ....................................................................................................... 69 BUSINESS RULES ................................................................................................................... 69 TIME CONSTRAINTS .............................................................................................................. 69
12.
12.1. 12.2. 12.3. 12.4. 12.5. 12.6. 12.7.
TO-BE FAIL TO PAY/DISPOSITION SUB-PROCESS ............................... 71
OVERVIEW............................................................................................................................ 71 WORKFLOW DIAGRAM .......................................................................................................... 72 ACTIVITIES ........................................................................................................................... 74 CORRESPONDENCE ................................................................................................................ 77 PERFORMANCE METRICS ....................................................................................................... 78 BUSINESS RULES ................................................................................................................... 79 TIME CONSTRAINTS .............................................................................................................. 79
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0. TO-BE PROCESS BENEFIT PAYMENT CONTROL (BPC)
0.1. OVERVIEW
The purpose of the Benefit Payment Control (BPC) area is overpayment detection, determination, and collection. This purpose is to prevent and deter the improper payment of benefits and to protect the integrity of the Unemployment Compensation Trust Fund. The function of BPC is to monitor payment of unemployment benefits and ensure the integrity of the program, the administering Agency, and recipients of unemployment benefits. It is the responsibility of BPC to detect unemployment compensation overpayment and recover those funds though various recovery methods to include payment agreements, legal prosecution, and other Court actions and referral to a collection agency. In the pursuit of this function, BPC is divided into three different units each with a specific set of responsibilities. The units are Wage Audit/Payment Processing, New Hire, and Recovery. Each unit is responsible for one or more of the BPC sub-processes. These sub-processes are listed below. 1. Wage Audit The Wage Audit sub-process is used to identify and investigate claimants who have been paid for a claim during a period in which an employer has also reported wages. 2. Payment Intake The Payment Intake sub-process is used to handle all money orders, personal checks, and cash that are sent to the Agency for repayment of overpaid benefits and to interact with the state contracted collection agency with regard to collection. 3. Overpayment Stop Any claim may be marked as a potential overpayment at a number of points during its processing. These overpayment stops can only be removed or finalized (overpayment determination) by BPC. This review and determination is made during the Overpayment Stop process. 4. Lottery The Florida Lottery provides information on lottery winners who are also claimants with outstanding overpayments. These claimants are handled during the Lottery process. 5. New Hire Audit The New Hire Audit sub-process is used to identify and investigate claimants who appear on a daily Florida Department of Revenue or US Department of Health and Human Services monthly New Hire report. 6. Multi-Address/Phone Audit The Multi-Address/Phone Audit sub-process is triggered when three or more claimants list the same address and/or phone number. An investigation is conducted to validate that all claimants are legitimate. 7. Waiver The Waiver sub-process is used to process requests for a Waiver of Recoupment. The Waiver may be granted or denied. The Waiver may also involve the “refund” of prior offset payments. 8. Interstate Overpayments (IRORA) The Interstate Reciprocal Overpayment Recovery Arrangement (IRORA) program allows states to collect overpayments on behalf of other states. Florida may act as the collector state (collecting another state’s
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overpayment) or as the requestor state (having another state collect on its behalf). 9. Overpayment Write-Off Overpayments which have exceeded the statute of limitations are no longer subject to active collections efforts. The potential write-off must be identified by BPC, submitted to the AWI financial section, and approved by the Florida Department of Financial Services. 10. Death Audit The Death Audit sub-process is used to identify and investigate payments made to claimants who have been reported by the Department of Health as being deceased. 11. Investigations Suspected cases of overpayment that cannot be resolved in the central office are referred to fraud recovery investigators for investigation. The investigative report is sent to the central office for a determination. 12. Fail To Pay/Disposition When an overpayment has exceeded a set time period between payments (usually six months), the overpayment will be reviewed and additional (possibly final) collection action will be taken. This process includes reviews of outstanding prosecutions and probation cases.
0.2. ASSUMPTIONS
This section lists any assumptions concerning technology, policy, statute, or process that must be implemented to enable the To-Be processes: • • • • • • The system will include a workflow engine used to create work items, manage work queues, and route work items between queues. All incoming and outgoing correspondence will be imaged and available on-line. The system will include Correspondence/Document Management capability used to attach imaged documents to specific work items. The system will include clearly defined roles and responsibilities for each user. Employers and Claimants will have system accounts and all work will be associated to those accounts. All claims, claim weeks, determinations, and payments will be traceable to funding sources and employer chargeability records. The system will maintain account balances for all accounts. The system will be capable of automatically recalculating these balances based on the reversal or modification of prior actions. External data sources will be available 24/7 with appropriate backup. Email will be considered a viable communication tool. Business rules and/or requirements will be built into the system whenever possible. The system will implement and support all upload/download capabilities of the Unemployment Insurance Electronic Entry System (UIEES).
• • • •
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0.3. WORKFLOW DIAGRAM
Wage Post Audit Unit/ Payment Processing
Process Start
New Hire Unit
Management
Investigations, Prosecutions, & Recovery
Process Start
Process Start
Process Start
03.01 Wage Audit
03.05 New Hire Audit
03.06 MultiAddress/Phone Audit
03.10 Death Audit
+
+
+
+
03.02 Payment Intake
03.07 Waiver
03.11 Investigations
+
+
+
03.03 Overpayment Stop
03.08 Interstate Overpayments (IRORA)
+
+
03.04 Lottery
03.09 Overpayment Write-Off
+
+
03.12 Fail To Pay/Disposition
+
Process Ends
Exhibit 1 – Benefit Payment Control (BPC) Workflow Diagram
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1. TO-BE WAGE AUDIT SUB-PROCESS
1.1. OVERVIEW
The Wage Audit sub-process is used to identify and investigate claimants who have been paid for a claim during a period in which an employer has also reported wages. The system will receive information on quarterly reported wages from the Department of Revenue. The system will then match that information against claims information from the affected quarter. If a conflict exists, the system will automatically generate a Wage Breakdown Form and send it to the Employer. If the Employer returns the Wage Breakdown form, the system will attempt to validate the information. If a conflict still exists a work-item will be created to review the issue, contact the Claimant and Employer if necessary, and make an overpayment determination. The objectives of this sub-process include: • • Identify Claimants who received wages at the same time they received benefits. Make a proper determination as to whether or not an overpayment has occurred.
Beginning Points • A Wage Breakdown Form is received back from an Employer.
Ending Points • • Issue an overpayment determination or, Determine there was no overpayment made.
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1.2. WORKFLOW DIAGRAM
User
Process Start
Examiner
Supervisor
Employer
Claimant
03.01.01 Enter Wage Breakdown Information
Missing Information
03.01.02 Validate Wage Breakdown
Information Request
UCCBIS No Missing Information
UCCBIS
03.01.03 Confirm Wage Breakdown
UCCBIS
03.01.04 Submit Wage Breakdown
Issue
03.01.05 Assign Wage Breakdown
UCCBIS 03.01.06 Select Wage Breakdown
UCCBIS
UCCBIS
03.01.07 Review Claim History No Issue UCCBIS Issue
Ad-Hoc/ Affidavit of Earnings Overpayment Pre-Determination Letter
Continued On Next Page Process Ends
Page 5
Exhibit 2 – Wage Audit Workflow Diagram
Page 6
1.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.01.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Enter Wage Breakdown Information
System Activity Description
Prior to this activity, the system will match employersubmitted quarterly data with the active claims filed during that quarter. Upon detecting a conflict, the system will create a Wage Breakdown Request and route it to the Employer’s selected communication medium (i.e., via the Portal or US Mail). If no response is received, no further action is taken. The system will validate the user provided information for completeness and correctness in accordance with established system requirements. The system will notify the user of any issues and prevent the user from proceeding until the issue(s) are resolved. The system will prompt the Examiner to generate a notification to the Employer requesting the missing information. The system will send the notification using the preferred method of communication for the Employer, if known.
Actor Activity Description
The User will enter the Wage Breakdown information into the system. If the User is the Examiner and issues exist with the application, the next step is “Validate Wage Breakdown”. If no issues exist, the next step is “Confirm Wage Breakdown”.
Actor(s)
User
03.01.02
Validate Wage Breakdown
The Examiner will gather information from the Employer by contacting them directly and/or requesting a notification to be sent to the Employer.
Examiner
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Index
03.01.03
Activity Label
Confirm Wage Breakdown
System Activity Description
The system will display the entered information for certification by the User that the information is complete and correct. If, based established system requirements, the system can determine that no issue exists (i.e., wages reported were not for a claimed week), the system will store the information and close the record. If the information is indeterminate or if a clear issue exists, the system will create a Wage Audit work item and make the item available for assignment. The system will place the work item in the assigned Examiner’s work queue. The system will record the assigned Examiner and the date and time of the Examiner selecting the work item.
Actor Activity Description
The User will confirm that the displayed information is complete and correct or the User will correct information as necessary. The User will elect to submit the information to the system.
Actor(s)
User
03.01.04
Submit Wage Breakdown
User
03.01.05
Assign Wage Breakdown Select Wage Breakdown
03.01.06
The Supervisor can assign an Examiner to the Wage Breakdown work item. The Examiner will select a Wage Breakdown work item for review
Supervisor
Examiner
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Index
03.01.07
Activity Label
Review Claim History
System Activity Description
The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer. Upon request, the system will create the Affidavit of Earnings and route it to the Employer’s selected communication medium (i.e., via the Portal, fax, or US Mail). Upon request, the system will route the Overpayment PreDetermination Letter to the Claimant’s selected communication medium (i.e., via the Portal, fax, or US Mail). Finally, the system will provide the capability to request investigations as necessary through the creation of new work items in the necessary work queue(s). The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer. Upon request, the system will create the Affidavit of Earnings and route it to the Employer’s selected communication medium (i.e., via the Portal, fax, or US Mail). Finally, the system will provide the capability to request investigations as necessary through the creation of new work items in the necessary work queue(s).
Actor Activity Description
The Examiner will review the claim history. If necessary, the Examiner will contact the Employer for clarifying information (were the reported wages in lieu of notice, etc.) and request the production of an Affidavit of Earnings to be completed by the Employer. If the Examiner determines that an issue still exists, the Examiner will create an Overpayment PreDetermination Letter to be sent to the Claimant.
Actor(s)
Examiner
03.01.08
Review Information
The Claimant has 10 days to respond to the Overpayment Pre-Determination Letter. Should the Claimant elect to respond, the Examiner will review the provided information. If necessary, the Examiner will contact the Employer for clarifying information (were the reported wages in lieu of notice, etc.) and request the production of an Affidavit of Earnings to be completed by the Employer (if not previously requested. If no response is received from the Claimant within the 10 day period, the Examiner will issue a determination based on the information at hand.
Examiner
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Index
03.01.09
Activity Label
Review Information
System Activity Description
The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer.
Actor Activity Description
If the Employer provides additional information as a result of the previous review (particularly a completed Affidavit of Earnings), the Examiner will review this information. Based on the information contained within the work item, the Examiner will create a Determination and enter it into the system.
Actor(s)
Examiner
03.01.10
Issue Determination
Upon request, the system will route the Notice of Determination to the Claimant’s selected communication medium (i.e., via the Portal, fax, or US Mail). The system will close the work item.
Examiner
1.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
Activity Label
Type
Purpose
Recipient
Occasion
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Index
03.01
Activity Label
Wage Audit
Type
Form
Purpose
To gather Wage Breakdown information concerning the quarter in question. To gather additional information as necessary
Recipient
Employer
Occasion
When a claim is paid in the same quarter that wages were reported. When the wage breakdown information is incomplete or unclear. When the submitted wage breakdown information indicates there is an issue with the claim. When the information gathered from the Employer indicates that an overpayment has occurred. When the Claimant wishes to contest the information provided by the employer. When the submitted wage breakdown information indicates there is an issue with the claim. When the wage audit is complete and an overpayment/nooverpayment determination has been made.
03.01.02
Validate Wage Breakdown
Ad-Hoc
Employer
03.01.07
Review Claim History
Form/Ad-Hoc
To obtain an Affidavit of Earnings and/or clarify previously submitted information To inform the Claimant that an Overpayment Determination is in process and provide an opportunity for the Claimant to respond with additional information. To respond to the Overpayment Predetermination Letter To obtain an Affidavit of Earnings (if not previously obtained)
Employer
03.01.07
Review Claim History
Notice
Claimant
03.01.08
Review Information
Ad-Hoc
Examiner
03.01.08
Review Information
Form
Employer
03.01.10
Issue Determination
Notice
To inform the Claimant of the outcome of the Wage Audit.
Claimant
1.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Wage Breakdowns Issued Wage Breakdowns Returned Wage Audit Workload A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count of Wage Breakdown forms sent to Employers per quarter. A count of Wage Breakdown forms returned by Employers per quarter. A count of Wage Audit work items processed by Examiner per quarter. -
Target
Source
AWI AWI AWI
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Title
Determinations Issued Determinations Appealed
Metric
A count of overpayment determinations and the total dollar amount issued by Type and Employee per quarter. A count of overpayment determinations appealed by Employee. -
Target
Source
AWI AWI
1.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.01.01 BR03.01.02 BR03.01.03 BR03.01.04 BR03.01.05 BR03.01.06 BR03.01.07 BR03.01.08 BR03.01.09 BR03.01.10 BR03.01.11 The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule. Conflict N N N N N N N N N N N
Description
20 C.F.R. § 603.08(b) (2009) – Obtaining information from cross matching with wage information. Fla. Stat. § 443.171 (5) (2009) – Each employing unit shall keep true and accurate work records containing the information required by AWI. Fla. Stat. § 443.171(3) (2009) – Delegate power and authority for the effective administration of this chapter. Fla. Stat. § 443.171(6) (2009) – May administer affirmations of earnings as evidence in connection with the administration of this chapter. Fla. Stat. § 443.036(16) (2009) – Definition of “earned income”. Fla. Stat. § 443.071(1) (2009) – False statement by individual to obtain benefits Fla. Stat. § 443.071(2) (2009) – False statement by employing unit to prevent payment of benefits. Fla. Stat. § 443.101(6) (2009) – Disqualified for a period not to exceed 1 year for making a false statement in order to obtain benefits. Fla. Stat. § 443.151(4) (b) (2009) – The claimant may appeal an adverse determination. Fla. Admin. Code R. 60BB-3.012. – Maintain an Address of Record. It is the responsibility of each employing unit and claimant to maintain a current address of record with the Agency. Fla. Stat. § 443.171(1) (2009) – The Agency is given the powers and duties to administer this chapter.
1.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.01 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Wage Audit
Source
External
Constraint
Wage information is submitted quarterly to the Department of Revenue.
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03.01.08
Review Information
The Claimant has 10 days to respond to the Overpayment Predetermination Letter.
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2. TO-BE PAYMENT INTAKE SUB-PROCESS
2.1. OVERVIEW
The purpose of the Payment Intake process is to receive payments and apply them to the appropriate overpayment record. Refunds may be necessary if the payment exceeds the amount of the outstanding overpayment. Finally, satisfied overpayments which have gone through the Small Claims Court or State Attorney Referral processes will require additional action to inform the necessary party that the overpayment has been satisfied. The objectives of this sub-process include: • • • • The correct and auditable receipt of payments. The association of payments to the proper claimant and overpayment. The proper issuance of refunds as necessary. The proper handling of paid-in-full overpayments.
Beginning Points • Claimant (or other party) sends in a payment.
Ending Points • • • • The payment is successfully applied and processed or, The payment (or some portion thereof) is refunded or, A bad payment is properly handled or, A paid-in full overpayment is properly closed.
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2.2. WORKFLOW DIAGRAM
Exhibit 3 – Payment Intake Workflow Diagram
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2.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.02.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Receive, Open, & Sort Payments
System Activity Description
-
Actor Activity Description
The AWI Mail Contractor will deliver the payment in a locked bag. An Examiner receives and opens the bag. The payments are sorted by number series. The Examiner will input the payments into the system.
Actor(s)
Examiner
03.02.02
Input & Apply Overpayments
03.02.03
Review Potential Refund
03.02.04
Process Payment
The system will provide a mechanism for recording pertinent information about the received payment. The system will update the Claimant’s overpayment balance by the input amount. The system will not allow a payment to be entered if the overpayment has been referred to the AWIcontracted collections agency. If the input payment results in a potential refund, the system will route the work item to a Supervisor for review and approval. The system will update the overpayment record.
Examiner
The Supervisor will review the refund to ensure that it is valid.
Supervisor
03.02.05
Update Overpayment Record
The system will reset the overpayment record to the status and amount prior to the payment. Upon request, the system will generate a Request Payment Letter and route it to the Claimant via their preferred communication method.
Financial Management will review and process all payments. If a refund is required a warrant will be generated and returned to BPC. If the payment is returned as invalid (insufficient funds or a bad check), the Examiner will retract the payment and request the creation of a Request Payment Letter. The Examiner will set the review date for 30 days to ensure a work item is properly created in the Fail To Pay/Disposition process.
Financial Management
Examiner
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Index
03.02.06
Activity Label
Update Record
System Activity Description
The system will provide a mechanism for recording the number of the refund warrant.
Actor Activity Description
The Examiner will update the overpayment record with the number of the refund warrant and send the warrant to the claimant. If the payment satisfies the full amount of the overpayment and the overpayment has been referred to a State Attorney, the Claimant is on probation making restitution, or a Conditional/Final Judgment has been received from Civil Court, the Examiner will generate a notification to the appropriate party stating that the overpayment has been paid in full.
Actor(s)
Examiner
03.02.07
Notify State Attorney or PO/Record Dismissal or Satisfaction of Lien
Upon request, the system will generate a paid-in-full letter, a dismissal for Civil Court, or a Satisfaction of Lien as required.
Examiner
2.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion
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Index
03.02.01
Activity Label
Receive, Open, & Sort Payments
Type
Ad-Hoc
Purpose
To submit payment for an outstanding overpayment. These payments may be in the form of offsets against new claims, checks, cash, money orders, or cashier’s checks. To inform the Claimant that their payment has been rejected and requiring submission of acceptable payment within 30 days. To refund any amount received in excess of the outstanding overpayment balance. To notify the appropriate party(ies) that an overpayment has been paid in full.
Recipient
AWI Benefit Payment Control
Occasion
When a payment is made on an existing overpayment.
03.02.05
Update Overpayment Record
Notice
Claimant
When a payment is rejected by the processing bank.
03.02.06
Update Record
Ad-Hoc
Claimant
03.02.07
Notify State Attorney or PO/Record Dismissal or Satisfaction of Lien.
Notice
State Attorney/Civil Court/Probation Officer
When a payment is received that exceeds the outstanding balance of the overpayment. When a payment is received that satisfies the full amount of an outstanding overpayment.
2.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Payments Received Payments Issued Collections Payments – Received Lottery Payments – Received IRORA Payment – Received A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
The count and dollar amount total of payments entered by Type daily. The count and dollar amount total of refunds issued by Type daily. The count and dollar amount total of payments received from Collections by Type daily. The count and dollar amount total of payments received from Lottery by Type daily. A count and total dollar amount of payments received from other states by Type and State. -
Target
Source
AWI AWI AWI AWI AWI
2.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
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Number Conflict Description Number
BR03.02.01 BR03.02.02 BR03.02.03 Conflict N N N
The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
Description
Fla. Stat. § 443.171 (3) (2009) – Delegate power and authority for the effective administration of this chapter Fla. Stat. § 443.151 (6) (a, b, c, d, e) (2009) – Allows for recovery and recoupment. Fla. Stat. § 68.065 (3) (2009) – Authority for requiring satisfaction of bad checks within 30 days.
2.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.02.05 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Update Overpayment Record
Source
AWI
Constraint
A Claimant who submits an invalid payment has thirty (30) days to satisfy the payment.
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3. TO-BE OVERPAYMENT STOP SUB-PROCESS
3.1. OVERVIEW
Any claim may be marked as a potential overpayment at a number of points during its processing. These overpayment stops can only be removed or finalized (overpayment determination) by BPC. The objectives of this sub-process include: • • Make a proper determination as to whether or not an overpayment has occurred. If no overpayment exists, release any held weeks as quickly as possible.
Beginning Points • An overpayment stop is entered into the system.
Ending Points • • Issue an overpayment determination or, Determine there was no overpayment made and release any weeks necessary.
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3.2. WORKFLOW DIAGRAM
Exhibit 4 – Overpayment Stop Workflow Diagram
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3.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.03.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Select Payment Stop
System Activity Description
The system will create a payment stop work item whenever an Overpayment Stop is entered against an active claim. Upon selection, the system will record the Examiner and the date and time of the Examiner selecting the work item. The system will provide the claim history and all documentation as necessary. The system will provide a mechanism to record any review activities and upload and attach information provided by the claimant, employer, or third parties. The system will allow previously held payments to be generated during the next payment cycle. Upon request, the system will generate a Notice of Determination and route it to the Claimant via their preferred communication method. The system will cancel any pending payments and will create an overpayment record.
Actor Activity Description
The Examiner will select a payment stop work item for review.
Actor(s)
Examiner
03.03.02
Review Payment Stop
The Examiner will review the claim history and attempt to ascertain whether or not an overpayment has made.
Examiner
03.03.03
Release Weeks
The Examiner will remove the overpayment stop and close the work item. The Examiner will request creation of a Notice of Determination that an overpayment has occurred.
Examiner
03.03.04
Issue Determination
Examiner
3.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents
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(e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
03.02.02
Activity Label
Review Payment Stop
Type
Ad-Hoc
Purpose
To gather information necessary to the review of a payment stop work item. To gather information necessary to the review of a payment stop work item. To notify a claimant that a determination of overpayment has been made.
Recipient
Claimant
Occasion
When information is required to properly review a payment stop work item. When information is required to properly review a payment stop work item. When review of a payment stop has resulted in a determination of overpayment.
03.02.02
Review Payment Stop
Ad-Hoc
Employer
03.02.04
Issue Determination
Notice
Claimant
3.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Overpayment Stop Aging A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
Elapsed time from entry of overpayment stop to resolution (removal or issuance of determination). -
Target
Source
AWI
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Title
Overpayment Stop Accuracy
Metric
A ratio of overpayment stops entered to overpayment determinations issued by count, dollar amount, and cost center daily. -
Target
Source
AWI
3.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.03.01 Conflict N The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
Description
U.C. Automated Nonmonetary Handbook - Allows BPC stop to be entered on claim to handle potential issue.
3.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Source
Constraint
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4. TO-BE LOTTERY SUB-PROCESS
4.1. OVERVIEW
The Florida Lottery receives a regular report of claimants with outstanding overpayments. If one of these claimants wins a prize, the Lottery will contact BPC to determine whether or not the overpayment has been satisfied. If it is not, the Lottery will satisfy the overpayment before paying the claimant any remaining winnings. The objectives of this sub-process include: • Properly identify Lottery winners with overpayments and retrieve funds as available.
Beginning Points • A Claimant with an outstanding overpayment wins the Florida Lottery.
Ending Points • Payment is received on the outstanding overpayment.
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4.2. WORKFLOW DIAGRAM
Examiner
Process Start
Claimant
Lottery
03.04.01 Receive Winner/ Overpayment Match Email
03.04.02 Create Verification Letter
Verification Letter
UCCBIS
03.04.03 Issue Payment
48 Hours Payment
03.02 Payment Intake
Payment
+
Process Ends
Exhibit 5 – Lottery Workflow Diagram
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4.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.04.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Receive Winner/Overpayment Match Email
System Activity Description
-
Actor Activity Description
The Examiner will receive an email notification from the Lottery that a winner has been matched to the overpayment list that BPC provides to the Lottery. The Examiner will request generation of a verification letter to be sent to the Lottery to specify the current amount of the overpayment, if one still exists. The Lottery will issue payment within 48 hours. AWI will receive an amount that satisfies the overpayment (or the entire amount if the winnings are not sufficient) and the Claimant will receive the remainder (if any). When a payment (partial or full) is received from the Florida Lottery, the payment will be received through the normal Payment Intake process.
Actor(s)
Examiner
03.04.02
Create Verification Letter
Upon request, the system will generate a verification letter.
Examiner
03.04.03
Issue Payment
-
Lottery
03.02
Payment Intake
-
BPC
4.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate
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action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
03.04.02
Activity Label
Create Verification Letter
Type
Notice
Purpose
To inform the Florida Lottery that an overpayment exists and to provide the full amount necessary to satisfy the overpayment.
Recipient
Florida Lottery
Occasion
When the Florida Lottery has informed AWI that a Claimant with a possible overpayment has won a prize from the Lottery.
4.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
Target
Source
4.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description
The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
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Number
BR03.04.01 BR03.04.02 BR03.04.03
Conflict N N N
Description
20 C.F.R. § 603.08(b) (2009) – Obtaining information from cross matching with wage information. Fla. Stat. § 443.171(3) (2009) – Delegate power and authority for the effective administration of this chapter. Fla. Stat. § 24.115 (4) (2009) – Provide Lottery outstanding debt owed to the State to be deducted from winnings and transmitted to Agency.
4.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.04.03 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Issue Payment
Source
Lottery Policy
Constraint
The Florida Lottery will issue payment within 48 hours.
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5. TO-BE NEW HIRE AUDIT SUB-PROCESS
5.1. OVERVIEW
The New Hire Audit process uses a cross-match of employer-submitted new hire information (transferred from the Florida Department of Revenue and US Department of Health and Human Services) and claim records to identify claimants who received UC benefits after a reported new hire date. The system will automatically identify conflicts based on active claims data and the information received from the New Hire reports. The system will then automatically issue requests for information to the Claimant and the Employer. At the time a response is received from either party or after a 5-day waiting period, the system will create a work item for BPC review. The objectives of this sub-process include: • • • Identify Claimants who received wages at the same time they received benefits. Make a proper determination as to whether or not an overpayment has occurred. If no overpayment exists, release any held weeks as quickly as possible.
Beginning Points • • A response to the request for information is received back from an Employer and/or a Claimant or, No response if received from the Claimant or Employer within five (5) business days.
Ending Points • • Issue an overpayment determination or, Determine there was no overpayment made and release any weeks necessary.
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5.2. WORKFLOW DIAGRAM
Exhibit 6 – New Hire Audit Workflow Diagram
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5.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.05.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Assign Audit Match
System Activity Description
Prior to this activity, the system will match employersubmitted new hire data from the Florida Department of Revenue and US Department of Health and Human Services. Upon detecting a conflict, the system will create a information request letter and route it to the Claimant’s and Employer’s selected communication medium (i.e., via the Portal or US Mail). If no response is received from the Claimant within five (5) days, the system will generate an Audit Match work item for Issue Determination. If a response is received from the Claimant or the Employer, the system will create an Audit Match work item and place the work item in the Examiner’s queue. The system will record the assigned Examiner and the date and time of the Examiner selecting the work item. The system will provide a mechanism to record review activities.
Actor Activity Description
The Supervisor can assign an Examiner to the Audit Match work item.
Actor(s)
Supervisor
03.05.02
Select Audit Match
The Examiner will select an Audit Match work item for review. The Examiner will review the information on the claim to determine if there is an issue. If there is no issue the Examiner will release the hold on payments (if one exists).
Examiner
03.05.03
Review Information
Examiner
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Index
03.05.04
Activity Label
Release Prior Weeks (If Necessary) Gather Additional Information
System Activity Description
The system will allow previously held payments to be generated during the next payment cycle. The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer. The system will provide the capability to request investigations as necessary through the creation of new work items in the necessary work queue(s). The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer. The system will provide the capability to request investigations as necessary through the creation of new work items in the necessary work queue(s). Upon request, the system will generate a Notice of Determination and route it to the Claimant via their preferred communication method. The system will cancel any pending payments and will create an overpayment record.
Actor Activity Description
The Examiner will remove the overpayment stop and close the work item. If necessary, the Examiner will contact the Employer or Claimant for clarifying information.
Actor(s)
Examiner
03.05.05
Examiner
03.05.06
Review Information
After collecting additional information the Examiner will conduct a final review to determine if there is an overpayment situation. If there is no issue the Examiner will release the hold on payments (if one exists).
Examiner
03.05.07
Issue Determination
The Examiner will request creation of a Notice of Determination that an overpayment has occurred.
Examiner
5.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. Messages are sent to convey required documentation, inform recipients about the status of an activity, to
Page 33
trigger the start or end of other activities, to grant or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
03.05
Activity Label
New Hire Audit
Type
Ad-Hoc
Purpose
To provide the Claimant with an opportunity to provide additional information concerning the New Hire match (information request letter). To gather information necessary to the review of a audit match work item. To gather information necessary to the review of a audit match work item. To notify a claimant that a determination of overpayment has been made.
Recipient
Claimant
Occasion
When a Claimant appears on the New Hire match.
03.05.05
Gather Additional Information
Ad-Hoc
Claimant
03.05.05
Gather Additional Information
Ad-Hoc
Employer
03.05.07
Issue Determination
Notice
Claimant
When information is required to properly review an audit match work item. When information is required to properly review an audit match work item. When review of a payment stop has resulted in a determination of overpayment.
5.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
New Hire Audit New Hire Audit Workload A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count of New Hire Audit work items created daily. A count of New Hire Audit work items processed by Examiner daily. -
Target
Source
AWI AWI
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Title
Determinations Issued Determinations Appealed
Metric
A count of overpayment/non-monetary determinations and the total dollar amount issued by Type and Employee per quarter. A count of overpayment determinations appealed by Employee. -
Target
Source
AWI AWI
5.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.05.01 Conflict N The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
Description
Personal Responsibility and Work Opportunity Reconciliation Act § 313, 42 U.S.C. § 653a – Requires employers to report all new hires to state agencies and the National Directory of New Hires. NDNH allows cross matching with state agencies. USDOL, Unemployment Insurance Program Letter No. 35-99 (6/21/1999) & 36-00 (10/10/2000) – Encourages state agencies to take full advantage of the “New Hires” system to prevent and detect overpayments. Fla. Stat. § 409.2576 (9) (a) 3 (2009) – Dept of Revenue will share new hire information with the UC program. 20 C.F.R. § 603.08(b) (2009) – Obtaining information from cross matching with wage information. F.A.C. 60BB-3.017 (2) (2009) – Notice of Determination. Fla. Stat. § 443.071 (1) (2009) – False statement by individual to obtain benefits Fla. Stat. § 443.101 (6) (2009) – Disqualified for a period not to exceed 1 year for making a false statement in order to obtain benefits. Fla. Stat. § 443.151 (4) (b) (2009) – The claimant may appeal an adverse determination. Fla. Stat. § 443.171(1) (2009) – The Agency is given the powers and duties to administer this chapter.
BR03.05.02
N
BR03.05.03 BR03.05.04 BR03.05.05 BR03.05.06 BR03.05.07
N N N N N
BR03.05.08 BR03.05.09
N N
5.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.05 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
New Hire Audit
Source
AWI
Constraint
A Claimant has five (5) days to respond to a request for additional information from the Agency.
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03.05.05
Gather Additional Information Gather Additional Information
AWI
03.05.05
AWI
A Claimant has forty-eight (48) hours to respond to a voice mail message or five (5) days to respond to a written request for additional information from the Agency. An Employer has five (5) days to respond to a written request for additional information from the Agency.
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6. TO-BE MULTI-ADDRESS/PHONE AUDIT SUB-PROCESS
6.1. OVERVIEW
The system will identify instances where multiple claimants are listing the same address and/or phone number. The claimants will be contacted for proof of residence. These claims may be referred for investigation. Validated claims will be marked to prevent that claimant/address combination from being re-audited (a new claimant at that address would be audited). The objectives of this sub-process include: • • • • Investigate claims with same address and/or phone number. Make a proper determination as to whether or not an overpayment has occurred. If no overpayment exists, release any held weeks as quickly as possible. Prevent the Claimant/claim combination from reappearing as an issue.
Beginning Points • A claim or claims
Ending Points • • Issue an overpayment determination or, Determine there was no overpayment made, release any weeks necessary, and prevent the claimant/claim combination from reappearing as an issue.
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6.2. WORKFLOW DIAGRAM
Exhibit 7 – Multi-Address/Phone Audit Workflow Diagram
Page 38
6.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.06.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Assign Audit Match
System Activity Description
Prior to this activity, the system will match claims and claimants and identify instances of multiple claimants reporting the same address and/or phone number. Those claimant/address combinations that have not been previously investigated and cleared will result in the creation of an Audit Match work item which will be placed in the Examiner’s queue. Certain addresses (shelters, etc) will be permanently flagged within the system to prevent audit matches from occurring. The system will record the assigned Examiner and the date and time of the Examiner selecting the work item. The system will automatically generate a Call-In Card or Request for ID Letter and route it to the Claimant’s selected communication medium (i.e., via the Portal, fax, or US Mail).
Actor Activity Description
The Supervisor can assign an Examiner to the Audit Match work item.
Actor(s)
Supervisor
03.06.02
Select Audit Match
The Examiner will select an Audit Match work item for review.
Examiner
03.06.03
Review Information
The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer.
After collecting additional information the Examiner will conduct a final review to determine if fraudulent activity may be occurring.
Examiner
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Index
03.11
Activity Label
Investigations
System Activity Description
The system will provide the capability to request investigations as necessary through the creation of new work items in the necessary work queue(s). The system will provide a mechanism to prevent future audits on a specific combination of claimant/address or claimant/phone.
Actor Activity Description
If it appears that fraudulent activity may be occurring, the Examiner will create a work item to request an investigation via the Investigations process. If there is no issue the Examiner will mark that particular claimant and address/phone as validated. This will prevent that specific combination from being audited again. Please note that a new claimant from that address will not be considered validated and will be audited. The Examiner will remove the overpayment stop and close the work item. The Examiner will request creation of a Notice of Determination that an overpayment has occurred.
Actor(s)
BPC
03.06.04
Validate Address/Phone
Examiner
03.06.05
Release Prior Weeks (if necessary) Issue Determination
03.06.06
The system will allow previously held payments to be generated during the next payment cycle. Upon request, the system will generate a Notice of Determination and route it to the Claimant via their preferred communication method. The system will cancel any pending payments and will create an overpayment record.
Examiner
Examiner
6.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
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Index Activity Label Type
Purpose Recipient Occasion Index
03.06.02
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Activity Label
Select Audit Match
Type
Ad-Hoc
Purpose
To gather information necessary to the review of a audit match work item. To notify a claimant that a determination of overpayment has been made.
Recipient
Claimant(s)
Occasion
When information is required to properly review an audit match work item. When review of a payment stop has resulted in a determination of overpayment.
03.06.06
Issue Determination
Notice
Claimant
6.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Multi-Address/Phone Audit Multi-Address/Phone Audit Workload Determinations Issued Determinations Appealed A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count of Multi-Address/Phone Audit work items created daily. A count of Multi-Address/Phone Audit work items processed by Examiner daily. A count of overpayment/non-monetary determinations and the total dollar amount issued by Type and Employee per quarter. A count of overpayment determinations appealed by Employee. -
Target
Source
AWI AWI AWI AWI
6.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
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Number Conflict Description Number
BR03.06.01 BR03.06.02 Conflict N N
The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
Description
Fla. Stat. § 443.071 (1) (2009) – False statement by individual to obtain benefits Fla. Stat. § 443.101 (6) (2009) – Disqualified for a period not to exceed 1 year for making a false statement in order to obtain benefits. Fla. Stat. § 443.151 (4) (b) (2009) – The claimant may appeal an adverse determination. Fla. Stat. § 443.171(1) (2009) – The Agency is given the powers and duties to administer this chapter.
BR03.06.03 BR03.06.04
N N
6.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.06.02 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Select Audit Match
Source
AWI
Constraint
A Claimant has five (5) days to respond to a written request for additional information from the Agency.
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7. TO-BE WAIVER SUB-PROCESS
7.1. OVERVIEW
The Agency receives requests to delay overpayment offsets (the satisfaction of an overpayment by withholding current benefits) due to hardship. These waiver requests must be reviewed and approved by a supervisor within BPC and the system must be adjusted accordingly. The objectives of this sub-process include: • • To make a proper determination as to the suitability of the Waiver Request. To adjust the system appropriately, based on the outcome of the Waiver Request review.
Beginning Points • A Request for a Waiver of Recoupment is received from a Claimant with an outstanding overpayment.
Ending Points • • The Waiver (or some portion) is granted and the system is updated and adjusted accordingly or, The Waiver is denied.
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7.2. WORKFLOW DIAGRAM
Supervisor Claimant
Process Start
03.07.01 Select Waiver of Recoupment
UCCBIS
03.07.02 Review Waiver of Recoupment
Letter
UCCBIS Granted
03.07.03 Back Out Prior Offsets (If Necessary)
UCCBIS
03.07.04 Enter Recoupment Amount or Percentage
UCCBIS
Process Ends
Exhibit 8 – Waiver Workflow Diagram
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7.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.07.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Select Waiver of Recoupment Review Waiver of Recoupment
System Activity Description
A waiver will be displayed in the Supervisor’s work queue for review. Upon request, the system will generate a letter detailing the outcome of the review that will be mailed to the claimant.
Actor Activity Description
The Supervisor will select a waiver from the work queue. The Supervisor will review the waiver and the associated claim and overpayment information to determine if a waiver will be a granted and, if granted, what type of waiver will be granted (full or partial). The Supervisor will use the system to generate a letter informing the Claimant of the outcome of the review. The Supervisor will back out prior offsets in the system. The Supervisor will enter the waiver amount or percentage in the system and the system will process the waiver.
Actor(s)
Supervisor
03.07.02
Supervisor
03.07.03
03.07.04
Back Out Prior Offsets (If Necessary) Enter Recoupment Amount or Percentage
The system will update the overpayment record as necessary. The system will apply the waiver amount or percentage to the claimant’s overpayment and will process payment to the claimant.
Supervisor
Supervisor
7.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery.
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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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
03.07.02
Activity Label
Review Waiver of Recoupment
Type
Notice
Purpose
To inform the Claimant of the outcome of the review of the Waiver of Recoupment.
Recipient
Claimant
Occasion
When the Supervisor completes the review of the Waiver of Recoupment.
7.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Waiver Waiver Aging Waiver Granted A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count of Waiver work items created. Elapsed time from receipt of waiver request to resolution (grant or denial). A count and the total overpayment dollars of waivers granted by type. -
Target
Source
AWI AWI AWI
7.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description
The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
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Number
BR03.07.01
Conflict N
Description
Fla. Stat. § 443.151 (6) (c) (2009) – Allows for waiver of recoupment.
7.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Source
Constraint
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8. TO-BE INTERSTATE OVERPAYMENTS (IRORA) SUBPROCESS
8.1. OVERVIEW
The Interstate Reciprocal Overpayment Recovery Arrangement (IRORA) program allows states to collect overpayments on behalf of other states. Florida may act as the collector state (collecting another state’s overpayment) or as the requestor state (having another state collect on its behalf). The objectives of this sub-process include: • • Request another state to collect an overpayment on Florida’s behalf. Collect overpayments on another state’s behalf.
Beginning Points • • A communication is received from another state requesting that Florida collect overpayments on its behalf or, A claimant with an outstanding Florida overpayment is identified as receiving claims from another state.
Ending Points • • Payments are withheld from a Florida claimant and a warrant is issued to another state until the overpayment is satisfied or, Payments are received from another state until the Florida overpayment is satisfied.
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8.2. WORKFLOW DIAGRAM
Supervisor
Process Start
Finance Management
Examiner
Other State
03.08.01 Assign IRORA Work Item
03.08.02 Select IRORA
UCCBIS Florida is Collector State
UCCBIS Florida is Requestor State
03.08.03 Enter Overpayment
03.08.07 Create Overpayment Request Letter
Letter/ Determination
UCCBIS
UCCBIS
03.02 Payment Intake
03.02 Payment Intake
Payments
+
+
03.08.05 Issue Warrant
03.08.04 Request Refund Warrant
PIF Letter
Monthly
Process Ends
Refund (Warrant)
03.08.06 Create Refund Cover Letter (incl. PIF Letter if necessary) UCCBIS
Letter(s)/ Warrant
Process Ends
Exhibit 9 – Interstate Overpayments (IRORA) Workflow Diagram
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8.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.08.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Assign IRORA Work Item
System Activity Description
Prior to this activity, the system will match Florida overpayment records with records of active claims in other IRORA participating states. When a match is detected, the system will create an IRORA work item and place it in the Supervisor’s queue. Work items will also be created when requests are received from other IRORA states. The system will record the assigned Examiner and the date and time of the Examiner selecting the work item.
Actor Activity Description
The Supervisor will assign an Examiner to the IRORA work item.
Actor(s)
Supervisor
03.08.02
Select IRORA
03.08.03
Enter Overpayment Payment Intake
03.02
The system will provide a mechanism for recording an out-of-state overpayment. The system will record offsets of Florida claims against the out of state overpayment.
03.08.04
Request Refund Warrant
The system will provide a mechanism to request refund warrants from Finance Management.
03.08.05
Issue Warrant
-
The Examiner will select an IRORA work item for review. The Examiner will determine whether Florida is the Collector or the Requestor State. The Examiner will enter the overpayment in the system as an out of state overpayment. Payments made against an outof-state overpayment (via offset of Florida claims) will be handled via the normal Payment Intake process. If the total of payments made against an out-of-state overpayment exceeds the amount due, the Examiner will request a refund warrant be issued to the Claimant. Financial Management will issue a refund warrant and return it to BPC for processing.
Examiner
Examiner
BPC
Examiner
Examiner
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Index
03.08.06
Activity Label
Create Refund Cover Letter (incl. PIF Letter if necessary)
System Activity Description
Upon request, the system will generate a Refund Cover Letter and Paid-In-Full Letter (if necessary) and route them to the Claimant’s selected communication medium (i.e., via the Portal, fax, or US Mail). Upon request, the system will generate an Overpayment Request Letter. The system will provide a copy of the Notice of Determination and other required documentation. The system will mark the overpayment as assigned to the Collector State. Upon satisfaction of the overpayment, the system will generate a Paid-In-Full letter to the Collector State advising them that the overpayment has been satisfied.
Actor Activity Description
The Examiner will create a Refund Cover Letter (and a Paid-In-Full Letter, if necessary).
Actor(s)
Examiner
03.08.07
Create Overpayment Request Letter
The Examiner will create an Overpayment Request Letter and mail it, along with a copy of the Notice of Determination and other required documentation to the Collector State.
Examiner
03.02
Payment Intake
When warrants are received from the Collector State, they will be processed via the normal Payment Intake process.
BPC
8.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
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Index Activity Label Type
Purpose Recipient Occasion Index
03.08.01
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Activity Label
Assign IRORA Work Item
Type
Notice
Purpose
To request that Florida act as Collector State on another participating IRORA state’s behalf. To request a participating IRORA state to act as Collector State on Florida’s behalf. To accompany a refund warrant.
Recipient
AWI
Occasion
When a participating IRORA state wishes Florida to collect overpayments on its behalf. When a Florida overpayment is matched with an active claim in another state. When Florida has collected an excess amount on another state’s behalf. When Florida has collected an amount sufficient to satisfy another state’s overpayment. When a Florida overpayment subject to an IRORA request is paid in full.
03.08.07
Create Overpayment Request Letter Create Refund Cover Letter (incl. PIF Letter if necessary) Create Refund Cover Letter (incl. PIF Letter if necessary) Payment Intake
Notice
IRORA State
03.08.06
Ad-Hoc
Claimant
03.08.06
Notice
To accompany a refund warrant (when necessary).
Claimant
03.02
Notice
To inform the Collector State that the Florida overpayment has been satisfied.
IRORA State
8.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
IRORA – Collections A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count and total dollar amount of payments collected on behalf of other states by Type and State. -
Target
Source
AWI
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8.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.08.01 BR03.08.02 BR03.08.03 Conflict N N N The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
Description
Social Security Act § 303(g), 42 U.S.C. § 503(g) (2006) – Participating states can recover overpayments on behalf of each other. Fla. Stat. § 443.151 (6) (a, b, c, d, e) (2009) – Allows for recovery and recoupment. Fla. Stat. § 443.151 (4) (b) (2009) – The Claimant may appeal recoupment.
8.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.08.05 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Issue Warrant
Source
AWI
Constraint
Refund warrants are issued weekly.
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9. TO-BE OVERPAYMENT WRITE-OFF SUB-PROCESS
9.1. OVERVIEW
Overpayments which have exceeded the statute of limitations are no longer subject to active collections efforts. Those which have gone through the Small Claims or State Attorney Referral process can still be collected in order to release any liens. The potential write-off must be identified by BPC and approved by the Florida Department of Financial Services (DFS). The objectives of this sub-process include: • • To identify overpayments which have exceeded the statute of limitations for active pursuit. To review such overpayments, obtain proper sign-off, and remove them from the necessary accounting systems as outstanding debts.
Beginning Points • An overpayment is identified as having exceeded the statute of limitations.
Ending Points • The overpayment is removed from the various accounting systems as an outstanding debt.
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9.2. WORKFLOW DIAGRAM
Exhibit 10 – Overpayment Write-Off Workflow Diagram
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9.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.09.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Prepare Memorandum
System Activity Description
Prior to this activity, the system will identify overpayment which have reached the Statute of Limitations and are no longer subject to active collections efforts. These items will be summarized quarterly and a work item created and placed in the Supervisor’s queue. Upon request the system will generate a Cover Letter.
Actor Activity Description
The Supervisor will create a Memorandum explaining the amount of the write-off and route it to the Deputy Director.
Actor(s)
Supervisor
03.09.02
Sign Memorandum
-
03.09.03
Prepare Cover Letter
03.09.04
Implement WriteOffs
Upon request the system will generate a data file of all pending write-offs in a format compatible with DFS’s requirements. Upon request, the system will mark all pending overpayments as having been written off.
The Deputy Director will review and sign the Memorandum. The Memorandum will be routed to the Director of Finance Management. The Director will create a Cover Letter to accompany a data file of all scheduled writeoffs. These will be routed to DFS. DFS will send an approval letter to the Director who will advise BPC. BPC will request the system to complete the write-off process.
Deputy Director
Finance Management
Finance Management
9.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect
Page 56
electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
03.09.01
Activity Label
Prepare Cover Letter
Type
Notice
Purpose
To inform DFS that certain overpayments have reached the Statute of Limitation and are eligible for write off. To inform DFS that certain overpayments have reached the Statute of Limitation and are eligible for write off.
Recipient
DFS
Occasion
When the quarterly write off process is initiated. When the data file is ready for routing to DFS.
03.09.03
Prepare Memo
Notice
DFS
9.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Write-Off A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count and total dollar amount of overpayments written-off by Type per quarter. -
Target
Source
AWI
9.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
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Number Conflict Description Number
BR03.09.01 BR03.09.02 Conflict N N
The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
Description
Fla. Stat. § 443.151 (6) (a, b) (2009) – Statute of Limitations on for recovery and recoupment. Fla. Stat. § 17.04 (2009) – Authority of the Chief Financial Officer to adjust indebtedness to the State.
9.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.09 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Overpayment Write-Off
Source
AWI
Constraint
The Overpayment Write-Off process is conducted quarterly.
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10. TO-BE DEATH AUDIT SUB-PROCESS
10.1. OVERVIEW
The Agency regularly receives data from the Department of Health on deceased persons. The system will match this information against active claimants and where a check was issued after the date of death, an investigation will be conducted. The objectives of this sub-process include: • • Identify Claimants who received benefits after a reported date of death. Make a proper determination as to whether or not an overpayment has occurred.
Beginning Points • A record of death is received from the Department of Health and matched with a payment made after the date of death.
Ending Points • • • Issue an overpayment determination or, File a police report or, Determine there was no overpayment made.
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10.2. WORKFLOW DIAGRAM
Exhibit 11 – Death Audit Workflow Diagram
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10.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.10.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Assign Death Match
System Activity Description
Prior to this activity, the system will match claims and death records from DOH and will identify instances of claim weeks that are after the claimant’s date of death. The system will record the assigned Investigator and the date and time of the Investigator selecting the work item. The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer.
Actor Activity Description
The Supervisor will assign an Investigator to the Death Match work item.
Actor(s)
Supervisor
03.10.02
Select Death Match
The Investigator will select a Death Match work item for review and will contact the family to request additional information. After collecting additional information the Investigator will conduct a final review to determine if fraudulent activity may be occurring. If the family of the deceased admits to the overpayment, the work item will be routed to an Examiner for a Notice of Determination. If the Claimant is not deceased, the work item will be routed to an Examiner to release the hold on payments (if one exists).
Investigator
03.10.03
Review Information
Investigator
03.10.04
File Police Report
-
If it appears that fraudulent activity is occurring and the family denies the activity, the Investigator will file a police report.
Investigator
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Index
03.10.05
Activity Label
Issue Determination
System Activity Description
Upon request, the system will route the Notice of Determination to the Claimant’s selected communication medium (i.e., via the Portal, fax, or US Mail). The system will close the work item.
Actor Activity Description
Based on the information contained within the work item, the Examiner will create a Determination and enter it into the system.
Actor(s)
Examiner
03.10.06
Release Prior Weeks (If Necessary)
The system will allow previously held payments to be generated during the next payment cycle.
The Examiner will remove the overpayment stop and close the work item.
Examiner
10.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion
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Index
03.11.02
Activity Label
Select Death Match Audit
Type
Ad-Hoc
Purpose
To gather information necessary to the review of a death match work item. To notify a claimant that a determination of overpayment has been made.
Recipient
Employer
Occasion
When information is required to properly review a death match work item. When review of a payment stop has resulted in a determination of overpayment.
03.11.05
Issue Determination
Notice
Claimant
10.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Death Audit Death Audit Aging Determinations Issued A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count of Death Audit work items created. Elapsed time from creation of work item to resolution. A count of overpayment determinations and the total dollar amount issued by Type. -
Target
Source
AWI AWI AWI
10.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.10.01 BR03.10.02 BR03.10.03 The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule. Conflict N N N
Description
20 C.F.R. § 603.08(b) (2009) – Obtaining information from cross matching with wage information. Fla. Stat. § 443.171(3) (2009) – Delegate power and authority for the effective administration of this chapter. Fla. Stat. § 443.171(1) (2009) – The Agency is given the powers and duties to administer this chapter.
10.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
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Index Activity Label Source Constraint Index
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Source
Constraint
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11. TO-BE INVESTIGATIONS SUB-PROCESS
11.1. OVERVIEW
Overpayment cases may be referred to Investigations for an investigation. Investigation requests may come from any point in the overpayment process and must be approved by the supervisor of the requesting unit. The objectives of this sub-process include: • To investigate referred potential overpayment cases to be investigated.
Beginning Points • An overpayment case is referred to the Investigation unit.
Ending Points • The results of the investigation are returned to the referring unit for determination.
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11.2. WORKFLOW DIAGRAM
Requestor Unit Supervisor Investigation Supervisor Investigator Claimant/ Employer/ Third-Party
Process Start
03.11.01 Request Investigation
03.11.02 Review Case
Approved
03.11.03 Assign Case
03.11.04 Select Case
UCCBIS
UCCBIS
UCCBIS
UCCBIS
Denied Declined
03.11.05 Investigate Case
Ad-Hoc
UCCBIS
03.11.08 Review Case
03.11.07 Review Case
03.11.06 Update Case
UCCBIS
UCCBIS
UCCBIS
Process Ends
Exhibit 12 – Investigations Workflow Diagram
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11.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.11.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Request Investigation
System Activity Description
The system will create an Investigation work item and place it in the Requestor’s Supervisor’s queue. If approved, the system will place the case in the Investigation Supervisor’s queue. If denied, the system will return the request to the Requestor with the Unit Supervisor’s comments. If the Investigation Supervisor accepts the case, the system will place the case in the Investigator’s work queue. If the Investigation Supervisor declines the case, the system will place the case in the Unit Supervisor’s queue. The system will record the assigned Investigator and the date and time of the Investigator selecting the work item. The system will provide a mechanism to record investigation activities, upload and attach information provided by the claimant, employer, or third parties.
Actor Activity Description
The Requestor will create an Investigation work item (case).
Actor(s)
Requestor
03.11.02
Review Case
The Unit Supervisor will review the case and determine whether or not an investigation is warranted.
Unit Supervisor
03.11.03
Assign Case
The Investigation Supervisor will review the case and determine whether or not an investigation is warranted. If the investigation is needed, the Supervisor will assign an Investigator to the case. The Investigator will select a case for review.
Investigation Supervisor
03.11.04
Select Case
Investigator
03.11.05
Investigate Case
The Investigator will review all the information in the system. The Investigator will communicate with claimants, employers, or other parties on an ad-hoc basis to clarify existing information or to gather additional information.
Investigator
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Index
03.11.06
Activity Label
Update Case
System Activity Description
The system will provide a mechanism to record the Investigator’s recommendation. The system will place the case in the Unit Supervisor’s queue. The system will provide a mechanism to record the Unit Supervisor’s comments. The system will place the case in the Requestor’s work queue. The system will provide all necessary documentation to the Requestor.
Actor Activity Description
The Investigator will enter a recommendation for the case.
Actor(s)
Investigator
03.11.07
Review Case
03.11.08
Review Case
The Unit Supervisor will review the Investigator’s recommendation, add additional comments as necessary, and return the case to the Requestor. The Requestor will review the case and close the work item.
Unit Supervisor
Requestor
11.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion
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Index
03.11.05
Activity Label
Investigate Case
Type
Ad-Hoc
Purpose
To gather information necessary to the investigation of an overpayment case.
Recipient
Claimant/ Employer/ Third-Party
Occasion
When information is required to properly complete an investigation.
11.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Investigations Workload Investigations Aging Recommendations Issued A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count of Investigations work items processed by Investigator per quarter. Elapsed time from creation of work item to resolution. A count of recommendations made by result (overpayment or no overpayment) . -
Target
Source
AWI AWI AWI
11.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.01.01 BR03.11.02 BR03.11.03 BR03.11.04 N N N The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule. Conflict N
Description
Fla. Stat. § 443.171(3) (2009) – Delegate power and authority for the effective administration of this chapter. Fla. Stat. § 443.171 (6, 7) (2009) – Ability to issue subpoenas to obtain records for court action. Fla. Stat. § 443.071 (5, 6, 7, 8) (2009) – Items of evidence for prosecution. Fla. Stat. § 443.171(1) (2009) – The Agency is given the powers and duties to administer this chapter.
11.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
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Index Activity Label Source Constraint Index
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Source
Constraint
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12. TO-BE FAIL TO PAY/DISPOSITION SUB-PROCESS
12.1. OVERVIEW
When an overpayment has exceeded a set time period between payments (usually six months), the system will trigger the fail-to-pay process. The overpayment will be reviewed and additional (possibly final) collection action will be taken. This process includes the review of outstanding prosecution cases, renewal of civil judgments, and the review of restitution cases. The objectives of this sub-process include: • • • To take appropriate action when an overpayment is not being repaid in a timely manner. To review and update the status of outstanding prosecutions and restitution cases. To review and maintain the status of civil judgments.
Beginning Points • An overpayment exceeds the user-defined parameter for receiving a payment and/or needs an update in status.
Ending Points • • • • • A police report is filed (Death Match) or, The case filed for judgment in Civil Court or, The case is forwarded to the contracted Collections Agency or, The case is referred to a State Attorney for prosecution or, A status update is received from a State Attorney or Probation Officer on a pending prosecution/restitution.
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12.2. WORKFLOW DIAGRAM
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AWI Legal
Continued From Previous Page (2)
Investigator
State Attorney
Claimant
Request Stipulation 03.12.11 Prepare Case
UCCBIS
Continued From Previous Page (1)
03.12.13 Review Case
03.12.12 Submit Case
UCCBIS Face-To-Face 03.12.07 Prepare Case 03.12.14 File Case UCCBIS No Service UCCBIS Service 03.12.15 File Dismissal UCCBIS UCCBIS Continued From Previous Page (3) Link To Refer to Collections Agency Decline 03.12.08 Submit Case 03.12.09 Review Case
03.12.16 Attend Hearing
Accept
03.12.19 Review Case
03.12.20 File Case
03.12.17 Record Judgment
03.12.10 Update Case
UCCBIS
UCCBIS
UCCBIS
Process Ends
Exhibit 13 – Fail To Pay/Disposition Workflow Diagram
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12.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.12.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Assign Fail To Pay
System Activity Description
Prior to this activity, the system will check each overpayment record for payment activity. Each record will contain a review date or pay-by date. If this date passes without payment being received a work item will be generated. The system will place the work item in the assigned Examiner’s work queue. The system will place the work item in the Examiner’s work queue. The system will provide the necessary output/information to the Reviewer and attach it to the work item (Non-Monetary Determination, Determination History, Adjudication File, Claim History, Overpayment History, Investigation Case File). The system will provide a mechanism to record review activities, upload and attach information provided to the Examiner.
Actor Activity Description
The Supervisor can assign an Examiner to the Fail To Pay work item.
Actor(s)
Supervisor
03.12.02
Select Fail To Pay
The Examiner will select an assigned work item for review.
Examiner
03.12.03
Review Information
The Examiner will review the overpayment history. Based on the original cause of the overpayment and prior actions taken in the case, the Examiner will determine the next action.
Examiner
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Index
03.12.04
Activity Label
Contact PO/State Attorney
System Activity Description
The system will provide a mechanism for storing the Probation Officer or State Attorney associated with a particular case. The system will accept an updated review date to create a new Fail To Pay work item should payment not be received.
Actor Activity Description
If the overpayment contains a record of a prior conviction and probation, the Examiner will contact the Probation Officer as listed in the case. The Probation will be informed that the Claimant is not making restitution as required. The Examiner will reset the review/pay-by date to a date one year from the date of contact with the Probation Officer. If the overpayment has been referred to a State Attorney but does not contain a final disposition, the State Attorney will be contacted for an update on the status. If the case is still pending, the review/pay-by date will be set to a date six months from the date of contact with the State Attorney. If the overpayment is the result of a Death Match audit, the Examiner will file a Police Report with the Claimant’s local Police Department. The overpayment case will be closed. If the overpayment is the result of a non-fraud determination below the system-defined threshold or if the case has been voluntarily dismissed from Civil Court due to a lack of process, the Examiner will mark the overpayment case to be referred to the AWIcontracted collection’s agency.
Actor(s)
Examiner
03.12.05
File Police Report
The system will provide supporting documentation as necessary.
Examiner
03.12.06
Refer To Collections Agency
The system will transfer information about the case to the AWI-contracted collections agency. The overpayment will be updated with the necessary fees. No further payments will be accepted to satisfy the overpayment, however, the overpayment will still be eligible for offset payments.
Examiner
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Index
03.12.07
Activity Label
Prepare Case
System Activity Description
The system will provide supporting documentation as necessary.
Actor Activity Description
If the overpayment is the result of fraudulent activity above a system-defined threshold or is the result of a bad check received for payment, then the Examiner will begin assembling a case file for submission to the relevant State Attorney. The Examiner may attempt to gain a confession or admission from the Claimant via a face-to-face meeting. The Examiner will print out the necessary information and submit it to the relevant State Attorney for review. The State Attorney will review the case and accept it for possible prosecution or decline to prosecute.
Actor(s)
Examiner
03.12.08
Submit Case
The system will provide supporting documentation as necessary. The system will provide a mechanism to record the State Attorney’s decision. If the State Attorney declines to prosecute, the case will be filed in Civil Court. The system will close the work item.
Examiner
03.12.09
Review Case
State Attorney
03.12.10
Update Case
03.12.11
Prepare Case
The system will provide supporting documentation as necessary.
03.12.12
Submit Case
The system will provide supporting documentation as necessary.
03.12.13
Review Case
The system will provide a mechanism to record the activities of AWI Legal.
If the State Attorney accepts the case, a review date will be entered for six months from the date of acceptance. If the overpayment is the result of fraudulent activity below a system-defined threshold, is the result of non-fraudulent activity above a systemdefined threshold, or a State Attorney has declined to prosecute, then the Examiner will begin assembling a case file for submission to Civil Court. The Examiner may attempt to gain a stipulation from the Claimant. The Examiner will print out the necessary information and submit it to the AWI Legal Office for review and signature. AWI Legal Staff will review the case and sign the necessary documents.
Examiner
Examiner
Examiner
AWI Legal
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Index
03.12.14
Activity Label
File Case
System Activity Description
The system will provide supporting documentation as necessary. The system will provide a mechanism to record the relevant information (Case #, Hearing Date, Service, etc). The system will provide a mechanism to record the failure of service.
Actor Activity Description
The Examiner will file the case with the Civil Court and request service of process.
Actor(s)
Examiner
03.12.15
File Dismissal
03.12.16
Attend Hearing
-
03.12.17
Record Judgment
The system will provide a mechanism to record the result of the Hearing. The system will provide supporting documentation as necessary to file a judgment/lien with the appropriate court.
03.12.18
Prepare Case
The system will provide supporting documentation as necessary.
03.12.19
Review Case
03.12.20
File Case
The system will provide a mechanism to record the activities of AWI Legal. The system will provide a mechanism to record the result of the Final Judgment of the Court.
If at the time of the Hearing, service has not been received (i.e., the Claimant has not been notified of the case), the case will be referred to the AWIcontracted collections agency. If service is received on a Civil Case, the Examiner and AWI Legal will attend the hearing. The Hearing will result in either a judgment or dismissal. If the matter is dismissed, the Overpayment review date will be set past the Statute of Limitations date as no further collections activity may occur. If the Hearing results in a judgment against the Claimant, the Examiner will enter that fact into the system. If the overpayment review is the result of a previously filed conditional judgment, the Examiner will file with the Court for Final Judgment. AWI Legal Staff will review the case and sign the necessary documents. The Examiner will file the case with the Civil Court and request Final Judgment. The Examiner will then proceed to Record Judgment.
Examiner
Examiner
Examiner
Examiner
AWI Legal
Examiner
12.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created
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when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
03.12.05
Activity Label
File Police Report
Type
Ad-Hoc
Purpose
To inform the a local Police Department of an overpayment case to be investigated. To establish the complaint against the Claimant for filing in Civil Court To provide the Claimant notice of the Civil suit and summon the Claimant to the Hearing. To request dismissal of a Civil Court action against a Claimant due to a failure to serve notice. To serve notice to the Court that a Claimant has failed to uphold the Conditional Judgment issued by the Court and request a Final Judgment.
Recipient
Police Department
Occasion
When the Death Match overpayment has not been repaid. When a case is being prepared for filing in Civil Court. When a case is being prepared for filing in Civil Court. When service of process has failed.
03.12.11
Prepare Case
Form
Leon County Civil Court Leon County Civil Court
03.12.11
Prepare Case
Form
03.12.15
File Dismissal
Form
Leon County Civil Court
03.12.18
Prepare Case
Form
Leon County Civil Court
When a Claimant fails to uphold the terms of a Conditional Judgment.
12.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source
A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
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Title
Collections Payments – Referred Civil Court – Referred State Attorney – Referred
Metric
The count, dollar amount total of overpayments, and amount recouped referred to Collections by Type daily and quarterly. The count, dollar amount total of overpayments, and amount recouped referred to Civil Court by Type daily and quarterly. The count, dollar amount total of overpayments, and amount recouped referred to States Attorney by Type daily and quarterly. -
Target
Source
AWI AWI AWI
12.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.12.01 BR03.12.02 BR03.12.03 BR03.12.04 BR03.12.05 BR03.12.06 BR03.12.07 BR03.12.08 BR03.12.09 BR03.12.10 BR03.12.11 The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule. Conflict N N N N N N N N N N N
Description
Fla. Stat. § 443.171 (3) (2009) – Delegate power and authority for the effective administration of this chapter Fla. Stat. § 443.171 (6, 7) (2009) – Ability to issue subpoenas to obtain records for court action. Fla. Stat. § 443.071 (5, 6, 7, 8) (2009) – Items of evidence for prosecution. Fla. Stat. § 443.151 (6) (a) (2009) – Allows for recovery and recoupment. Fla. Stat. § 443.151 (6) (d) (2009) – Allows for collection through civil action. Fla. Stat. § 17.0415 (2009) – Allows for transfer and assignment of claims in order to facilitate collection. Fla. Stat. § 17.20 (2, 3) (2009) – Allows for assignment of claims to authorized collection agency. Fla. Stat. § 832.06 (2009) – Allows for prosecution for worthless checks. Fla. Stat. § 832.08 (2009) – Violations involving checks. Fla. Stat. § 27.02 (2009) –State Attorney shall appear within judicial circuit to prosecute on behalf of the State. Fla. Stat. § 47.011 (2009) – Civil action shall be brought in the county where the cause of action accrued.
12.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.12 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Fail To Pay/Disposition
Source
Fla. Stat. § 443.151 (6) (a)
Constraint
Fraud overpayments must be collected within five (5) years of the date of the determination (Statute of Limitations).
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03.12
Fail To Pay/Disposition
Fla. Stat. § 443.151 (6) (b)
Nonfraud overpayments must be collected within three (3) years of the date of the determination (Statute of Limitations).
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doc_313629131.pdf
Unemployment (or joblessness) occurs when people are without work and actively seeking work. The unemployment rate is a measure of the prevalence of unemployment and it is calculated as a percentage by dividing the number of unemployed individuals by all individuals currently in the labor force.
State of Florida Agency for Workforce Innovation
Unemployment Compensation Project – Phase 2
To-Be Business Process – Benefit Payment Control (BPC)
Document Control
Revision History
Date
01/27/2010
Version
1.00
Description
Final Deliverable Pete Peterson
Author
Quality Review History
Date
01/26/2010
Reviewer
Robin Nichols/Dianne Parcell Client Review – Approved.
Comments
Page i
Table of Contents
0.
0.1. 0.2. 0.3.
TO-BE PROCESS BENEFIT PAYMENT CONTROL (BPC)........................ 1
OVERVIEW.............................................................................................................................. 1 ASSUMPTIONS ......................................................................................................................... 2 WORKFLOW DIAGRAM ............................................................................................................ 3
1.
1.1. 1.2. 1.3. 1.4. 1.5. 1.6. 1.7.
TO-BE WAGE AUDIT SUB-PROCESS .......................................................... 4
OVERVIEW.............................................................................................................................. 4 WORKFLOW DIAGRAM ............................................................................................................ 5 ACTIVITIES ............................................................................................................................. 7 CORRESPONDENCE ................................................................................................................ 10 PERFORMANCE METRICS ....................................................................................................... 11 BUSINESS RULES ................................................................................................................... 12 TIME CONSTRAINTS .............................................................................................................. 12
2.
2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7.
TO-BE PAYMENT INTAKE SUB-PROCESS .............................................. 14
OVERVIEW............................................................................................................................ 14 WORKFLOW DIAGRAM .......................................................................................................... 15 ACTIVITIES ........................................................................................................................... 16 CORRESPONDENCE ................................................................................................................ 17 PERFORMANCE METRICS ....................................................................................................... 18 BUSINESS RULES ................................................................................................................... 18 TIME CONSTRAINTS .............................................................................................................. 19
3.
3.1. 3.2. 3.3. 3.4. 3.5. 3.6. 3.7.
TO-BE OVERPAYMENT STOP SUB-PROCESS ........................................ 20
OVERVIEW............................................................................................................................ 20 WORKFLOW DIAGRAM .......................................................................................................... 21 ACTIVITIES ........................................................................................................................... 22 CORRESPONDENCE ................................................................................................................ 22 PERFORMANCE METRICS ....................................................................................................... 23 BUSINESS RULES ................................................................................................................... 24 TIME CONSTRAINTS .............................................................................................................. 24
4.
4.1. 4.2. 4.3. 4.4. 4.5. 4.6. 4.7.
TO-BE LOTTERY SUB-PROCESS ............................................................... 25
OVERVIEW............................................................................................................................ 25 WORKFLOW DIAGRAM .......................................................................................................... 26 ACTIVITIES ........................................................................................................................... 27 CORRESPONDENCE ................................................................................................................ 27 PERFORMANCE METRICS ....................................................................................................... 28 BUSINESS RULES ................................................................................................................... 28 TIME CONSTRAINTS .............................................................................................................. 29
5.
5.1. 5.2. 5.3. 5.4. 5.5.
TO-BE NEW HIRE AUDIT SUB-PROCESS ................................................ 30
OVERVIEW............................................................................................................................ 30 WORKFLOW DIAGRAM .......................................................................................................... 31 ACTIVITIES ........................................................................................................................... 32 CORRESPONDENCE ................................................................................................................ 33 PERFORMANCE METRICS ....................................................................................................... 34
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5.6. 5.7.
BUSINESS RULES ................................................................................................................... 35 TIME CONSTRAINTS .............................................................................................................. 35
6.
6.1. 6.2. 6.3. 6.4. 6.5. 6.6. 6.7.
TO-BE MULTI-ADDRESS/PHONE AUDIT SUB-PROCESS ..................... 37
OVERVIEW............................................................................................................................ 37 WORKFLOW DIAGRAM .......................................................................................................... 38 ACTIVITIES ........................................................................................................................... 39 CORRESPONDENCE ................................................................................................................ 40 PERFORMANCE METRICS ....................................................................................................... 41 BUSINESS RULES ................................................................................................................... 41 TIME CONSTRAINTS .............................................................................................................. 42
7.
7.1. 7.2. 7.3. 7.4. 7.5. 7.6. 7.7.
TO-BE WAIVER SUB-PROCESS.................................................................. 43
OVERVIEW............................................................................................................................ 43 WORKFLOW DIAGRAM .......................................................................................................... 44 ACTIVITIES ........................................................................................................................... 45 CORRESPONDENCE ................................................................................................................ 45 PERFORMANCE METRICS ....................................................................................................... 46 BUSINESS RULES ................................................................................................................... 46 TIME CONSTRAINTS .............................................................................................................. 47
8.
8.1. 8.2. 8.3. 8.4. 8.5. 8.6. 8.7.
TO-BE INTERSTATE OVERPAYMENTS (IRORA) SUB-PROCESS ....... 48
OVERVIEW............................................................................................................................ 48 WORKFLOW DIAGRAM .......................................................................................................... 49 ACTIVITIES ........................................................................................................................... 50 CORRESPONDENCE ................................................................................................................ 51 PERFORMANCE METRICS ....................................................................................................... 52 BUSINESS RULES ................................................................................................................... 53 TIME CONSTRAINTS .............................................................................................................. 53
9.
9.1. 9.2. 9.3. 9.4. 9.5. 9.6. 9.7.
TO-BE OVERPAYMENT WRITE-OFF SUB-PROCESS ............................ 54
OVERVIEW............................................................................................................................ 54 WORKFLOW DIAGRAM .......................................................................................................... 55 ACTIVITIES ........................................................................................................................... 56 CORRESPONDENCE ................................................................................................................ 56 PERFORMANCE METRICS ....................................................................................................... 57 BUSINESS RULES ................................................................................................................... 57 TIME CONSTRAINTS .............................................................................................................. 58
10.
10.1. 10.2. 10.3. 10.4. 10.5. 10.6. 10.7.
TO-BE DEATH AUDIT SUB-PROCESS ....................................................... 59
OVERVIEW............................................................................................................................ 59 WORKFLOW DIAGRAM .......................................................................................................... 60 ACTIVITIES ........................................................................................................................... 61 CORRESPONDENCE ................................................................................................................ 62 PERFORMANCE METRICS ....................................................................................................... 63 BUSINESS RULES ................................................................................................................... 63 TIME CONSTRAINTS .............................................................................................................. 63
11.
TO-BE INVESTIGATIONS SUB-PROCESS ................................................ 65
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11.1. 11.2. 11.3. 11.4. 11.5. 11.6. 11.7.
OVERVIEW............................................................................................................................ 65 WORKFLOW DIAGRAM .......................................................................................................... 66 ACTIVITIES ........................................................................................................................... 67 CORRESPONDENCE ................................................................................................................ 68 PERFORMANCE METRICS ....................................................................................................... 69 BUSINESS RULES ................................................................................................................... 69 TIME CONSTRAINTS .............................................................................................................. 69
12.
12.1. 12.2. 12.3. 12.4. 12.5. 12.6. 12.7.
TO-BE FAIL TO PAY/DISPOSITION SUB-PROCESS ............................... 71
OVERVIEW............................................................................................................................ 71 WORKFLOW DIAGRAM .......................................................................................................... 72 ACTIVITIES ........................................................................................................................... 74 CORRESPONDENCE ................................................................................................................ 77 PERFORMANCE METRICS ....................................................................................................... 78 BUSINESS RULES ................................................................................................................... 79 TIME CONSTRAINTS .............................................................................................................. 79
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0. TO-BE PROCESS BENEFIT PAYMENT CONTROL (BPC)
0.1. OVERVIEW
The purpose of the Benefit Payment Control (BPC) area is overpayment detection, determination, and collection. This purpose is to prevent and deter the improper payment of benefits and to protect the integrity of the Unemployment Compensation Trust Fund. The function of BPC is to monitor payment of unemployment benefits and ensure the integrity of the program, the administering Agency, and recipients of unemployment benefits. It is the responsibility of BPC to detect unemployment compensation overpayment and recover those funds though various recovery methods to include payment agreements, legal prosecution, and other Court actions and referral to a collection agency. In the pursuit of this function, BPC is divided into three different units each with a specific set of responsibilities. The units are Wage Audit/Payment Processing, New Hire, and Recovery. Each unit is responsible for one or more of the BPC sub-processes. These sub-processes are listed below. 1. Wage Audit The Wage Audit sub-process is used to identify and investigate claimants who have been paid for a claim during a period in which an employer has also reported wages. 2. Payment Intake The Payment Intake sub-process is used to handle all money orders, personal checks, and cash that are sent to the Agency for repayment of overpaid benefits and to interact with the state contracted collection agency with regard to collection. 3. Overpayment Stop Any claim may be marked as a potential overpayment at a number of points during its processing. These overpayment stops can only be removed or finalized (overpayment determination) by BPC. This review and determination is made during the Overpayment Stop process. 4. Lottery The Florida Lottery provides information on lottery winners who are also claimants with outstanding overpayments. These claimants are handled during the Lottery process. 5. New Hire Audit The New Hire Audit sub-process is used to identify and investigate claimants who appear on a daily Florida Department of Revenue or US Department of Health and Human Services monthly New Hire report. 6. Multi-Address/Phone Audit The Multi-Address/Phone Audit sub-process is triggered when three or more claimants list the same address and/or phone number. An investigation is conducted to validate that all claimants are legitimate. 7. Waiver The Waiver sub-process is used to process requests for a Waiver of Recoupment. The Waiver may be granted or denied. The Waiver may also involve the “refund” of prior offset payments. 8. Interstate Overpayments (IRORA) The Interstate Reciprocal Overpayment Recovery Arrangement (IRORA) program allows states to collect overpayments on behalf of other states. Florida may act as the collector state (collecting another state’s
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overpayment) or as the requestor state (having another state collect on its behalf). 9. Overpayment Write-Off Overpayments which have exceeded the statute of limitations are no longer subject to active collections efforts. The potential write-off must be identified by BPC, submitted to the AWI financial section, and approved by the Florida Department of Financial Services. 10. Death Audit The Death Audit sub-process is used to identify and investigate payments made to claimants who have been reported by the Department of Health as being deceased. 11. Investigations Suspected cases of overpayment that cannot be resolved in the central office are referred to fraud recovery investigators for investigation. The investigative report is sent to the central office for a determination. 12. Fail To Pay/Disposition When an overpayment has exceeded a set time period between payments (usually six months), the overpayment will be reviewed and additional (possibly final) collection action will be taken. This process includes reviews of outstanding prosecutions and probation cases.
0.2. ASSUMPTIONS
This section lists any assumptions concerning technology, policy, statute, or process that must be implemented to enable the To-Be processes: • • • • • • The system will include a workflow engine used to create work items, manage work queues, and route work items between queues. All incoming and outgoing correspondence will be imaged and available on-line. The system will include Correspondence/Document Management capability used to attach imaged documents to specific work items. The system will include clearly defined roles and responsibilities for each user. Employers and Claimants will have system accounts and all work will be associated to those accounts. All claims, claim weeks, determinations, and payments will be traceable to funding sources and employer chargeability records. The system will maintain account balances for all accounts. The system will be capable of automatically recalculating these balances based on the reversal or modification of prior actions. External data sources will be available 24/7 with appropriate backup. Email will be considered a viable communication tool. Business rules and/or requirements will be built into the system whenever possible. The system will implement and support all upload/download capabilities of the Unemployment Insurance Electronic Entry System (UIEES).
• • • •
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0.3. WORKFLOW DIAGRAM
Wage Post Audit Unit/ Payment Processing
Process Start
New Hire Unit
Management
Investigations, Prosecutions, & Recovery
Process Start
Process Start
Process Start
03.01 Wage Audit
03.05 New Hire Audit
03.06 MultiAddress/Phone Audit
03.10 Death Audit
+
+
+
+
03.02 Payment Intake
03.07 Waiver
03.11 Investigations
+
+
+
03.03 Overpayment Stop
03.08 Interstate Overpayments (IRORA)
+
+
03.04 Lottery
03.09 Overpayment Write-Off
+
+
03.12 Fail To Pay/Disposition
+
Process Ends
Exhibit 1 – Benefit Payment Control (BPC) Workflow Diagram
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1. TO-BE WAGE AUDIT SUB-PROCESS
1.1. OVERVIEW
The Wage Audit sub-process is used to identify and investigate claimants who have been paid for a claim during a period in which an employer has also reported wages. The system will receive information on quarterly reported wages from the Department of Revenue. The system will then match that information against claims information from the affected quarter. If a conflict exists, the system will automatically generate a Wage Breakdown Form and send it to the Employer. If the Employer returns the Wage Breakdown form, the system will attempt to validate the information. If a conflict still exists a work-item will be created to review the issue, contact the Claimant and Employer if necessary, and make an overpayment determination. The objectives of this sub-process include: • • Identify Claimants who received wages at the same time they received benefits. Make a proper determination as to whether or not an overpayment has occurred.
Beginning Points • A Wage Breakdown Form is received back from an Employer.
Ending Points • • Issue an overpayment determination or, Determine there was no overpayment made.
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1.2. WORKFLOW DIAGRAM
User
Process Start
Examiner
Supervisor
Employer
Claimant
03.01.01 Enter Wage Breakdown Information
Missing Information
03.01.02 Validate Wage Breakdown
Information Request
UCCBIS No Missing Information
UCCBIS
03.01.03 Confirm Wage Breakdown
UCCBIS
03.01.04 Submit Wage Breakdown
Issue
03.01.05 Assign Wage Breakdown
UCCBIS 03.01.06 Select Wage Breakdown
UCCBIS
UCCBIS
03.01.07 Review Claim History No Issue UCCBIS Issue
Ad-Hoc/ Affidavit of Earnings Overpayment Pre-Determination Letter
Continued On Next Page Process Ends
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Exhibit 2 – Wage Audit Workflow Diagram
Page 6
1.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.01.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Enter Wage Breakdown Information
System Activity Description
Prior to this activity, the system will match employersubmitted quarterly data with the active claims filed during that quarter. Upon detecting a conflict, the system will create a Wage Breakdown Request and route it to the Employer’s selected communication medium (i.e., via the Portal or US Mail). If no response is received, no further action is taken. The system will validate the user provided information for completeness and correctness in accordance with established system requirements. The system will notify the user of any issues and prevent the user from proceeding until the issue(s) are resolved. The system will prompt the Examiner to generate a notification to the Employer requesting the missing information. The system will send the notification using the preferred method of communication for the Employer, if known.
Actor Activity Description
The User will enter the Wage Breakdown information into the system. If the User is the Examiner and issues exist with the application, the next step is “Validate Wage Breakdown”. If no issues exist, the next step is “Confirm Wage Breakdown”.
Actor(s)
User
03.01.02
Validate Wage Breakdown
The Examiner will gather information from the Employer by contacting them directly and/or requesting a notification to be sent to the Employer.
Examiner
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Index
03.01.03
Activity Label
Confirm Wage Breakdown
System Activity Description
The system will display the entered information for certification by the User that the information is complete and correct. If, based established system requirements, the system can determine that no issue exists (i.e., wages reported were not for a claimed week), the system will store the information and close the record. If the information is indeterminate or if a clear issue exists, the system will create a Wage Audit work item and make the item available for assignment. The system will place the work item in the assigned Examiner’s work queue. The system will record the assigned Examiner and the date and time of the Examiner selecting the work item.
Actor Activity Description
The User will confirm that the displayed information is complete and correct or the User will correct information as necessary. The User will elect to submit the information to the system.
Actor(s)
User
03.01.04
Submit Wage Breakdown
User
03.01.05
Assign Wage Breakdown Select Wage Breakdown
03.01.06
The Supervisor can assign an Examiner to the Wage Breakdown work item. The Examiner will select a Wage Breakdown work item for review
Supervisor
Examiner
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Index
03.01.07
Activity Label
Review Claim History
System Activity Description
The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer. Upon request, the system will create the Affidavit of Earnings and route it to the Employer’s selected communication medium (i.e., via the Portal, fax, or US Mail). Upon request, the system will route the Overpayment PreDetermination Letter to the Claimant’s selected communication medium (i.e., via the Portal, fax, or US Mail). Finally, the system will provide the capability to request investigations as necessary through the creation of new work items in the necessary work queue(s). The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer. Upon request, the system will create the Affidavit of Earnings and route it to the Employer’s selected communication medium (i.e., via the Portal, fax, or US Mail). Finally, the system will provide the capability to request investigations as necessary through the creation of new work items in the necessary work queue(s).
Actor Activity Description
The Examiner will review the claim history. If necessary, the Examiner will contact the Employer for clarifying information (were the reported wages in lieu of notice, etc.) and request the production of an Affidavit of Earnings to be completed by the Employer. If the Examiner determines that an issue still exists, the Examiner will create an Overpayment PreDetermination Letter to be sent to the Claimant.
Actor(s)
Examiner
03.01.08
Review Information
The Claimant has 10 days to respond to the Overpayment Pre-Determination Letter. Should the Claimant elect to respond, the Examiner will review the provided information. If necessary, the Examiner will contact the Employer for clarifying information (were the reported wages in lieu of notice, etc.) and request the production of an Affidavit of Earnings to be completed by the Employer (if not previously requested. If no response is received from the Claimant within the 10 day period, the Examiner will issue a determination based on the information at hand.
Examiner
Page 9
Index
03.01.09
Activity Label
Review Information
System Activity Description
The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer.
Actor Activity Description
If the Employer provides additional information as a result of the previous review (particularly a completed Affidavit of Earnings), the Examiner will review this information. Based on the information contained within the work item, the Examiner will create a Determination and enter it into the system.
Actor(s)
Examiner
03.01.10
Issue Determination
Upon request, the system will route the Notice of Determination to the Claimant’s selected communication medium (i.e., via the Portal, fax, or US Mail). The system will close the work item.
Examiner
1.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
Activity Label
Type
Purpose
Recipient
Occasion
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Index
03.01
Activity Label
Wage Audit
Type
Form
Purpose
To gather Wage Breakdown information concerning the quarter in question. To gather additional information as necessary
Recipient
Employer
Occasion
When a claim is paid in the same quarter that wages were reported. When the wage breakdown information is incomplete or unclear. When the submitted wage breakdown information indicates there is an issue with the claim. When the information gathered from the Employer indicates that an overpayment has occurred. When the Claimant wishes to contest the information provided by the employer. When the submitted wage breakdown information indicates there is an issue with the claim. When the wage audit is complete and an overpayment/nooverpayment determination has been made.
03.01.02
Validate Wage Breakdown
Ad-Hoc
Employer
03.01.07
Review Claim History
Form/Ad-Hoc
To obtain an Affidavit of Earnings and/or clarify previously submitted information To inform the Claimant that an Overpayment Determination is in process and provide an opportunity for the Claimant to respond with additional information. To respond to the Overpayment Predetermination Letter To obtain an Affidavit of Earnings (if not previously obtained)
Employer
03.01.07
Review Claim History
Notice
Claimant
03.01.08
Review Information
Ad-Hoc
Examiner
03.01.08
Review Information
Form
Employer
03.01.10
Issue Determination
Notice
To inform the Claimant of the outcome of the Wage Audit.
Claimant
1.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Wage Breakdowns Issued Wage Breakdowns Returned Wage Audit Workload A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count of Wage Breakdown forms sent to Employers per quarter. A count of Wage Breakdown forms returned by Employers per quarter. A count of Wage Audit work items processed by Examiner per quarter. -
Target
Source
AWI AWI AWI
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Title
Determinations Issued Determinations Appealed
Metric
A count of overpayment determinations and the total dollar amount issued by Type and Employee per quarter. A count of overpayment determinations appealed by Employee. -
Target
Source
AWI AWI
1.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.01.01 BR03.01.02 BR03.01.03 BR03.01.04 BR03.01.05 BR03.01.06 BR03.01.07 BR03.01.08 BR03.01.09 BR03.01.10 BR03.01.11 The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule. Conflict N N N N N N N N N N N
Description
20 C.F.R. § 603.08(b) (2009) – Obtaining information from cross matching with wage information. Fla. Stat. § 443.171 (5) (2009) – Each employing unit shall keep true and accurate work records containing the information required by AWI. Fla. Stat. § 443.171(3) (2009) – Delegate power and authority for the effective administration of this chapter. Fla. Stat. § 443.171(6) (2009) – May administer affirmations of earnings as evidence in connection with the administration of this chapter. Fla. Stat. § 443.036(16) (2009) – Definition of “earned income”. Fla. Stat. § 443.071(1) (2009) – False statement by individual to obtain benefits Fla. Stat. § 443.071(2) (2009) – False statement by employing unit to prevent payment of benefits. Fla. Stat. § 443.101(6) (2009) – Disqualified for a period not to exceed 1 year for making a false statement in order to obtain benefits. Fla. Stat. § 443.151(4) (b) (2009) – The claimant may appeal an adverse determination. Fla. Admin. Code R. 60BB-3.012. – Maintain an Address of Record. It is the responsibility of each employing unit and claimant to maintain a current address of record with the Agency. Fla. Stat. § 443.171(1) (2009) – The Agency is given the powers and duties to administer this chapter.
1.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.01 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Wage Audit
Source
External
Constraint
Wage information is submitted quarterly to the Department of Revenue.
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03.01.08
Review Information
The Claimant has 10 days to respond to the Overpayment Predetermination Letter.
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2. TO-BE PAYMENT INTAKE SUB-PROCESS
2.1. OVERVIEW
The purpose of the Payment Intake process is to receive payments and apply them to the appropriate overpayment record. Refunds may be necessary if the payment exceeds the amount of the outstanding overpayment. Finally, satisfied overpayments which have gone through the Small Claims Court or State Attorney Referral processes will require additional action to inform the necessary party that the overpayment has been satisfied. The objectives of this sub-process include: • • • • The correct and auditable receipt of payments. The association of payments to the proper claimant and overpayment. The proper issuance of refunds as necessary. The proper handling of paid-in-full overpayments.
Beginning Points • Claimant (or other party) sends in a payment.
Ending Points • • • • The payment is successfully applied and processed or, The payment (or some portion thereof) is refunded or, A bad payment is properly handled or, A paid-in full overpayment is properly closed.
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2.2. WORKFLOW DIAGRAM
Exhibit 3 – Payment Intake Workflow Diagram
Page 15
2.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.02.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Receive, Open, & Sort Payments
System Activity Description
-
Actor Activity Description
The AWI Mail Contractor will deliver the payment in a locked bag. An Examiner receives and opens the bag. The payments are sorted by number series. The Examiner will input the payments into the system.
Actor(s)
Examiner
03.02.02
Input & Apply Overpayments
03.02.03
Review Potential Refund
03.02.04
Process Payment
The system will provide a mechanism for recording pertinent information about the received payment. The system will update the Claimant’s overpayment balance by the input amount. The system will not allow a payment to be entered if the overpayment has been referred to the AWIcontracted collections agency. If the input payment results in a potential refund, the system will route the work item to a Supervisor for review and approval. The system will update the overpayment record.
Examiner
The Supervisor will review the refund to ensure that it is valid.
Supervisor
03.02.05
Update Overpayment Record
The system will reset the overpayment record to the status and amount prior to the payment. Upon request, the system will generate a Request Payment Letter and route it to the Claimant via their preferred communication method.
Financial Management will review and process all payments. If a refund is required a warrant will be generated and returned to BPC. If the payment is returned as invalid (insufficient funds or a bad check), the Examiner will retract the payment and request the creation of a Request Payment Letter. The Examiner will set the review date for 30 days to ensure a work item is properly created in the Fail To Pay/Disposition process.
Financial Management
Examiner
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Index
03.02.06
Activity Label
Update Record
System Activity Description
The system will provide a mechanism for recording the number of the refund warrant.
Actor Activity Description
The Examiner will update the overpayment record with the number of the refund warrant and send the warrant to the claimant. If the payment satisfies the full amount of the overpayment and the overpayment has been referred to a State Attorney, the Claimant is on probation making restitution, or a Conditional/Final Judgment has been received from Civil Court, the Examiner will generate a notification to the appropriate party stating that the overpayment has been paid in full.
Actor(s)
Examiner
03.02.07
Notify State Attorney or PO/Record Dismissal or Satisfaction of Lien
Upon request, the system will generate a paid-in-full letter, a dismissal for Civil Court, or a Satisfaction of Lien as required.
Examiner
2.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion
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Index
03.02.01
Activity Label
Receive, Open, & Sort Payments
Type
Ad-Hoc
Purpose
To submit payment for an outstanding overpayment. These payments may be in the form of offsets against new claims, checks, cash, money orders, or cashier’s checks. To inform the Claimant that their payment has been rejected and requiring submission of acceptable payment within 30 days. To refund any amount received in excess of the outstanding overpayment balance. To notify the appropriate party(ies) that an overpayment has been paid in full.
Recipient
AWI Benefit Payment Control
Occasion
When a payment is made on an existing overpayment.
03.02.05
Update Overpayment Record
Notice
Claimant
When a payment is rejected by the processing bank.
03.02.06
Update Record
Ad-Hoc
Claimant
03.02.07
Notify State Attorney or PO/Record Dismissal or Satisfaction of Lien.
Notice
State Attorney/Civil Court/Probation Officer
When a payment is received that exceeds the outstanding balance of the overpayment. When a payment is received that satisfies the full amount of an outstanding overpayment.
2.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Payments Received Payments Issued Collections Payments – Received Lottery Payments – Received IRORA Payment – Received A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
The count and dollar amount total of payments entered by Type daily. The count and dollar amount total of refunds issued by Type daily. The count and dollar amount total of payments received from Collections by Type daily. The count and dollar amount total of payments received from Lottery by Type daily. A count and total dollar amount of payments received from other states by Type and State. -
Target
Source
AWI AWI AWI AWI AWI
2.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
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Number Conflict Description Number
BR03.02.01 BR03.02.02 BR03.02.03 Conflict N N N
The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
Description
Fla. Stat. § 443.171 (3) (2009) – Delegate power and authority for the effective administration of this chapter Fla. Stat. § 443.151 (6) (a, b, c, d, e) (2009) – Allows for recovery and recoupment. Fla. Stat. § 68.065 (3) (2009) – Authority for requiring satisfaction of bad checks within 30 days.
2.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.02.05 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Update Overpayment Record
Source
AWI
Constraint
A Claimant who submits an invalid payment has thirty (30) days to satisfy the payment.
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3. TO-BE OVERPAYMENT STOP SUB-PROCESS
3.1. OVERVIEW
Any claim may be marked as a potential overpayment at a number of points during its processing. These overpayment stops can only be removed or finalized (overpayment determination) by BPC. The objectives of this sub-process include: • • Make a proper determination as to whether or not an overpayment has occurred. If no overpayment exists, release any held weeks as quickly as possible.
Beginning Points • An overpayment stop is entered into the system.
Ending Points • • Issue an overpayment determination or, Determine there was no overpayment made and release any weeks necessary.
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3.2. WORKFLOW DIAGRAM
Exhibit 4 – Overpayment Stop Workflow Diagram
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3.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.03.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Select Payment Stop
System Activity Description
The system will create a payment stop work item whenever an Overpayment Stop is entered against an active claim. Upon selection, the system will record the Examiner and the date and time of the Examiner selecting the work item. The system will provide the claim history and all documentation as necessary. The system will provide a mechanism to record any review activities and upload and attach information provided by the claimant, employer, or third parties. The system will allow previously held payments to be generated during the next payment cycle. Upon request, the system will generate a Notice of Determination and route it to the Claimant via their preferred communication method. The system will cancel any pending payments and will create an overpayment record.
Actor Activity Description
The Examiner will select a payment stop work item for review.
Actor(s)
Examiner
03.03.02
Review Payment Stop
The Examiner will review the claim history and attempt to ascertain whether or not an overpayment has made.
Examiner
03.03.03
Release Weeks
The Examiner will remove the overpayment stop and close the work item. The Examiner will request creation of a Notice of Determination that an overpayment has occurred.
Examiner
03.03.04
Issue Determination
Examiner
3.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents
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(e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
03.02.02
Activity Label
Review Payment Stop
Type
Ad-Hoc
Purpose
To gather information necessary to the review of a payment stop work item. To gather information necessary to the review of a payment stop work item. To notify a claimant that a determination of overpayment has been made.
Recipient
Claimant
Occasion
When information is required to properly review a payment stop work item. When information is required to properly review a payment stop work item. When review of a payment stop has resulted in a determination of overpayment.
03.02.02
Review Payment Stop
Ad-Hoc
Employer
03.02.04
Issue Determination
Notice
Claimant
3.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Overpayment Stop Aging A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
Elapsed time from entry of overpayment stop to resolution (removal or issuance of determination). -
Target
Source
AWI
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Title
Overpayment Stop Accuracy
Metric
A ratio of overpayment stops entered to overpayment determinations issued by count, dollar amount, and cost center daily. -
Target
Source
AWI
3.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.03.01 Conflict N The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
Description
U.C. Automated Nonmonetary Handbook - Allows BPC stop to be entered on claim to handle potential issue.
3.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Source
Constraint
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4. TO-BE LOTTERY SUB-PROCESS
4.1. OVERVIEW
The Florida Lottery receives a regular report of claimants with outstanding overpayments. If one of these claimants wins a prize, the Lottery will contact BPC to determine whether or not the overpayment has been satisfied. If it is not, the Lottery will satisfy the overpayment before paying the claimant any remaining winnings. The objectives of this sub-process include: • Properly identify Lottery winners with overpayments and retrieve funds as available.
Beginning Points • A Claimant with an outstanding overpayment wins the Florida Lottery.
Ending Points • Payment is received on the outstanding overpayment.
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4.2. WORKFLOW DIAGRAM
Examiner
Process Start
Claimant
Lottery
03.04.01 Receive Winner/ Overpayment Match Email
03.04.02 Create Verification Letter
Verification Letter
UCCBIS
03.04.03 Issue Payment
48 Hours Payment
03.02 Payment Intake
Payment
+
Process Ends
Exhibit 5 – Lottery Workflow Diagram
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4.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.04.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Receive Winner/Overpayment Match Email
System Activity Description
-
Actor Activity Description
The Examiner will receive an email notification from the Lottery that a winner has been matched to the overpayment list that BPC provides to the Lottery. The Examiner will request generation of a verification letter to be sent to the Lottery to specify the current amount of the overpayment, if one still exists. The Lottery will issue payment within 48 hours. AWI will receive an amount that satisfies the overpayment (or the entire amount if the winnings are not sufficient) and the Claimant will receive the remainder (if any). When a payment (partial or full) is received from the Florida Lottery, the payment will be received through the normal Payment Intake process.
Actor(s)
Examiner
03.04.02
Create Verification Letter
Upon request, the system will generate a verification letter.
Examiner
03.04.03
Issue Payment
-
Lottery
03.02
Payment Intake
-
BPC
4.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate
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action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
03.04.02
Activity Label
Create Verification Letter
Type
Notice
Purpose
To inform the Florida Lottery that an overpayment exists and to provide the full amount necessary to satisfy the overpayment.
Recipient
Florida Lottery
Occasion
When the Florida Lottery has informed AWI that a Claimant with a possible overpayment has won a prize from the Lottery.
4.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
Target
Source
4.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description
The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
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Number
BR03.04.01 BR03.04.02 BR03.04.03
Conflict N N N
Description
20 C.F.R. § 603.08(b) (2009) – Obtaining information from cross matching with wage information. Fla. Stat. § 443.171(3) (2009) – Delegate power and authority for the effective administration of this chapter. Fla. Stat. § 24.115 (4) (2009) – Provide Lottery outstanding debt owed to the State to be deducted from winnings and transmitted to Agency.
4.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.04.03 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Issue Payment
Source
Lottery Policy
Constraint
The Florida Lottery will issue payment within 48 hours.
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5. TO-BE NEW HIRE AUDIT SUB-PROCESS
5.1. OVERVIEW
The New Hire Audit process uses a cross-match of employer-submitted new hire information (transferred from the Florida Department of Revenue and US Department of Health and Human Services) and claim records to identify claimants who received UC benefits after a reported new hire date. The system will automatically identify conflicts based on active claims data and the information received from the New Hire reports. The system will then automatically issue requests for information to the Claimant and the Employer. At the time a response is received from either party or after a 5-day waiting period, the system will create a work item for BPC review. The objectives of this sub-process include: • • • Identify Claimants who received wages at the same time they received benefits. Make a proper determination as to whether or not an overpayment has occurred. If no overpayment exists, release any held weeks as quickly as possible.
Beginning Points • • A response to the request for information is received back from an Employer and/or a Claimant or, No response if received from the Claimant or Employer within five (5) business days.
Ending Points • • Issue an overpayment determination or, Determine there was no overpayment made and release any weeks necessary.
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5.2. WORKFLOW DIAGRAM
Exhibit 6 – New Hire Audit Workflow Diagram
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5.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.05.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Assign Audit Match
System Activity Description
Prior to this activity, the system will match employersubmitted new hire data from the Florida Department of Revenue and US Department of Health and Human Services. Upon detecting a conflict, the system will create a information request letter and route it to the Claimant’s and Employer’s selected communication medium (i.e., via the Portal or US Mail). If no response is received from the Claimant within five (5) days, the system will generate an Audit Match work item for Issue Determination. If a response is received from the Claimant or the Employer, the system will create an Audit Match work item and place the work item in the Examiner’s queue. The system will record the assigned Examiner and the date and time of the Examiner selecting the work item. The system will provide a mechanism to record review activities.
Actor Activity Description
The Supervisor can assign an Examiner to the Audit Match work item.
Actor(s)
Supervisor
03.05.02
Select Audit Match
The Examiner will select an Audit Match work item for review. The Examiner will review the information on the claim to determine if there is an issue. If there is no issue the Examiner will release the hold on payments (if one exists).
Examiner
03.05.03
Review Information
Examiner
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Index
03.05.04
Activity Label
Release Prior Weeks (If Necessary) Gather Additional Information
System Activity Description
The system will allow previously held payments to be generated during the next payment cycle. The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer. The system will provide the capability to request investigations as necessary through the creation of new work items in the necessary work queue(s). The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer. The system will provide the capability to request investigations as necessary through the creation of new work items in the necessary work queue(s). Upon request, the system will generate a Notice of Determination and route it to the Claimant via their preferred communication method. The system will cancel any pending payments and will create an overpayment record.
Actor Activity Description
The Examiner will remove the overpayment stop and close the work item. If necessary, the Examiner will contact the Employer or Claimant for clarifying information.
Actor(s)
Examiner
03.05.05
Examiner
03.05.06
Review Information
After collecting additional information the Examiner will conduct a final review to determine if there is an overpayment situation. If there is no issue the Examiner will release the hold on payments (if one exists).
Examiner
03.05.07
Issue Determination
The Examiner will request creation of a Notice of Determination that an overpayment has occurred.
Examiner
5.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. Messages are sent to convey required documentation, inform recipients about the status of an activity, to
Page 33
trigger the start or end of other activities, to grant or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
03.05
Activity Label
New Hire Audit
Type
Ad-Hoc
Purpose
To provide the Claimant with an opportunity to provide additional information concerning the New Hire match (information request letter). To gather information necessary to the review of a audit match work item. To gather information necessary to the review of a audit match work item. To notify a claimant that a determination of overpayment has been made.
Recipient
Claimant
Occasion
When a Claimant appears on the New Hire match.
03.05.05
Gather Additional Information
Ad-Hoc
Claimant
03.05.05
Gather Additional Information
Ad-Hoc
Employer
03.05.07
Issue Determination
Notice
Claimant
When information is required to properly review an audit match work item. When information is required to properly review an audit match work item. When review of a payment stop has resulted in a determination of overpayment.
5.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
New Hire Audit New Hire Audit Workload A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count of New Hire Audit work items created daily. A count of New Hire Audit work items processed by Examiner daily. -
Target
Source
AWI AWI
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Title
Determinations Issued Determinations Appealed
Metric
A count of overpayment/non-monetary determinations and the total dollar amount issued by Type and Employee per quarter. A count of overpayment determinations appealed by Employee. -
Target
Source
AWI AWI
5.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.05.01 Conflict N The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
Description
Personal Responsibility and Work Opportunity Reconciliation Act § 313, 42 U.S.C. § 653a – Requires employers to report all new hires to state agencies and the National Directory of New Hires. NDNH allows cross matching with state agencies. USDOL, Unemployment Insurance Program Letter No. 35-99 (6/21/1999) & 36-00 (10/10/2000) – Encourages state agencies to take full advantage of the “New Hires” system to prevent and detect overpayments. Fla. Stat. § 409.2576 (9) (a) 3 (2009) – Dept of Revenue will share new hire information with the UC program. 20 C.F.R. § 603.08(b) (2009) – Obtaining information from cross matching with wage information. F.A.C. 60BB-3.017 (2) (2009) – Notice of Determination. Fla. Stat. § 443.071 (1) (2009) – False statement by individual to obtain benefits Fla. Stat. § 443.101 (6) (2009) – Disqualified for a period not to exceed 1 year for making a false statement in order to obtain benefits. Fla. Stat. § 443.151 (4) (b) (2009) – The claimant may appeal an adverse determination. Fla. Stat. § 443.171(1) (2009) – The Agency is given the powers and duties to administer this chapter.
BR03.05.02
N
BR03.05.03 BR03.05.04 BR03.05.05 BR03.05.06 BR03.05.07
N N N N N
BR03.05.08 BR03.05.09
N N
5.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.05 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
New Hire Audit
Source
AWI
Constraint
A Claimant has five (5) days to respond to a request for additional information from the Agency.
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03.05.05
Gather Additional Information Gather Additional Information
AWI
03.05.05
AWI
A Claimant has forty-eight (48) hours to respond to a voice mail message or five (5) days to respond to a written request for additional information from the Agency. An Employer has five (5) days to respond to a written request for additional information from the Agency.
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6. TO-BE MULTI-ADDRESS/PHONE AUDIT SUB-PROCESS
6.1. OVERVIEW
The system will identify instances where multiple claimants are listing the same address and/or phone number. The claimants will be contacted for proof of residence. These claims may be referred for investigation. Validated claims will be marked to prevent that claimant/address combination from being re-audited (a new claimant at that address would be audited). The objectives of this sub-process include: • • • • Investigate claims with same address and/or phone number. Make a proper determination as to whether or not an overpayment has occurred. If no overpayment exists, release any held weeks as quickly as possible. Prevent the Claimant/claim combination from reappearing as an issue.
Beginning Points • A claim or claims
Ending Points • • Issue an overpayment determination or, Determine there was no overpayment made, release any weeks necessary, and prevent the claimant/claim combination from reappearing as an issue.
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6.2. WORKFLOW DIAGRAM
Exhibit 7 – Multi-Address/Phone Audit Workflow Diagram
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6.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.06.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Assign Audit Match
System Activity Description
Prior to this activity, the system will match claims and claimants and identify instances of multiple claimants reporting the same address and/or phone number. Those claimant/address combinations that have not been previously investigated and cleared will result in the creation of an Audit Match work item which will be placed in the Examiner’s queue. Certain addresses (shelters, etc) will be permanently flagged within the system to prevent audit matches from occurring. The system will record the assigned Examiner and the date and time of the Examiner selecting the work item. The system will automatically generate a Call-In Card or Request for ID Letter and route it to the Claimant’s selected communication medium (i.e., via the Portal, fax, or US Mail).
Actor Activity Description
The Supervisor can assign an Examiner to the Audit Match work item.
Actor(s)
Supervisor
03.06.02
Select Audit Match
The Examiner will select an Audit Match work item for review.
Examiner
03.06.03
Review Information
The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer.
After collecting additional information the Examiner will conduct a final review to determine if fraudulent activity may be occurring.
Examiner
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Index
03.11
Activity Label
Investigations
System Activity Description
The system will provide the capability to request investigations as necessary through the creation of new work items in the necessary work queue(s). The system will provide a mechanism to prevent future audits on a specific combination of claimant/address or claimant/phone.
Actor Activity Description
If it appears that fraudulent activity may be occurring, the Examiner will create a work item to request an investigation via the Investigations process. If there is no issue the Examiner will mark that particular claimant and address/phone as validated. This will prevent that specific combination from being audited again. Please note that a new claimant from that address will not be considered validated and will be audited. The Examiner will remove the overpayment stop and close the work item. The Examiner will request creation of a Notice of Determination that an overpayment has occurred.
Actor(s)
BPC
03.06.04
Validate Address/Phone
Examiner
03.06.05
Release Prior Weeks (if necessary) Issue Determination
03.06.06
The system will allow previously held payments to be generated during the next payment cycle. Upon request, the system will generate a Notice of Determination and route it to the Claimant via their preferred communication method. The system will cancel any pending payments and will create an overpayment record.
Examiner
Examiner
6.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
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Index Activity Label Type
Purpose Recipient Occasion Index
03.06.02
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Activity Label
Select Audit Match
Type
Ad-Hoc
Purpose
To gather information necessary to the review of a audit match work item. To notify a claimant that a determination of overpayment has been made.
Recipient
Claimant(s)
Occasion
When information is required to properly review an audit match work item. When review of a payment stop has resulted in a determination of overpayment.
03.06.06
Issue Determination
Notice
Claimant
6.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Multi-Address/Phone Audit Multi-Address/Phone Audit Workload Determinations Issued Determinations Appealed A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count of Multi-Address/Phone Audit work items created daily. A count of Multi-Address/Phone Audit work items processed by Examiner daily. A count of overpayment/non-monetary determinations and the total dollar amount issued by Type and Employee per quarter. A count of overpayment determinations appealed by Employee. -
Target
Source
AWI AWI AWI AWI
6.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
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Number Conflict Description Number
BR03.06.01 BR03.06.02 Conflict N N
The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
Description
Fla. Stat. § 443.071 (1) (2009) – False statement by individual to obtain benefits Fla. Stat. § 443.101 (6) (2009) – Disqualified for a period not to exceed 1 year for making a false statement in order to obtain benefits. Fla. Stat. § 443.151 (4) (b) (2009) – The claimant may appeal an adverse determination. Fla. Stat. § 443.171(1) (2009) – The Agency is given the powers and duties to administer this chapter.
BR03.06.03 BR03.06.04
N N
6.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.06.02 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Select Audit Match
Source
AWI
Constraint
A Claimant has five (5) days to respond to a written request for additional information from the Agency.
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7. TO-BE WAIVER SUB-PROCESS
7.1. OVERVIEW
The Agency receives requests to delay overpayment offsets (the satisfaction of an overpayment by withholding current benefits) due to hardship. These waiver requests must be reviewed and approved by a supervisor within BPC and the system must be adjusted accordingly. The objectives of this sub-process include: • • To make a proper determination as to the suitability of the Waiver Request. To adjust the system appropriately, based on the outcome of the Waiver Request review.
Beginning Points • A Request for a Waiver of Recoupment is received from a Claimant with an outstanding overpayment.
Ending Points • • The Waiver (or some portion) is granted and the system is updated and adjusted accordingly or, The Waiver is denied.
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7.2. WORKFLOW DIAGRAM
Supervisor Claimant
Process Start
03.07.01 Select Waiver of Recoupment
UCCBIS
03.07.02 Review Waiver of Recoupment
Letter
UCCBIS Granted
03.07.03 Back Out Prior Offsets (If Necessary)
UCCBIS
03.07.04 Enter Recoupment Amount or Percentage
UCCBIS
Process Ends
Exhibit 8 – Waiver Workflow Diagram
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7.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.07.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Select Waiver of Recoupment Review Waiver of Recoupment
System Activity Description
A waiver will be displayed in the Supervisor’s work queue for review. Upon request, the system will generate a letter detailing the outcome of the review that will be mailed to the claimant.
Actor Activity Description
The Supervisor will select a waiver from the work queue. The Supervisor will review the waiver and the associated claim and overpayment information to determine if a waiver will be a granted and, if granted, what type of waiver will be granted (full or partial). The Supervisor will use the system to generate a letter informing the Claimant of the outcome of the review. The Supervisor will back out prior offsets in the system. The Supervisor will enter the waiver amount or percentage in the system and the system will process the waiver.
Actor(s)
Supervisor
03.07.02
Supervisor
03.07.03
03.07.04
Back Out Prior Offsets (If Necessary) Enter Recoupment Amount or Percentage
The system will update the overpayment record as necessary. The system will apply the waiver amount or percentage to the claimant’s overpayment and will process payment to the claimant.
Supervisor
Supervisor
7.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery.
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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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
03.07.02
Activity Label
Review Waiver of Recoupment
Type
Notice
Purpose
To inform the Claimant of the outcome of the review of the Waiver of Recoupment.
Recipient
Claimant
Occasion
When the Supervisor completes the review of the Waiver of Recoupment.
7.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Waiver Waiver Aging Waiver Granted A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count of Waiver work items created. Elapsed time from receipt of waiver request to resolution (grant or denial). A count and the total overpayment dollars of waivers granted by type. -
Target
Source
AWI AWI AWI
7.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description
The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
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Number
BR03.07.01
Conflict N
Description
Fla. Stat. § 443.151 (6) (c) (2009) – Allows for waiver of recoupment.
7.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Source
Constraint
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8. TO-BE INTERSTATE OVERPAYMENTS (IRORA) SUBPROCESS
8.1. OVERVIEW
The Interstate Reciprocal Overpayment Recovery Arrangement (IRORA) program allows states to collect overpayments on behalf of other states. Florida may act as the collector state (collecting another state’s overpayment) or as the requestor state (having another state collect on its behalf). The objectives of this sub-process include: • • Request another state to collect an overpayment on Florida’s behalf. Collect overpayments on another state’s behalf.
Beginning Points • • A communication is received from another state requesting that Florida collect overpayments on its behalf or, A claimant with an outstanding Florida overpayment is identified as receiving claims from another state.
Ending Points • • Payments are withheld from a Florida claimant and a warrant is issued to another state until the overpayment is satisfied or, Payments are received from another state until the Florida overpayment is satisfied.
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8.2. WORKFLOW DIAGRAM
Supervisor
Process Start
Finance Management
Examiner
Other State
03.08.01 Assign IRORA Work Item
03.08.02 Select IRORA
UCCBIS Florida is Collector State
UCCBIS Florida is Requestor State
03.08.03 Enter Overpayment
03.08.07 Create Overpayment Request Letter
Letter/ Determination
UCCBIS
UCCBIS
03.02 Payment Intake
03.02 Payment Intake
Payments
+
+
03.08.05 Issue Warrant
03.08.04 Request Refund Warrant
PIF Letter
Monthly
Process Ends
Refund (Warrant)
03.08.06 Create Refund Cover Letter (incl. PIF Letter if necessary) UCCBIS
Letter(s)/ Warrant
Process Ends
Exhibit 9 – Interstate Overpayments (IRORA) Workflow Diagram
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8.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.08.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Assign IRORA Work Item
System Activity Description
Prior to this activity, the system will match Florida overpayment records with records of active claims in other IRORA participating states. When a match is detected, the system will create an IRORA work item and place it in the Supervisor’s queue. Work items will also be created when requests are received from other IRORA states. The system will record the assigned Examiner and the date and time of the Examiner selecting the work item.
Actor Activity Description
The Supervisor will assign an Examiner to the IRORA work item.
Actor(s)
Supervisor
03.08.02
Select IRORA
03.08.03
Enter Overpayment Payment Intake
03.02
The system will provide a mechanism for recording an out-of-state overpayment. The system will record offsets of Florida claims against the out of state overpayment.
03.08.04
Request Refund Warrant
The system will provide a mechanism to request refund warrants from Finance Management.
03.08.05
Issue Warrant
-
The Examiner will select an IRORA work item for review. The Examiner will determine whether Florida is the Collector or the Requestor State. The Examiner will enter the overpayment in the system as an out of state overpayment. Payments made against an outof-state overpayment (via offset of Florida claims) will be handled via the normal Payment Intake process. If the total of payments made against an out-of-state overpayment exceeds the amount due, the Examiner will request a refund warrant be issued to the Claimant. Financial Management will issue a refund warrant and return it to BPC for processing.
Examiner
Examiner
BPC
Examiner
Examiner
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Index
03.08.06
Activity Label
Create Refund Cover Letter (incl. PIF Letter if necessary)
System Activity Description
Upon request, the system will generate a Refund Cover Letter and Paid-In-Full Letter (if necessary) and route them to the Claimant’s selected communication medium (i.e., via the Portal, fax, or US Mail). Upon request, the system will generate an Overpayment Request Letter. The system will provide a copy of the Notice of Determination and other required documentation. The system will mark the overpayment as assigned to the Collector State. Upon satisfaction of the overpayment, the system will generate a Paid-In-Full letter to the Collector State advising them that the overpayment has been satisfied.
Actor Activity Description
The Examiner will create a Refund Cover Letter (and a Paid-In-Full Letter, if necessary).
Actor(s)
Examiner
03.08.07
Create Overpayment Request Letter
The Examiner will create an Overpayment Request Letter and mail it, along with a copy of the Notice of Determination and other required documentation to the Collector State.
Examiner
03.02
Payment Intake
When warrants are received from the Collector State, they will be processed via the normal Payment Intake process.
BPC
8.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
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Index Activity Label Type
Purpose Recipient Occasion Index
03.08.01
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Activity Label
Assign IRORA Work Item
Type
Notice
Purpose
To request that Florida act as Collector State on another participating IRORA state’s behalf. To request a participating IRORA state to act as Collector State on Florida’s behalf. To accompany a refund warrant.
Recipient
AWI
Occasion
When a participating IRORA state wishes Florida to collect overpayments on its behalf. When a Florida overpayment is matched with an active claim in another state. When Florida has collected an excess amount on another state’s behalf. When Florida has collected an amount sufficient to satisfy another state’s overpayment. When a Florida overpayment subject to an IRORA request is paid in full.
03.08.07
Create Overpayment Request Letter Create Refund Cover Letter (incl. PIF Letter if necessary) Create Refund Cover Letter (incl. PIF Letter if necessary) Payment Intake
Notice
IRORA State
03.08.06
Ad-Hoc
Claimant
03.08.06
Notice
To accompany a refund warrant (when necessary).
Claimant
03.02
Notice
To inform the Collector State that the Florida overpayment has been satisfied.
IRORA State
8.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
IRORA – Collections A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count and total dollar amount of payments collected on behalf of other states by Type and State. -
Target
Source
AWI
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8.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.08.01 BR03.08.02 BR03.08.03 Conflict N N N The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
Description
Social Security Act § 303(g), 42 U.S.C. § 503(g) (2006) – Participating states can recover overpayments on behalf of each other. Fla. Stat. § 443.151 (6) (a, b, c, d, e) (2009) – Allows for recovery and recoupment. Fla. Stat. § 443.151 (4) (b) (2009) – The Claimant may appeal recoupment.
8.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.08.05 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Issue Warrant
Source
AWI
Constraint
Refund warrants are issued weekly.
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9. TO-BE OVERPAYMENT WRITE-OFF SUB-PROCESS
9.1. OVERVIEW
Overpayments which have exceeded the statute of limitations are no longer subject to active collections efforts. Those which have gone through the Small Claims or State Attorney Referral process can still be collected in order to release any liens. The potential write-off must be identified by BPC and approved by the Florida Department of Financial Services (DFS). The objectives of this sub-process include: • • To identify overpayments which have exceeded the statute of limitations for active pursuit. To review such overpayments, obtain proper sign-off, and remove them from the necessary accounting systems as outstanding debts.
Beginning Points • An overpayment is identified as having exceeded the statute of limitations.
Ending Points • The overpayment is removed from the various accounting systems as an outstanding debt.
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9.2. WORKFLOW DIAGRAM
Exhibit 10 – Overpayment Write-Off Workflow Diagram
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9.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.09.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Prepare Memorandum
System Activity Description
Prior to this activity, the system will identify overpayment which have reached the Statute of Limitations and are no longer subject to active collections efforts. These items will be summarized quarterly and a work item created and placed in the Supervisor’s queue. Upon request the system will generate a Cover Letter.
Actor Activity Description
The Supervisor will create a Memorandum explaining the amount of the write-off and route it to the Deputy Director.
Actor(s)
Supervisor
03.09.02
Sign Memorandum
-
03.09.03
Prepare Cover Letter
03.09.04
Implement WriteOffs
Upon request the system will generate a data file of all pending write-offs in a format compatible with DFS’s requirements. Upon request, the system will mark all pending overpayments as having been written off.
The Deputy Director will review and sign the Memorandum. The Memorandum will be routed to the Director of Finance Management. The Director will create a Cover Letter to accompany a data file of all scheduled writeoffs. These will be routed to DFS. DFS will send an approval letter to the Director who will advise BPC. BPC will request the system to complete the write-off process.
Deputy Director
Finance Management
Finance Management
9.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect
Page 56
electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
03.09.01
Activity Label
Prepare Cover Letter
Type
Notice
Purpose
To inform DFS that certain overpayments have reached the Statute of Limitation and are eligible for write off. To inform DFS that certain overpayments have reached the Statute of Limitation and are eligible for write off.
Recipient
DFS
Occasion
When the quarterly write off process is initiated. When the data file is ready for routing to DFS.
03.09.03
Prepare Memo
Notice
DFS
9.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Write-Off A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count and total dollar amount of overpayments written-off by Type per quarter. -
Target
Source
AWI
9.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
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Number Conflict Description Number
BR03.09.01 BR03.09.02 Conflict N N
The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule.
Description
Fla. Stat. § 443.151 (6) (a, b) (2009) – Statute of Limitations on for recovery and recoupment. Fla. Stat. § 17.04 (2009) – Authority of the Chief Financial Officer to adjust indebtedness to the State.
9.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.09 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Overpayment Write-Off
Source
AWI
Constraint
The Overpayment Write-Off process is conducted quarterly.
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10. TO-BE DEATH AUDIT SUB-PROCESS
10.1. OVERVIEW
The Agency regularly receives data from the Department of Health on deceased persons. The system will match this information against active claimants and where a check was issued after the date of death, an investigation will be conducted. The objectives of this sub-process include: • • Identify Claimants who received benefits after a reported date of death. Make a proper determination as to whether or not an overpayment has occurred.
Beginning Points • A record of death is received from the Department of Health and matched with a payment made after the date of death.
Ending Points • • • Issue an overpayment determination or, File a police report or, Determine there was no overpayment made.
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10.2. WORKFLOW DIAGRAM
Exhibit 11 – Death Audit Workflow Diagram
Page 60
10.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.10.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Assign Death Match
System Activity Description
Prior to this activity, the system will match claims and death records from DOH and will identify instances of claim weeks that are after the claimant’s date of death. The system will record the assigned Investigator and the date and time of the Investigator selecting the work item. The system will provide a mechanism to record review activities, upload and attach information provided by the claimant or employer.
Actor Activity Description
The Supervisor will assign an Investigator to the Death Match work item.
Actor(s)
Supervisor
03.10.02
Select Death Match
The Investigator will select a Death Match work item for review and will contact the family to request additional information. After collecting additional information the Investigator will conduct a final review to determine if fraudulent activity may be occurring. If the family of the deceased admits to the overpayment, the work item will be routed to an Examiner for a Notice of Determination. If the Claimant is not deceased, the work item will be routed to an Examiner to release the hold on payments (if one exists).
Investigator
03.10.03
Review Information
Investigator
03.10.04
File Police Report
-
If it appears that fraudulent activity is occurring and the family denies the activity, the Investigator will file a police report.
Investigator
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Index
03.10.05
Activity Label
Issue Determination
System Activity Description
Upon request, the system will route the Notice of Determination to the Claimant’s selected communication medium (i.e., via the Portal, fax, or US Mail). The system will close the work item.
Actor Activity Description
Based on the information contained within the work item, the Examiner will create a Determination and enter it into the system.
Actor(s)
Examiner
03.10.06
Release Prior Weeks (If Necessary)
The system will allow previously held payments to be generated during the next payment cycle.
The Examiner will remove the overpayment stop and close the work item.
Examiner
10.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion
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Index
03.11.02
Activity Label
Select Death Match Audit
Type
Ad-Hoc
Purpose
To gather information necessary to the review of a death match work item. To notify a claimant that a determination of overpayment has been made.
Recipient
Employer
Occasion
When information is required to properly review a death match work item. When review of a payment stop has resulted in a determination of overpayment.
03.11.05
Issue Determination
Notice
Claimant
10.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Death Audit Death Audit Aging Determinations Issued A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count of Death Audit work items created. Elapsed time from creation of work item to resolution. A count of overpayment determinations and the total dollar amount issued by Type. -
Target
Source
AWI AWI AWI
10.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.10.01 BR03.10.02 BR03.10.03 The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule. Conflict N N N
Description
20 C.F.R. § 603.08(b) (2009) – Obtaining information from cross matching with wage information. Fla. Stat. § 443.171(3) (2009) – Delegate power and authority for the effective administration of this chapter. Fla. Stat. § 443.171(1) (2009) – The Agency is given the powers and duties to administer this chapter.
10.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
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Index Activity Label Source Constraint Index
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Source
Constraint
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11. TO-BE INVESTIGATIONS SUB-PROCESS
11.1. OVERVIEW
Overpayment cases may be referred to Investigations for an investigation. Investigation requests may come from any point in the overpayment process and must be approved by the supervisor of the requesting unit. The objectives of this sub-process include: • To investigate referred potential overpayment cases to be investigated.
Beginning Points • An overpayment case is referred to the Investigation unit.
Ending Points • The results of the investigation are returned to the referring unit for determination.
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11.2. WORKFLOW DIAGRAM
Requestor Unit Supervisor Investigation Supervisor Investigator Claimant/ Employer/ Third-Party
Process Start
03.11.01 Request Investigation
03.11.02 Review Case
Approved
03.11.03 Assign Case
03.11.04 Select Case
UCCBIS
UCCBIS
UCCBIS
UCCBIS
Denied Declined
03.11.05 Investigate Case
Ad-Hoc
UCCBIS
03.11.08 Review Case
03.11.07 Review Case
03.11.06 Update Case
UCCBIS
UCCBIS
UCCBIS
Process Ends
Exhibit 12 – Investigations Workflow Diagram
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11.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.11.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Request Investigation
System Activity Description
The system will create an Investigation work item and place it in the Requestor’s Supervisor’s queue. If approved, the system will place the case in the Investigation Supervisor’s queue. If denied, the system will return the request to the Requestor with the Unit Supervisor’s comments. If the Investigation Supervisor accepts the case, the system will place the case in the Investigator’s work queue. If the Investigation Supervisor declines the case, the system will place the case in the Unit Supervisor’s queue. The system will record the assigned Investigator and the date and time of the Investigator selecting the work item. The system will provide a mechanism to record investigation activities, upload and attach information provided by the claimant, employer, or third parties.
Actor Activity Description
The Requestor will create an Investigation work item (case).
Actor(s)
Requestor
03.11.02
Review Case
The Unit Supervisor will review the case and determine whether or not an investigation is warranted.
Unit Supervisor
03.11.03
Assign Case
The Investigation Supervisor will review the case and determine whether or not an investigation is warranted. If the investigation is needed, the Supervisor will assign an Investigator to the case. The Investigator will select a case for review.
Investigation Supervisor
03.11.04
Select Case
Investigator
03.11.05
Investigate Case
The Investigator will review all the information in the system. The Investigator will communicate with claimants, employers, or other parties on an ad-hoc basis to clarify existing information or to gather additional information.
Investigator
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Index
03.11.06
Activity Label
Update Case
System Activity Description
The system will provide a mechanism to record the Investigator’s recommendation. The system will place the case in the Unit Supervisor’s queue. The system will provide a mechanism to record the Unit Supervisor’s comments. The system will place the case in the Requestor’s work queue. The system will provide all necessary documentation to the Requestor.
Actor Activity Description
The Investigator will enter a recommendation for the case.
Actor(s)
Investigator
03.11.07
Review Case
03.11.08
Review Case
The Unit Supervisor will review the Investigator’s recommendation, add additional comments as necessary, and return the case to the Requestor. The Requestor will review the case and close the work item.
Unit Supervisor
Requestor
11.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion
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Index
03.11.05
Activity Label
Investigate Case
Type
Ad-Hoc
Purpose
To gather information necessary to the investigation of an overpayment case.
Recipient
Claimant/ Employer/ Third-Party
Occasion
When information is required to properly complete an investigation.
11.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source Title
Investigations Workload Investigations Aging Recommendations Issued A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
Metric
A count of Investigations work items processed by Investigator per quarter. Elapsed time from creation of work item to resolution. A count of recommendations made by result (overpayment or no overpayment) . -
Target
Source
AWI AWI AWI
11.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.01.01 BR03.11.02 BR03.11.03 BR03.11.04 N N N The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule. Conflict N
Description
Fla. Stat. § 443.171(3) (2009) – Delegate power and authority for the effective administration of this chapter. Fla. Stat. § 443.171 (6, 7) (2009) – Ability to issue subpoenas to obtain records for court action. Fla. Stat. § 443.071 (5, 6, 7, 8) (2009) – Items of evidence for prosecution. Fla. Stat. § 443.171(1) (2009) – The Agency is given the powers and duties to administer this chapter.
11.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
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Index Activity Label Source Constraint Index
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Source
Constraint
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12. TO-BE FAIL TO PAY/DISPOSITION SUB-PROCESS
12.1. OVERVIEW
When an overpayment has exceeded a set time period between payments (usually six months), the system will trigger the fail-to-pay process. The overpayment will be reviewed and additional (possibly final) collection action will be taken. This process includes the review of outstanding prosecution cases, renewal of civil judgments, and the review of restitution cases. The objectives of this sub-process include: • • • To take appropriate action when an overpayment is not being repaid in a timely manner. To review and update the status of outstanding prosecutions and restitution cases. To review and maintain the status of civil judgments.
Beginning Points • An overpayment exceeds the user-defined parameter for receiving a payment and/or needs an update in status.
Ending Points • • • • • A police report is filed (Death Match) or, The case filed for judgment in Civil Court or, The case is forwarded to the contracted Collections Agency or, The case is referred to a State Attorney for prosecution or, A status update is received from a State Attorney or Probation Officer on a pending prosecution/restitution.
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12.2. WORKFLOW DIAGRAM
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AWI Legal
Continued From Previous Page (2)
Investigator
State Attorney
Claimant
Request Stipulation 03.12.11 Prepare Case
UCCBIS
Continued From Previous Page (1)
03.12.13 Review Case
03.12.12 Submit Case
UCCBIS Face-To-Face 03.12.07 Prepare Case 03.12.14 File Case UCCBIS No Service UCCBIS Service 03.12.15 File Dismissal UCCBIS UCCBIS Continued From Previous Page (3) Link To Refer to Collections Agency Decline 03.12.08 Submit Case 03.12.09 Review Case
03.12.16 Attend Hearing
Accept
03.12.19 Review Case
03.12.20 File Case
03.12.17 Record Judgment
03.12.10 Update Case
UCCBIS
UCCBIS
UCCBIS
Process Ends
Exhibit 13 – Fail To Pay/Disposition Workflow Diagram
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12.3. ACTIVITIES
The table below lists the activities that make up this process. The following is a description and definition of each of the columns in this table.
Index Activity Label System Activity Description Actor Activity Description Actor(s) Index
03.12.01 A number for use in referencing the activity A short name for that activity that is used to represent it in the detailed workflow diagram. The full-text description of that activity from the perspective of the system. The full-text description of that activity from the perspective of the user or actor. The job or role title of the individuals having a primary role for that activity.
Activity Label
Assign Fail To Pay
System Activity Description
Prior to this activity, the system will check each overpayment record for payment activity. Each record will contain a review date or pay-by date. If this date passes without payment being received a work item will be generated. The system will place the work item in the assigned Examiner’s work queue. The system will place the work item in the Examiner’s work queue. The system will provide the necessary output/information to the Reviewer and attach it to the work item (Non-Monetary Determination, Determination History, Adjudication File, Claim History, Overpayment History, Investigation Case File). The system will provide a mechanism to record review activities, upload and attach information provided to the Examiner.
Actor Activity Description
The Supervisor can assign an Examiner to the Fail To Pay work item.
Actor(s)
Supervisor
03.12.02
Select Fail To Pay
The Examiner will select an assigned work item for review.
Examiner
03.12.03
Review Information
The Examiner will review the overpayment history. Based on the original cause of the overpayment and prior actions taken in the case, the Examiner will determine the next action.
Examiner
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Index
03.12.04
Activity Label
Contact PO/State Attorney
System Activity Description
The system will provide a mechanism for storing the Probation Officer or State Attorney associated with a particular case. The system will accept an updated review date to create a new Fail To Pay work item should payment not be received.
Actor Activity Description
If the overpayment contains a record of a prior conviction and probation, the Examiner will contact the Probation Officer as listed in the case. The Probation will be informed that the Claimant is not making restitution as required. The Examiner will reset the review/pay-by date to a date one year from the date of contact with the Probation Officer. If the overpayment has been referred to a State Attorney but does not contain a final disposition, the State Attorney will be contacted for an update on the status. If the case is still pending, the review/pay-by date will be set to a date six months from the date of contact with the State Attorney. If the overpayment is the result of a Death Match audit, the Examiner will file a Police Report with the Claimant’s local Police Department. The overpayment case will be closed. If the overpayment is the result of a non-fraud determination below the system-defined threshold or if the case has been voluntarily dismissed from Civil Court due to a lack of process, the Examiner will mark the overpayment case to be referred to the AWIcontracted collection’s agency.
Actor(s)
Examiner
03.12.05
File Police Report
The system will provide supporting documentation as necessary.
Examiner
03.12.06
Refer To Collections Agency
The system will transfer information about the case to the AWI-contracted collections agency. The overpayment will be updated with the necessary fees. No further payments will be accepted to satisfy the overpayment, however, the overpayment will still be eligible for offset payments.
Examiner
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Index
03.12.07
Activity Label
Prepare Case
System Activity Description
The system will provide supporting documentation as necessary.
Actor Activity Description
If the overpayment is the result of fraudulent activity above a system-defined threshold or is the result of a bad check received for payment, then the Examiner will begin assembling a case file for submission to the relevant State Attorney. The Examiner may attempt to gain a confession or admission from the Claimant via a face-to-face meeting. The Examiner will print out the necessary information and submit it to the relevant State Attorney for review. The State Attorney will review the case and accept it for possible prosecution or decline to prosecute.
Actor(s)
Examiner
03.12.08
Submit Case
The system will provide supporting documentation as necessary. The system will provide a mechanism to record the State Attorney’s decision. If the State Attorney declines to prosecute, the case will be filed in Civil Court. The system will close the work item.
Examiner
03.12.09
Review Case
State Attorney
03.12.10
Update Case
03.12.11
Prepare Case
The system will provide supporting documentation as necessary.
03.12.12
Submit Case
The system will provide supporting documentation as necessary.
03.12.13
Review Case
The system will provide a mechanism to record the activities of AWI Legal.
If the State Attorney accepts the case, a review date will be entered for six months from the date of acceptance. If the overpayment is the result of fraudulent activity below a system-defined threshold, is the result of non-fraudulent activity above a systemdefined threshold, or a State Attorney has declined to prosecute, then the Examiner will begin assembling a case file for submission to Civil Court. The Examiner may attempt to gain a stipulation from the Claimant. The Examiner will print out the necessary information and submit it to the AWI Legal Office for review and signature. AWI Legal Staff will review the case and sign the necessary documents.
Examiner
Examiner
Examiner
AWI Legal
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Index
03.12.14
Activity Label
File Case
System Activity Description
The system will provide supporting documentation as necessary. The system will provide a mechanism to record the relevant information (Case #, Hearing Date, Service, etc). The system will provide a mechanism to record the failure of service.
Actor Activity Description
The Examiner will file the case with the Civil Court and request service of process.
Actor(s)
Examiner
03.12.15
File Dismissal
03.12.16
Attend Hearing
-
03.12.17
Record Judgment
The system will provide a mechanism to record the result of the Hearing. The system will provide supporting documentation as necessary to file a judgment/lien with the appropriate court.
03.12.18
Prepare Case
The system will provide supporting documentation as necessary.
03.12.19
Review Case
03.12.20
File Case
The system will provide a mechanism to record the activities of AWI Legal. The system will provide a mechanism to record the result of the Final Judgment of the Court.
If at the time of the Hearing, service has not been received (i.e., the Claimant has not been notified of the case), the case will be referred to the AWIcontracted collections agency. If service is received on a Civil Case, the Examiner and AWI Legal will attend the hearing. The Hearing will result in either a judgment or dismissal. If the matter is dismissed, the Overpayment review date will be set past the Statute of Limitations date as no further collections activity may occur. If the Hearing results in a judgment against the Claimant, the Examiner will enter that fact into the system. If the overpayment review is the result of a previously filed conditional judgment, the Examiner will file with the Court for Final Judgment. AWI Legal Staff will review the case and sign the necessary documents. The Examiner will file the case with the Civil Court and request Final Judgment. The Examiner will then proceed to Record Judgment.
Examiner
Examiner
Examiner
Examiner
AWI Legal
Examiner
12.4. CORRESPONDENCE
The table below lists any messages, such as the US mail, emails, faxes, phone calls and any other correspondence, regularly used in the normal course of this process. Note: The Unemployment Compensation Claims and Benefits System (UCCBIS) will provide a selfservice portal to allow users (claimants and employers) to “opt in” to electronic delivery of documents (e.g., messages, notices, and other correspondence). Documents will not be “sent” to users who elect electronic communications, rather, email notifications will be issued to inform users they have documents available for review. A user will log on to the account using their unique security credentials (created
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when they initially set up their online account) to read the documents and will then undertake appropriate action(s). Unless otherwise precluded by law, any message listed in the following table may be delivered via the self-service portal once a user “opts in” for electronic delivery. 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 or withdraw 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. The following is a description and definition of each of the columns in this table.
Index Activity Label Type
A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. Form – An official request for specific information based in a pre-defined format. Notice – Notice of an official Agency action or determination. Ad-Hoc – Requests for information, responses, and general communications. Normally used to validate or complete existing records. Memo - Internal communication for the purpose of sharing information. The intended purpose for sending the message. The organization or role of the intended recipient. Event or action that triggers the requirement to send the message
Purpose Recipient Occasion Index
03.12.05
Activity Label
File Police Report
Type
Ad-Hoc
Purpose
To inform the a local Police Department of an overpayment case to be investigated. To establish the complaint against the Claimant for filing in Civil Court To provide the Claimant notice of the Civil suit and summon the Claimant to the Hearing. To request dismissal of a Civil Court action against a Claimant due to a failure to serve notice. To serve notice to the Court that a Claimant has failed to uphold the Conditional Judgment issued by the Court and request a Final Judgment.
Recipient
Police Department
Occasion
When the Death Match overpayment has not been repaid. When a case is being prepared for filing in Civil Court. When a case is being prepared for filing in Civil Court. When service of process has failed.
03.12.11
Prepare Case
Form
Leon County Civil Court Leon County Civil Court
03.12.11
Prepare Case
Form
03.12.15
File Dismissal
Form
Leon County Civil Court
03.12.18
Prepare Case
Form
Leon County Civil Court
When a Claimant fails to uphold the terms of a Conditional Judgment.
12.5. PERFORMANCE METRICS
The table below lists any performance metrics that may be used to measure the outcome, accuracy or efficiency of this process.
Title Metric Target Source
A description of the metric Complete description of the performance measure Goal or Target to expected or N/A if not applicable The performance metric source (Florida Statutes, AWI policy, etc.).
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Title
Collections Payments – Referred Civil Court – Referred State Attorney – Referred
Metric
The count, dollar amount total of overpayments, and amount recouped referred to Collections by Type daily and quarterly. The count, dollar amount total of overpayments, and amount recouped referred to Civil Court by Type daily and quarterly. The count, dollar amount total of overpayments, and amount recouped referred to States Attorney by Type daily and quarterly. -
Target
Source
AWI AWI AWI
12.6. BUSINESS RULES
The table below lists any statutes or policies that govern the execution of this process. These business rules may be executed by the system or the user. The following is a description and definition of each of the columns in this table.
Number Conflict Description Number
BR03.12.01 BR03.12.02 BR03.12.03 BR03.12.04 BR03.12.05 BR03.12.06 BR03.12.07 BR03.12.08 BR03.12.09 BR03.12.10 BR03.12.11 The unique number assigned to the business rule. Y(Yes) if the current Statute, Administrative Code, or AWI Policy conflicts with the to-be process or N (No) if the current Statute, Administrative Code, or AWI Policy does not conflict with the to-be process. A full-text description of the business rule. Conflict N N N N N N N N N N N
Description
Fla. Stat. § 443.171 (3) (2009) – Delegate power and authority for the effective administration of this chapter Fla. Stat. § 443.171 (6, 7) (2009) – Ability to issue subpoenas to obtain records for court action. Fla. Stat. § 443.071 (5, 6, 7, 8) (2009) – Items of evidence for prosecution. Fla. Stat. § 443.151 (6) (a) (2009) – Allows for recovery and recoupment. Fla. Stat. § 443.151 (6) (d) (2009) – Allows for collection through civil action. Fla. Stat. § 17.0415 (2009) – Allows for transfer and assignment of claims in order to facilitate collection. Fla. Stat. § 17.20 (2, 3) (2009) – Allows for assignment of claims to authorized collection agency. Fla. Stat. § 832.06 (2009) – Allows for prosecution for worthless checks. Fla. Stat. § 832.08 (2009) – Violations involving checks. Fla. Stat. § 27.02 (2009) –State Attorney shall appear within judicial circuit to prosecute on behalf of the State. Fla. Stat. § 47.011 (2009) – Civil action shall be brought in the county where the cause of action accrued.
12.7. TIME CONSTRAINTS
The table below lists any time constraints that are placed on activities within this process. Time constraints may be required completion times or required pauses in the process to allow for responses. The following is a description and definition of each of the columns in this table.
Index Activity Label Source Constraint Index
03.12 A number for use in referencing the activity. A short name for that activity that is used to represent it in the detailed workflow diagram. The source of the constraint (Florida Statutes, AWI policy, etc.). A full-text description of the constraint.
Activity Label
Fail To Pay/Disposition
Source
Fla. Stat. § 443.151 (6) (a)
Constraint
Fraud overpayments must be collected within five (5) years of the date of the determination (Statute of Limitations).
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03.12
Fail To Pay/Disposition
Fla. Stat. § 443.151 (6) (b)
Nonfraud overpayments must be collected within three (3) years of the date of the determination (Statute of Limitations).
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