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New Jersey Department of Labor

New Jersey Department of Labor

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New Jersey Department of Labor

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  1. New Jersey Department of Labor Unemployment Insurance Modernization Project Technical Architecture – NJ SUCCESSRevolutionizing Unemployment Insurance services in New Jersey 13 June 2003

  2. Technical architecture for NJ SUCCESS • NewJersey’s • State • Unemployment • Compensation • Claimant (and) • Employer • Service • System

  3. Contents… Contents • Context for this report • Summary of recommendations • NJDOL’s business vision requires IT that enables business flexibility • NJ SUCCESS must use a modern architecture • NJ SUCCESS needs a standard approach for data and interfaces • NJ SUCCESS will contain modern IT technologies • Likely total costs for NJ SUCCESS are affordable • RFP crosswalk • Summary of product evaluations provided • Appendices • Appendix A: metrics, presentation and business layer technologies • Appendix B: application and data layer technologies • Appendix C: infrastructure and overall architecture • Appendix D: workflow and imaging technologies • Appendix E: business rules and UI package technologies • Appendix F: CRM technologies • Appendix G: data architecture • Appendix H: security and networking Overall approach (97 pages) Detailed discussion of technologies (390 pages)

  4. Context… Context of this report in the UI Modernization Program The Technical Architecture defines the future technical environmentfor NJ SUCCESS, providing capability of delivering UI’s requirementsfrom the Business Process Conceptual Design stage. • 1. Baseline Description • ‘as-is’ analysis of current business and technology environment in UI • reviewing parallel initiatives • 2. Business Process Conceptual Design • ‘to-be’ analysis of desired final future business environment • 3. Technical Architecture • ‘to-be’ analysis of desired final future technical environment • 4. Strategic Plan • desired implementation and migration approach • including any intermediate stages on the way to the final technical architecture • revisiting parallel initiatives This report

  5. Modern IT technologies… Scope of the UI Modernization technical architecture • The technical architecture report discusses all the IT components necessary to deliver the processes and performance envisioned in the UI Modernization Business Process Conceptual Design. • this report delivers the requirements set out in the RFP • a conceptual [logical] and a technical architecture • an evaluation of the best appropriate combination of technologies • high level analysis of Commercial Off The Shelf (COTS) vs. custom build – and associated costs • by agreement with the technical architecture team, network bandwidth sizing will be determined at a high level estimate in the Strategic Plan, with further iterations through the NJ SUCCESS design phase. • additionally we have familiarized the State UI technical team with modern technologies • we ran 25 hours of workshops on modern technologies and candidate products- supported by extensive technical research (see slides in appendices) • helped build the UI-DIT-OIT technical team for NJ SUCCESS • the report’s technical architecture and approach have been validated • leading UI software vendors and other states were assessed at the UI Technology Connection conference (June 9-12, 2003) The technical architecture and approach proposed in this reportwill make NJ SUCCESS one of the most capable UI solutionsdeployed, positioning New Jersey as a leader in the use oftechnology to revolutionize Unemployment Insurance services

  6. Summary of recommendations… Summary of recommendations NJDOL’s vision for UI Modernization is to deliver revolutionized UI services while maintaining the integrity of the Trust Fund To meet this vision, NJDOL needs to develop a modern UI system (NJ SUCCESS) NJDOL’s business vision requires IT that enables business flexibility NJ SUCCESS must use a modern architecture NJ SUCCESS needs a standard approach for data and interfaces NJ SUCCESS will contain modern IT technologies Likely total IT costs for NJ SUCCESS are affordable

  7. NJDOL’s business vision requires IT that enables business flexibility NJDOL’s vision for UI Modernization is to deliver revolutionized UI services while maintaining the integrity of the Trust Fund To meet this vision, NJDOL needs to develop a modern UI system (NJ SUCCESS) NJDOL’s business vision requires IT that enables business flexibility NJ SUCCESS must use a modern architecture NJ SUCCESS needs a standard approach for data and interfaces NJ SUCCESS will contain modern IT technologies Likely total IT costs for NJ SUCCESS are affordable

  8. NJDOL’s vision requires IT that enables business flexibility… BPCD: vision is to be integrated and responsive to customers The Business Process Conceptual Design (BPCD) identified a clear vision for future UI services: “We will deliver revolutionized unemployment insurance services,while maintaining the integrity of the Trust Fund. At each point of customer contact, we will provide a fair, friendly andhigh quality service to every member of the workforce community.” This is a high quality customer service vision that will require investments in new IT.

  9. Requirements from business process conceptual design phase BPCD: business principles have technical implications • The Business Conceptual Design identified business principles that had strong technical implications: • customers will be able to access a holistic UI electronic case file remotely • prevent incorrect payments, before they happen • maintain equallythe integrity of systems, processes and finances • there must be ‘one system’ and uniform, easy to access data • get accurate data from the start – and reuse it to avoid redundancy • …therefore information needs to be captured and stored electronically • optimize staff resources by balancing workload across the state • use tools effectively to enable performance management, development and policy improvement • use workflow and case management to optimize end-to-end case processing • … therefore processes need to be measured and managed • automate the repetitive tasks, thereby freeing up staff to help our customers • encourage remote self-service (via phone, web or email) • streamline communications using modern tools and encourage customers to use the same tools, particularly employers • … therefore efficiency improvements need improved automation

  10. Requirements from business conceptual design phase These business design principles translate into functionality typical of modern systems • Information needs to be captured electronically implies… • digital imaging and recording • requirement for robust electronic forms • enable eCommunications with all customers and partners • requirement to handle an electronic case file • be easily integrated with workforce partners’ applications and packages • advanced configurable reporting and business intelligence capabilities are needed to support operations management, research, Federal reporting and strategic planning • Processes need to be measured and managed implies… • possess multi-level fine granular role based security, with detailed audit trail • should have built in / integrated control and monitoring tools – for processes and systems • requirement for workflow, business rules engine, customer relationship management, content management, imaging and document management functionality Efficiency improvements need improved automation implies… • business logic and workflow must be easily configurable – and not reliant on a technical specialist • be easily expandable – for example, easy to add a new benefit program • should be scalable, robust and flexible to adjust to variations in workload • services should be available to customers and staff, 24x7 • a common look and feel for all modules, easy navigation and rich functionality

  11. Requirements from business conceptual design phase BPCD: principles for the implementation phase • In addition, the State has defined some fundamental implementation principles that impact the technical architecture and implementation approach selected: • strategic ownership must remain with the State • the new system must not tie NJDOL to a vendor • i.e. NJ SUCCESS must be an ‘open’ architecture • the end-to-end solution must be easily maintainable, in-house • implementation must be phased, constituting a series of ‘building block’ projects that individually deliver value to the business • modernization must be achieved within reasonable cost • throughout the design and delivery of new processes and system tools, we must maintain the integrity of services - benefits, system, data, trust fund

  12. Requirements from business conceptual design phase BPCD: future core processes have been identified

  13. Requirements from business conceptual design phase BPCD: IT impacts of the modernization blueprint Enabling customers to self serve wherever possible Providing multiple means for customers to communicatewith us in real-time (phone, internet, in person) and for us to communicate with our customers Establishing a triage function that enables a quick assessment of a customer’s needs and linking him/her to the service that they need Enabling UI staff to view and work with a claimant’s or employer’s full case information easily (everything from claims to appeals information) Allowing claimants and employers to update specific information (e.g. address, etc.) depending on the claim processing step Improving coordination between UI partners through phone/internet web links Enabling claimants and employers to access (by phone or internet) their own case information Providing different payment options: direct deposit and debit cards Enabling claimants and employers to interact with UI on a 24 hour, 7 day a week basis

  14. Requirements from business conceptual design phase BPCD: further IT impacts of the modernization blueprint Providing UI staff with the ability to create their own reports Providing meaningful training and career paths better to enable our workforce Preventing improper payments or overpayments by performing systematic cross checks at multiple points in the life of a claim (at claim entry, certification, etc.) Allowing employees to view their performance to the quantifiable measures through the ability to see their performance versus measures in a report Enabling “what if” analysis on process changes before they are implemented – understanding the ramifications of decisions early Provide capabilities that enable all staff to propose process and policy improvements, at any time Showing all UI staff the end-to-end process, where their roles fit in, and how their efforts contribute to overall success

  15. Logical architecture…. NJ SUCCESS logical architecture • Why is a logical architecture important? • translates between the business process conceptual design and the IT technology options • creates ‘terms of reference’ when looking at technologies and technical architecture • helps to crystallize and map the different migration options • helps enable a clearer comparison of alternative vendor approaches and architectures during procurement • provides a common reference point that the team can use to compare alternative technical options • helps communicate progress and status to non-technical business stakeholders The following pages provide a description of the logical architecture

  16. NJDOL’s vision requires IT that enables business flexibility… UI processes translate to eight core logical areas Manage customer channels Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments Manage UI information

  17. Inquiry and Triage Intake Adjudicate NJDOL’s vision requires IT that enables business flexibility… NJ SUCCESS logical architecture – key functions (1) Capture inquiry Capture claim information Capture adjudication information Verify claimant validity Support adjudication decision making Decide automated eligibility(claims without agents subset) Manage triage Manage intake Manage adjudication Capture inquiry Capture claim information Verify claimant validity Capture adjudication information Key business functionality for Inquiry and Triage, Intake and Adjudicate is shown above. Specific key functions run across all functions (e.g. Quality Control, Security, and Financial Controls)

  18. Certify Appeal Control Benefit Payments NJDOL’s vision requires IT that enables business flexibility… NJ SUCCESS logical architecture – key functions (2) Capture certification information Capture appeal information Verify claimant validity Identify potential fraud and overpayment cases Support appeal decision-making Manage certification Manage appeals Manage investigations Make payment Identify potential fraud and overpayment cases Capture certification information Verify claimant validity Capture appeal information Key business functionality for Certify, Appeal and Control Benefit Payments is shown above. Specific key functions run across all functions (e.g. Quality Control, Security, and Financial Controls)

  19. NJDOL’s vision requires IT that enables business flexibility… The logical architecture is grouped into four layers Present and capture information Presentation Support for managing business rules and processes Business Core process handling capability Application Data Store and retrieve information Grouping the architecture using these layers helps to ensure thatthe NJ SUCCESS is flexible to business change and scalable

  20. NJDOL’s vision requires IT that enables business flexibility… The logical areas can be mapped against the layers Manage customer channels Presentation Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments Business Application Data Manage UI information

  21. Manage customer channels Web IVR In person Presentation Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments Capture inquiry Capture claim information Capture adjudication information Capture certification information Capture appeal information Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations & debt collection Make payment Application Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information NJDOL’s vision requires IT that enables business flexibility… Summary: NJ SUCCESS logical architecture Key business functionality is shown above for NJ SUCCESS, this was identified in the Business Conceptual Design phase. Specific key functions run across all functions (e.g. Quality Control, Security, and Financial Controls)

  22. NJDOL’s vision requires IT that enables business flexibility… How will NJ SUCCESS support key scenarios? • Five sample scenarios have been mapped to NJ SUCCESS’s logical architecture to illustrate how NJ SUCCESS will support the redesigned UI processes: • Scenario 1: A straightforward new UI claim • Scenario 2: Certification for a continued claim • Scenario 3: Employer appeals determination • Scenario 4: Potentially fraudulent new claim • Scenario 5: Controlling benefit payments

  23. Manage customer channels 1 Web IVR In person Presentation Inquiry and Triage Intake 3 Adjudicate Certify Appeal Control BenefitPayments 2 Capture inquiry Capture claim information Capture adjudication information Capture certification information Capture appeal information 4 Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) 5 Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations Make payment Application 6 Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information NJDOL’s vision requires IT that enables business flexibility… Scenario 1: a straightforward new UI claim Customer contacts agency by phone with a query Customer question about ability to claim is captured by IVR, and an automatic response provided. Customer selects the option to file a new UI claim immediately. Identifying information is requested and all information pertaining to that person is pulled from the Operational Data Store (ODS). During information capture, claim validity and identity are cross-checked Claim is identified as straightforward and appropriate for ‘claims-without-agents’ Email notification is generated automatically

  24. NJDOL’s vision requires IT that enables business flexibility… Scenario 2: certification for continued claim Manage customer channels 1 5 Web IVR In person • Customer chooses to certify for continuing benefits via the web • Claimant • enters identifying information • answers certification questions • Both sets of information are validated against internal data as well as cross-matches • Certification is completed cleanly and the ‘make payment’ process is triggered • Claimant has opted for notification by the web and direct deposit of her benefits Presentation Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments 2 3 Capture inquiry Capture claim information Capture adjudication information Capture certification information Capture appeal information Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations & debt collection Make payment Application 4 Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information

  25. 1 Manage customer channels Web IVR In person Presentation Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments 2 Capture inquiry Capture claim information Capture adjudication information Capture certification information Capture appeal information Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business 4 3 8 Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations & debt collection Make payment 7 5 Application 6 Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information NJDOL’s vision requires IT that enables business flexibility… Scenario 3: employer appeals determination An employer disputes the agency’s determination; and calls the agency to appeal The employer selects the ‘appeal’ option on the IVR. He then answers a series of questions to file the appeal. The answers are translated from voice-to-text and stored A determination review is immediately triggered for the adjudication center responsible for the original determination A senior adjudicator reviews the determination, using the information in the Claimant’s case file The review results in no change to the determination. This result is logged Actions to review the appeal and schedule a hearing are triggered A hearing is held, with potential use of a business rules tool to guide the questioning. The decision is created and recorded digitally The result of the appeal is logged and notifications are triggered.

  26. NJDOL’s vision requires IT that enables business flexibility… Scenario 4: potentially fraudulent new claim A potential claimant access the agency via the web in order to file a new claim She begins the application process, entering identifying information This information is cross-matched against a number of sources, including the new hire directory The result of the cross-match – that the social security number entered is shown to have current wages in New Jersey – is presented back to the claimant, with the option of contacting an agent. The claimant chooses to continue with the claim process Manage customer channels 1 Web IVR In person Presentation Inquiry and Triage Intake 4 Adjudicate Certify Appeal Control BenefitPayments 2 Capture inquiry Capture claim information 3 Capture adjudication information Capture certification information Capture appeal information Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations Make payment Application Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information

  27. Manage customer channels 1 Web IVR In person Presentation Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments 1 Capture inquiry Capture claim information Capture adjudication information Capture certification information Capture appeal information Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business 2 Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations & debt collection Make payment 3 Application Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information NJDOL’s vision requires IT that enables business flexibility… Scenario 5: controlling benefit payments Using predictive software, a member of BPC staff queries a BPC data mart for a particular fraud or overpayment pattern. He has a web front-end, making the task more intuitive The query results in many potential cases. The member of staff selects the top 100 and adds them as work items to the investigations workload. The investigations and debt collection process is managed by the workflow system.

  28. NJDOL’s vision requires IT that enables business flexibility… Scenario 5: controlling benefit payments (cont) • Three elements of NJ SUCCESS’s architecture in particular will deliver enhanced BPC capability: • operational data store / data warehouse • single database for all UI and DDU claims information (with security for confidential information): no need to run extracts • analysis data marts, designed to enable easy interrogation by business intelligence tools • business intelligence tools • manage cross-matches with other systems • pattern detection within NJ SUCCESS’s own data / audit trail • integrated workflow • workflow tool will automate BPC case load and case management • integrated workflow also means that transfers of cases to collections, adjudication, appeals etc can be done electronically, with a full audit trail

  29. NJDOL’s vision requires IT that enables business flexibility… Increased flexibility for managing the organization • Management will derive most immediate benefit from these technologies: • operational data store / data warehouse • analysis data marts enable managers to quickly view reports and perform ‘ad-hoc’ analyses on any discrepancies (see slide 51 for details on data marts) • a real-time ‘performance dashboard’ is possible for operational managers • storage of a full audit trail (covering accounting, data, system security) will enhance the integrity of UI • integrated workflow • workflow management tools will enable managers at all levels to monitor operations performance more immediately– and see the impact of adjustments fast • end-to-end workflow reporting will provide management with an ability to manage workloads across the process chain • integrated customer channel management • this will enable multiple customer channels to be managed in an integrated manner • updates and new services can more easily be communicated across all channels • this enables the future introduction of ‘contact’ centers- providing customer service contacts across all channels from one center

  30. NJDOL’s vision requires IT that enables business flexibility… Key UI business performance metrics… • In 2002 NJ UI handled • 860,000 claims (new and additional) • of which 640,000 were new • of which 500,000 were valid • initial claims • 20,200 per week (high) • 7,800 per week (low) • continued claims • average: 135,000 per week • high: 160,000 per week • Summary volumes (average per year) • average 0.5M - 1M per year • Characteristics of claims volumes • Cyclic – largest volume in 1st calendar quarter • Able to predict peak weeks • Average annual payout $3 B – including federal TVC • Claimants may have multiple claims • Average claim duration – 18, 19 weeks • More business involvement for the initial process • Workforce expands or contracts based on weekly projections

  31. NJDOL’s vision requires IT that enables business flexibility… Key UI business performance metrics (continued) • In 2002 NJ UI handled • claims have increased over past two years • 2002 was 23% more than 2001 • 2001 was 27% more than 2000 • average benefit payout has increased • 2001 reached $2.1 Billion • 2002reached $3 Billion • phone calls (claims, pends, and inquiries): • 2002 - 1,722,044 calls received • 2002 - 963,339 calls answered – 58% of total • 2003 (1/03 – 4/03) - 753,087 calls received • 2003 (1/03 – 4/03) - 383,063 calls answered – 52% * Note this was information for the three RCCS – the assumption is that there are more calls trying to contact the offices than can be handled

  32. NJDOL’s vision requires IT that enables business flexibility… …NJ SUCCESS performance requirements • On the basis of the claims volumes for 2002, the technical architecture team agreed that the following broad assumptions were reasonable to inform this high level technical architecture: • size to handle a 30% increase in claims volume above 2002 figures • max of 1.1M initial claims (both new and additional claims) per year • assume peak volumes are 200% of 2002 volumes • weekly peak of 44K initial claims, 350K continued claims • assume peak hourly volume of 15,000 for continued claims and the ability to handle 225 calls at any one time

  33. NJ SUCCESS must use a modern architecture NJDOL’s vision for UI Modernization is to deliver revolutionized UI services while maintaining the integrity of the Trust Fund To meet this vision, NJDOL needs to develop a modern UI system (NJ SUCCESS) NJDOL’s business vision requires IT that enables business flexibility NJ SUCCESS must use a modern architecture NJ SUCCESS needs a standard approach for data and interfaces NJ SUCCESS will contain modern IT technologies Likely total IT costs for NJ SUCCESS are affordable

  34. NJ SUCCESS must use a modern architecture… NJ SUCCESS candidate architecture options - general • The technical architecture team, including representatives from NJDOL UI, DIT and the State OIT, collectively considered potential suppliers and candidate architecture options. • The next three slides summarize these options and the conclusions reached by the team for each option.

  35. NJ SUCCESS must use a modern architecture… NJ SUCCESS candidate architecture options - general • The following general candidate architecture options were considered: • 1. Linux based architecture • using an open source based architecture • REJECTED- technology is not sufficiently mature to be a viable supplier for NJ State • 2. Microsoft based architecture • using MS .NET based architecture • REJECTED- Microsoft technology is not viewed as sufficiently ‘open’ for use within the State for strategic applications- the State’s strategic architecture / platforms / experience is not aligned with Microsoft technologies • 3. IBM based architecture • using Websphere based J2EE technology • REJECTED- technically equivalent to Sun / Oracle- however impact on OIT would be to have to support two different stacks, causing resourcing problems

  36. NJ SUCCESS must use a modern architecture… NJ SUCCESS candidate architecture options - LOOPS • 4. Extending LOOPS application • this approach would build on LOOPS’ existing capabilities • REJECTED- difficult to join LOOPS’ procedural languages with J2EE components- ongoing maintenance would be expensive compared with using modern technology • The benefits of building on the proven environment of LOOPS areoutweighed by the flexibility limitations and relatively expensivemaintenance compared to a more modern technology architecture.

  37. NJ SUCCESS must use a modern architecture… NJ SUCCESS candidate architecture options – Sun / Oracle • 5. Sun / Oracle technology based architecture • following State IT standards • using modern J2EE based environment • RECOMMENDED- modern architecture- technologies aligned with State technical resources • Sun / Oracle technology provides the benefit of a flexible ITarchitecture with the ability for support and maintenanceto be provided by the State’s IT technical resources.

  38. Portal infrastructure Eforms Business intelligence Business rules engine Workflow + UI objects framework Operational data store NJDOL’s vision requires IT that enables business flexibility… Where will NJ SUCCESS use modern technologies? • The following slides highlight where five of the modern technologies in NJ SUCCESS will help enable functionality in the logical architecture: • portal infrastructure • eforms • business intelligence • business rules engine • workflow and UI objects framework • operational data store (ODS)

  39. NJDOL’s vision requires IT that enables business flexibility… Where will portal infrastructure be used? Manage customer channels Web IVR In person Presentation Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments Portal infrastructure will allow different channels to be managed consistently and customer interactions to be consolidated. Capture inquiry Capture claim information Capture adjudication information Capture certification information Capture appeal information Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations & debt collection Make payment Application Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information

  40. Manage customer channels Web IVR In person Presentation Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments Capture inquiry Capture claim information Capture adjudication information Capture certification information Capture appeal information Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations & debt collection Make payment Application Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information NJDOL’s vision requires IT that enables business flexibility… Where will eforms be used? Electronic forms (eforms) technologies simplify capturing information in a user-friendly manner. Forms are used widely for data capture throughout the UI business processes – meaning eforms will have a large impact on efficiency.

  41. Manage customer channels Web IVR In person Presentation Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments Capture inquiry Capture claim information Capture adjudication information Capture certification information Capture appeal information Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations & debt collection Make payment Application Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information NJDOL’s vision requires IT that enables business flexibility… Where will business intelligence be used? • Business intelligence tools enable users to report and drill into information rapidly. They also form a basis for enabling cross-matches which will tighten the security of the system against external fraud and incorrect payments. • Business intelligence tools will be deployed • during initial intake • repeatedly throughout the life of a claim (at least at every certification event) • ad hoc (as defined for BPC spot-checks)

  42. Manage customer channels Web IVR In person Presentation Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments Capture inquiry Capture claim information Capture adjudication information Capture certification information Capture appeal information Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations & debt collection Make payment Application Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information NJDOL’s vision requires IT that enables business flexibility… Where will business rules engines be used? • Business rules engines simplify the capture and modification of UI’s business rules (laws, procedures, etc). They will provide structure and quality control at the key decision points in the claims process: • monetary determination. Automatic financial calculator. • adjudication. Structured decision trees, with procedures/guidance as ‘help’ text. • appeal decision. Potential for structured decision trees, with case law and guidance as ‘help’ text. Note For ‘claims-without-agents’, the ambition articulated in the business design workshops was to fully automate the determination, with close quality control by senior agents. Key business functionality is shown above for NJ SUCCESS, this was identified in the Business Conceptual Design phase.

  43. Manage customer channels Web IVR In person Presentation Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments Capture inquiry Capture claim information Capture adjudication information Capture certification information Capture appeal information Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations & debt collection Make payment Application Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information NJDOL’s vision requires IT that enables business flexibility… Where will workflow be used? • Workflow technology enables business processes to be automated. For NJ SUCCESS, it will provide controlled process management across the end-to-end UI organization • enabling performance management of every step of the claims process • ensuring that each claim progresses as efficiently as possible for that claim • e.g. claims with a straightforward monetary calculation (assuming that a non-monetary issue has been detected) will automatically be transferred immediately to the next available adjudication slot anywhere in the State if a non-monetary issue is detected

  44. Manage customer channels Web IVR In person Presentation Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments Capture inquiry Capture claim information Capture adjudication information Capture certification information Capture appeal information Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations & debt collection Make payment Application Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information NJDOL’s vision requires IT that enables business flexibility… Where will the operational data store be used? • The operational data store (ODS) allows all information to be consistently captured in one place. For NJ SUCCESS it will be the single store for all information. • the ODS will support everyday business transactions • research and reports will be pulled from a separate, regularly updated, data warehouse The operational data store will also enable NJ SUCCESS to simplify its management of data and interfaces (described in more detail later).

  45. Portal infrastructure Eforms Business intelligence Business rules engine Workflow + UI objects framework Operational data store Summary: use of key technologies Manage customer channels Web IVR In person Presentation Inquiry and Triage Intake Adjudicate Certify Appeal Control BenefitPayments Capture inquiry Capture claim information Capture adjudication information Capture certification information Capture appeal information Verify claimant validity Verify claimant validity Identify potential fraud and overpayment cases Business Support adjudication decision making Support appeal decision-making Decide automated eligibility(claims w-o agents subset) Manage triage Manage intake Manage adjudication Manage certification Manage appeals Manage investigations & debt collection Make payment Application Capture claim information Verify claimant validity Capture adjudication information Verify claimant validity Identify potential fraud and overpayment cases Capture inquiry Capture certification information Capture appeal information Data Manage UI information Provide UI performance information Provide electronic case file information Provide financial reporting information

  46. NJ SUCCESS needs a standard approach for data and interfaces NJDOL’s vision for UI Modernization is to deliver revolutionized UI services while maintaining the integrity of the Trust Fund To meet this vision, NJDOL needs to develop a modern UI system (NJ SUCCESS) NJDOL’s business vision requires IT that enables business flexibility NJ SUCCESS must use a modern architecture NJ SUCCESS needs a standard approach for data and interfaces NJ SUCCESS will contain modern IT technologies Likely total IT costs for NJ SUCCESS are affordable

  47. “Its all about the data”… • New Jersey’s Unemployment Insurance business processes require data to be shared and exchanged with other organizations and systems. This means that NJ SUCCESS will need to manage several interfaces: • This section outlines how using a common approach for data and interfaces, with associated principles, can both simplify NJ SUCCESS’ architecture and also provide the State with a valuable pool of information and foundation for more general information sharing across the State. • The separate report System interfaces for the NJ SUCCESS system provides a more detailed analysis

  48. Standard approach for data and interfaces… Data layer – terminology • Operational Data Store (ODS) • logical part of information architecture where the day-to-day transactions are stored • contains real-time transaction information • contains sufficient historical information for operational use • e.g. older data is archived off automatically through predefined business rules • Data Warehouse (DW) • logical part of information architecture where historical information is stored and accessed • sourced primarily from the ODS • contains archive of historical transaction information • contains ‘near-real’ time information • information latency will vary by type of informatione.g. one day old, four hours old • Data Mart (DM) • logical part of information architecture that users query to perform analysis • sourced exclusively from the DW • will include information constructed to address types of analysis required • e.g. ‘no. of previous contacts’, ‘no. of claims’ • Metadata • reference information that describes other information • e.g. ‘this data is one month old’ • includes ‘taxonomy’ information

  49. Standard approach for data and interfaces… Data layer – architectural principles • In order to ensure information is reliably shared, common architectural principles are required: • information that is to be shared must be captured consistently • using the State Logical Data Model • all accesses to shared information must be consistently controlled • using the shared user security in the NJ SUCCESS architecture • all data sharing is done via the data environment • there are no direct links between systems • users can only access historical data in the data warehouse via a data mart • only simple 'operational queries' are allowed on data in the ODS • sources of data populate the operational data store before the data goes to the data warehouse • data interface errors must be fixed in the data source and thenresubmitted to the operational data store

  50. Standard approach for data and interfaces… Data layer – data / interface architecture NJ SUCCESS NJ SUCCESS will store its operational data within the NJDOL ODS. Users will access historical information via the data marts.e.g. federal reporting; financial analysis NJDOL Operational Data store (ODS) NJDOL operational data store (ODS) Data Warehouse (DW) data warehouse (DW) Data Mart 1 data mart 1 Data Mart 2 data mart 2 Common State metadata and Logical Data Model Common State metadata and logical data model