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NMDWS Fraud Prevention-uDetect

NMDWS Fraud Prevention-uDetect. Sue Anne Athens, CIO July 23, 2014. Agenda. Project Purpose Scope Business Objectives Technical Objectives Budget Schedule Lessons Learned Incorporated into this project Questions. Project Purpose.

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NMDWS Fraud Prevention-uDetect

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  1. NMDWS Fraud Prevention-uDetect Sue Anne Athens, CIO July 23, 2014

  2. Agenda • Project Purpose • Scope • Business Objectives • Technical Objectives • Budget • Schedule • Lessons Learned Incorporated into this project • Questions

  3. Project Purpose • The State of New Mexico Department of Workforce Solutions (DWS) is seeking to gain insight into the sources, causes, and factors of overpayment fraud in Unemployment Insurance. • The purpose of the project is to improve the detection and reduction of overpayment fraud through the use of uDetect™, an analytical system comprised of algorithmic solutions which will be customized to DWS historical data to identify unemployment insurance claims with a higher propensity to involve fraudulent activity. • This supports our strategic goal to reduce the amount of improper payments by focusing on the reduction of unemployment insurance fraud. This was included in our 2013 Supplemental Budget Requests and is directly supported with US Department of Labor funding.

  4. Scope • Phase 1. Algorithmic Solutions Analysis: Evaluate, customize, and enhance uDetect fraud detection on unemployment insurance claims from DWS.-- this research has been completed and was precursor to pursuing solution. • Phase 2. Scoring Engine Deployment: Implement Scoring Engine for uDetect in a technology solution to score unemployment insurance claims for the purpose of identifying and reducing potential overpayment fraud. • Phase 3. uFACTS Integration: Integrate the uDetect Scoring Engine within the uFACTS application, including configuration of input and output data streams to the Scoring Engine and design and development of a user interface. • Phase 4. Business Implementation: Enhance the businesses process whereby claims messaging and processing incorporating analysis results and subsequently managed within uFACTS

  5. Business Objectives • To reduce fraud by a minimum of 20% through predictive measures in the area of claim certifications, separation overpayment and anomaly detection. • To provide structured workflows for BPC and Fraud Team to ensure UI performance measures are maintained and workloads effectively managed for specialized cases

  6. Technical Objectives • Implement the uDetect™ Scoring Engine in the DWS technology platform to score unemployment insurance claims for the purpose of identifying and reducing potential overpayments and fraud. • Integrate the process into the Unemployment Insurance Application (UIA) system to enhance the management of UIA initial claims, continued claims, adjudication, workflow and reporting processes to support the fraud analytics business processes

  7. I T E M C O S T E S T I M A T E I T E M C O S T E S T I M A T E Project organization $1 30,000 and planning Implementation and $454,980 Reporting Design Testing $650,000 Implementation $65,000 Total $1,299,980 Budget Note: Federal Funding Received via Supplemental Budget Request

  8. Schedule

  9. Lessons Learned Incorporated • Proof of concept utilized • Engagement of user community early on – business users have been involved throughout, approach will utilize an agile method of development

  10. Questions

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