Unemployment Compensation Project Phase 2

Transcription

1 State of Florida Agency for Workforce Innovation Unemployment Compensation Project Phase 2 System Use Cases Overview

2 Document Control Revision History Date Version Description Author 01/20/ Initial Draft Pete Peterson 02/23/ Added Audit Context Diagrams Pete Peterson 02/23/ Added BPC Context Diagrams Pete Peterson 03/11/ Added Appeals Context Diagrams Tad McDonald 03/18/ Added Overview Text Tad McDonald 03/22/ Added Claims and Adjudication Aaron Dienger Overview Text 03/22/ Update Intro Text Tad McDonald 04/05/ Final Wayne Messina Quality Review History Date Reviewer Comments Page i

3 Table of Contents 0. USE CASES SYSTEM USE CASES FOR CLAIMS SYSTEM USE CASES FOR ADJUDICATION SYSTEM USE CASES FOR BENEFIT PAYMENT CONTROL (BPC) SYSTEM USE CASES FOR SHORT TERM COMPENSATION (STC) SYSTEM USE CASES FOR TRADE READJUSTMENT ASSISTANCE (TRA) SYSTEM USE CASES FOR DISASTER UNEMPLOYMENT ASSISTANCE (DUA) SYSTEM USE CASES FOR SPECIAL PAYMENTS SYSTEM USE CASES FOR APPEALS SYSTEM USE CASES FOR AUDIT SYSTEM USE CASES FOR CUSTOMER INFORMATION REQUESTS (CIR) 31 Page ii

4 0. USE CASES 0.1. OVERVIEW As part of our analysis and documentation of the Unemployment Compensation Modernization project, we created fully dressed use cases, based on the Writing Effective Use Cases by Alistair Cockburn. A use case is defined as a contract between system stakeholders and the behavior of the system under various conditions. A particular stakeholder, also referred to as a Primary Actor, initiates an interaction with the system to accomplish a defined goal. The system responds in a manner to protect the interests of all stakeholders. Different sequences of behavior, or scenarios, may unfold, depending upon the particular requests made and the conditions surrounding the requests. A use case documents those scenarios in a manner which facilitates communication between various users and user groups. Use cases are primarily textual descriptions of stakeholder (user) interactions with the automated system. We created visual representations ( context diagrams ) of each use case to provide a more thorough understanding of system behaviors by various UC Modernization stakeholders. This document contains the context diagrams associated with the use cases (the use cases themselves are contained in separate documents) and provides the reader with a graphical description of the textual use cases. It is important to note that we did not create a use case for every system activity. However, for the most part, use cases were drafted to document a majority of system functionality. Use cases (text) and context diagrams (graphical) are not meant to represent system workflow or to communicate various operational system components such as work queues. Use cases and context diagrams present a view of a user s interaction with the system. However, the use cases and context diagrams, in conjunction with the process flows and activity descriptions contained in the To Be documents, provide a complete representation of the future Unemployment Compensation system. Use Case Types Use cases document functional system behaviors (e.g., Filing a claim, Adjudicating a claim, Filing an Appeal), but as part of our analysis we discovered a significant number of routines or activities that were shared between many functional areas. For instance, we learned a large number of system activities involved the creation and dissemination of notices to UC customers (e.g., claimants, appellants, employers). We created common use cases to document system behaviors that are shared between multiple stakeholder groups. The functional or system use cases were grouped according to major core process areas (e.g., Claims, Adjudication, Appeals) and common use cases were documented to fully describe activities invoked by many of the functional use cases. Because of their generic nature, context diagrams were not created for the common use cases (common use cases were, however, fully vetted with re-engineering staff members and current system users see below). Page 1

5 Approach We utilized a multi-step approach to developing the use cases. The methodology allowed us to manage the level of precision required for the final fully dressed use cases as part of our project deliverable. Exhibit 1 Use Case Development Approach, depicts the approach and primary tasks completed in the business process analysis and re-engineering phase. Key tasks are delineated below. Exhibit 1 Use Case Development Approach Step 1 Define Actor and Goals: Listed actors who will use the system by leveraging To Be process documentation; Documented user touch points with the system and user goals related to touch points; Defined which of the actors goals the system will support; Prioritized, assigned goals, and documented actor goals; Reviewed actor goals list with UC re-engineering staff and subject matter experts. Step 2 Define Main Success Scenario: Outlined the main success scenario; Defined minimal guarantees for each scenario (what happens even if the use case fails ); Validated the success scenarios fulfill actor goals; Reviewed main success scenarios with UC re-engineering staff and subject matter experts. Step 3 Define Extensions and Failure Conditions: Brainstormed non-failure scenario extensions; Page 2

6 Brainstormed failures that could occur; Completed a list of failure events; Reviewed extensions and failure events with UC re-engineering staff and subject matter experts. Step 4 Define Failure Handling: Reviews Defined how the system will respond to each failure; Reviewed failure handling with UC re-engineering staff and subject matter experts. As depicted above, at each step of the process, we engaged both re-engineering resources and subject matter experts (current UC functional users) to review the use cases and to provide feedback to guarantee we accurately captured the expected future system behaviors for a variety of scenarios. Guidelines We drafted guidelines to define and document a common set of standards to ensure the final use cases would be consistent in their content, concepts, and vernacular. The use case guidelines are contained in a separate document USE CASE GLOSSARY Term Actor Main Success Scenario Extensions (Alternate Path) Context Diagram Use Case Relationship Extends Stakeholder Time Use Case Definition A user who calls on the system to deliver a service. An Actor is a person interacting with the system. A full description of a scenario in which an Actor s goal is delivered and all stakeholder interests are satisfied. The main success scenario represents a series of steps without error conditions or deviations. Extensions are scenarios which represent alternate behavior(s) from steps in the main success scenario. Extensions may include steps taken due to error conditions or processes that result from unexpected user behavior(s). A diagram showing the relationship between Actors and Use Cases. Any time a Use Case invokes or relies upon another Use Case to complete its stated purpose, a relationship is said to exist between the Use Cases. An Use Case is a Use Case that is invoked from an originating Use Case. It is used to simplify Use Cases and to leverage re-usability across Use Cases, reducing repetition and duplication. Extends Use Cases are written for complex Use Cases to provide clarity and simplification. Any entity (organization, role, Actor) that has a vested interest in the outcome of a Use Case. An Actor used to depict events triggered by time or other system event. For example, Time is an Actor that triggers a Use Case at a preset time or date to send a notification. A Use Case is a contract between the stakeholders of a system about its behavior. Page 3

7 Term Definition The Use Case describes the system s behavior under various conditions as the system responds to a request from an Actor. When depicted in diagrams, it is represented by an oval. Page 4

8 1. SYSTEM USE CASES FOR CLAIMS 1.1. OVERVIEW The purpose of the Claims area is intake and process initial and continuing claims. In the pursuit of this function, Claims is divided into distinct business units each with a specific set of responsibilities. The units are the Claims Hubs and the Wage Determination Unit. The purpose the Wage Determination Unit is to ensure that wages are appropriately applied to a wage transcript, respond to wage reconsideration requests, resolve blocked claims (i.e., those involving tax issues) timely, resolve billing discrepancies on a quarterly basis and apply modifications/reversals of previous wage determinations upon receipt of an appeal modification/reversal resulting from Agency Orders, Unemployment Appeals Commission (UAC) Orders or Judicial Orders SYSTEM USE CASE CONTEXT DIAGRAM Claims Submit Claim Intake User (External) Certify Weeks Execute Search Process Claim Generate User (Internal) Generate Benefit Documentation Setup Benefit Program Generate Mass Exhibit 2 Claims Context Diagram Page 5

9 Wage Determination Unit Intake Apply Out of State Wages Resolve Wage Issue Generate User (Internal) Resolve Prior Quarter Billing Issues Release Wages Exhibit 3 Wage Determination Unit Context Diagram Page 6

10 2. SYSTEM USE CASES FOR ADJUDICATION 2.1. OVERVIEW The purpose of Adjudication is to address non-monetary issues associated with claims. Adjudication resolves issues by conducting the following steps: identifying the root cause of the issue, resolving the issue and adjudicating the claim according to the results of fact finding efforts. The purpose of the Employer Charge Unit is to accurately charge or non-charge an Employer s account based upon a review of separation information for an associated claim. The objectives of this business unit include: address protested charges, review responses to a Quarterly Tax Statement and update Employer chargeability based upon the results of the review of the reason for separation SYSTEM USE CASE CONTEXT DIAGRAM Adjudication Generate Modify Determination Issue Determination User (Internal) Release Payments Conduct Fact Finding Exhibit 4 Adjudication Context Diagram Page 7

11 Employer Charge Unit Closeout Labor Dispute Confirm and Activate Labor Dispute Intake User (Internal) Determine Chargeability Generate Exhibit 5 Employer Charge Unit Context Diagram Page 8

12 3. SYSTEM USE CASES FOR BENEFIT PAYMENT CONTROL (BPC) 3.1. OVERVIEW The purpose of the Benefit Payment Control (BPC) area is fraud detection, investigation, determination, prosecution, 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 several different units each with a specific set of responsibilities. The units are Wage Audit, New Hire, Management, and Recovery. Fail To Pay activities may be conducted by any of the above units SYSTEM USE CASE CONTEXT DIAGRAM BPC Wage Audit/Payment Processing Unit Enter Response User Conduct Fact Finding Examiner Release Payments Issue Determination Intake Payment Execute Search Supervisor Exhibit 6 BPC Wage Audit Context Diagram Page 9

13 BPC New Hire Unit Conduct Fact Finding Examiner Issue Determination Release Payments Exhibit 7 BPC New Hire Audit Context Diagram Conduct Fact Finding BPC Management Unit Release Payments Issue Determination Examiner Validate Address/Phone Enter IRORA Overpayment Execute Search Process Waiver Supervisor Exhibit 8 BPC Management Context Diagram Page 10

14 BPC Recovery Unit Examiner Issue Determination Release Payments Conduct Fact Finding Conduct Investigation Intake Investigator Enter Response Exhibit 9 BPC Recovery Context Diagram BPC All Units Examiner/ Investigator Refer Overpayment Schedule Event Exhibit 10 BPC Fail To Pay Context Diagram Page 11

15 4. SYSTEM USE CASES FOR SHORT TERM COMPENSATION (STC) 4.1. OVERVIEW The Short Time Compensation (STC) Program is voluntary and designed to help Employers retain staff during temporary business slowdowns by reducing Employees weekly hours instead of laying them off. The Employer must complete an STC Plan Application that will be in effect for up to one year. It may be renewed if the Employees in the plan have returned to full-time work during the plan year. Plan approval is contingent on (a) having at least 10% (but not less than a total of 2) of non-seasonal Employees working reduced hours and (b) the reduced weekly hours are at least 10% but not greater than 40% of the normal work week. Employees represented by a union or Collective Bargaining Agent may participate if the Collective Bargaining Agent signs the plan. Workers from Leasing Companies providing services to the Employer may also participate if the Leasing Company agrees and signs the plan as well. An increase in unemployment compensation tax will likely occur as a result of partaking in the STC Plan, and the increase may be applied to all corporations joining in the plan. Once the plan is approved, the selected Employee must apply for the benefit and report hours worked on a biweekly basis. The new STC process will reduce and potentially eliminate many labor-intensive, manual tasks involving paper documentation and communications between AWI and the Employer and all entities involved in the STC Plan: Employees, Leasing Companies, and Collective Bargaining Agents. Significant process enhancements will be leveraged from standardizing common processes across all unemployment compensation programs. A common process for claims, certification, and payment processes for STC will be used to efficiently and consistently execute the STC program. Although a common process will used, business rules specific to STC will still be applied. The STC claims related system interactions are documented within the Claims use cases. Page 12

16 4.2. SYSTEM USE CASE CONTEXT DIAGRAM STC External Users Submit Claim Claimant Certify Weeks Submit Weekly Hours Employer Maintain STC Plan Application Maintain STC Claimants Execute Search Authorize Item Collaborative Bargaining Agent Exhibit 11 Short Term Compensation (STC) Context Diagram Page 13

17 STC Generate Mass STC Specialist Authorize Item Benefits Operations Administrator Exhibit 12 STC Authorization Context Diagram Page 14

18 5. SYSTEM USE CASES FOR TRADE READJUSTMENT ASSISTANCE (TRA) 5.1. OVERVIEW The Trade Adjustment Assistance (TAA) program was first established at the U.S. Department of Labor (DOL) by the Trade Act of 1974 to assist workers in firms hurt by foreign trade. Examples of workers hurt by foreign trade include the shifting of production of a product to a foreign country, outsourcing of services to a foreign county, or the increasing of imports of articles or services. The Trade Act has been amended several times over the past thirty-five years. The latest amendments in the 2009 Act expand TAA coverage to more workers and firms, including the service sector. The TAA includes two programs, the Trade Readjustment Allowances (TRA) and Reemployment Trade Adjustment Assistance (RTAA). These programs enable eligible workers access to assistance. This assistance includes benefits associated with training, job search, healthcare, relocation allowances, supplemental income, and other reemployment services. These benefits are provided at no tax expense to Employers. The new TRA processes will reduce, and potentially eliminate, many labor-intensive, manual tasks involving paper documentation and communications with the U.S. Department of Labor, One Stop Centers, Educational Organizations, Media Outlets, and Employees. Page 15

19 5.2. SYSTEM USE CASE CONTEXT DIAGRAM TRA External Users Submit Claim Claimant Certify Weeks One Stop Maintain Training Information Educational Organization Exhibit 13 Trade Readjustment Assistance (TRA) External Users Context Diagram Page 16

20 TRA Maintain TRA Petition Execute Search TRA Specialist Maintain TRA Claimants Generate Mass Authorize Item Benefits Operations Administrator Exhibit 14 TRA Context Diagram Page 17

21 6. SYSTEM USE CASES FOR DISASTER UNEMPLOYMENT ASSISTANCE (DUA) 6.1. OVERVIEW The Disaster Unemployment Assistance (DUA) program provides unemployment compensation and reemployment assistance to eligible recipients (including the self-employed) who have lost employment as a direct consequence of a major disaster. DUA is always associated with an Individual Assistance Declaration issued by the President of the United States, and is unavailable until such Declaration is received by the Florida Agency for Workforce Innovation (AWI). Each Declaration is specific to one particular disaster, and opens a claims-filing window to affected workers in specified counties. To be eligible for these benefits, claimants must meet special eligibility requirements pertaining to their loss of employment (or self-employment) and proof of income. Certain As-Is DUA processes occur outside of the Unemployment Compensation Claims and Benefits Information System (UCCBIS). These include the processes of applying for, receiving, and amending the Individual Assistance Declaration, as well as the administrative finance processes. Beyond the DUA-specific eligibility criteria, a DUA claim will be processed much like any other claim for unemployment compensation. This process does not address functionality held in common with other unemployment compensation process flows. Page 18

22 6.2. SYSTEM USE CASE CONTEXT DIAGRAM Benefit Program: DUA Submit Claim Claimant Certify Weeks Setup Benefit Program User Generate Benefit Documentation Exhibit 15 Disaster Unemployment Assistance (DUA) Context Diagram Page 19

23 7. SYSTEM USE CASES FOR SPECIAL PAYMENTS 7.1. OVERVIEW Special Payment processes address the payment of Claimant benefits for all claim types as well as the processes related to handling payment matters. The Special Payments sub-processes are predicated on the Issue Payment sub-process where Claimants certify their weeks in order to receive their Unemployment Compensation (UI) benefits. For the week(s) being certified, the Claimant will be required to answer predefined questions based on claim type to determine their eligibility to continue receiving UI benefits. Claimants meeting the criteria for eligibility during the weeks being certified will receive their UI benefits. Claimants ineligible to receive UI benefits for any given week(s) will still enter their weekly certification and are not precluded from being eligible in the future. All other Special Payment sub-processes handle a variety of payment matters. These processes require unrestricted access to claimant records in order to update them with payment actions SYSTEM USE CASE CONTEXT DIAGRAM Amend Amend 1099 Special Payments Examiner Exhibit 16 Amend 1099 Context Diagram Page 20

24 Process Beneficiary Payment Special Payments Examiner Process Beneficiary Payment Intake Exhibit 17 Process Beneficiary Payment Context Diagram Process Duplicate Warrant Process Duplicate Warrant User Exhibit 18 Process Duplicate Warrant Context Diagram Page 21

25 Process Forgery Decision Process Forgery Decision Special Payments Examiner Exhibit 19 Process Forgery Decision Context Diagram Process Returned Warrant Process Returned Warrant Special Payments Examiner Exhibit 20 Process Returned Warrant Page 22

26 8. SYSTEM USE CASES FOR APPEALS 8.1. OVERVIEW During the intake phase, the Clerk s Office receives information from an appellant (an appellant may be an employee/claimant or an employer) wishing to appeal a determination made by the Unemployment Compensation (UC) Claims Adjudication Unit, the Benefit Payment Control Unit, the Wage Determination Unit, a decision made by an UC Appeals Referee (an appeals hearing officer), or a determination made by the Florida Department of Revenue (DOR). Once an appeal is validated by the Clerk s Office examiners, the case is docketed and a hearing is scheduled, any discovery requested by the parties is completed, and a hearing is held with a Hearing Referee to provide an opportunity for all interested parties to present information in support of their case. The Referee weighs the evidence (documentation as well as oral testimony presented during the hearings) and prepares a written decision which is distributed to all affected parties. Once a decision is rendered, additional opportunities to appeal the decision are available. Normally, decisions made by UC Referees may be appealed to the Florida Unemployment Appeals Commission (UAC). UAC Orders may be appealed to the Florida District Court of Appeal according to jurisdiction. In special circumstances (e.g., cases involving Disaster Unemployment Appeals), decisions may be appealed directly to the federal government s Department of Labor. AWI is statutorily mandated to collect unemployment insurance taxes, to determine employer liability, and to establish unemployment insurance tax rates for employers. Each year, AWI contracts with DOR to perform those efforts on behalf of AWI (DOR acts as AWI s agent ). Employers may appeal to AWI determinations made by DOR; these cases are referred to as Special Deputy appeals. The Special Deputy issues a recommended order to which a party may file exceptions. When the period for exceptions is completed, a final order is drafted in the Office of Appeals and signed by the Agency s Director or designee. The final order of the Agency may be appealed to the Florida District Courts of Appeal SYSTEM USE CASE CONTEXT DIAGRAM Appeals File Appeal External User Withdraw Appeal Enter Response Appeals Staff Execute Search Exhibit 21 File Appeals Context Diagram Page 23

27 Clerk s Office Intake Appeal Information Docket Appeal Examiner Remand Case Correct Decision Examiner II Execute Search Re-Open Case Withdraw Appeal Exhibit 22 Appeals Intake Context Diagram Page 24

28 Field Office Schedule Event (Hearing) Scheduler Conduct Hearing Referee Exhibit 23 Schedule Event (Hearing) Context Diagram Field Office Enter Decision Referee Deputy Clerk Exhibit 24 Enter Decision Context Diagram Page 25

29 Field Office Execute Search Enter Response Correct Decision Enter Decision Referee Modify Determination Adjudications Docket Appeal Clerk s Office Exhibit 25 Correct Decision Context Diagram Field Office Remand Case Referee Docket Appeal Clerk s Office Exhibit 26 Remand Case Context Diagram Page 26

30 Field Office Execute Search Re-Open Case Referee Modify Determination Adjudications Docket Appeal Clerk s Office Exhibit 27 Re-Open Case Context Diagram Page 27

31 Special Deputy Unit Process Special Deputy Appeals Incudes Enter Response Special Deputy Conduct Hearing Schedule Event (Hearing) Chief of Appeals Docket Appeal Clerk s Office Issue Special Deputy Final Order Agency Director Exhibit 28 Process Special Deputy Appeals Context Diagram Page 28

32 11. SYSTEM USE CASES FOR AUDIT OVERVIEW The Audit section is comprised of two distinct business units: Benefit Accuracy Measurement (BAM) and Benefit Timeliness and Quality (BTQ). Benefit Accuracy Measurement (BAM) BAM is a federally mandated program providing the basis for assessing the accuracy of Unemployment Insurance payments made to claimants and the accuracy of benefits denied to claimants. BAM is also a diagnostic tool for Federal and State workforce agency staff members to assist in error identification and causal analysis. BAM supports the Agency s desire to implement corrective actions and to track the effectiveness of those remedial actions. This is accomplished through Weekly Reviews of selected cases. Benefit Timeliness and Quality (BTQ) The BTQ unit performs a number of functions related to U.S. Department of Labor (DOL) required reporting for state unemployment insurance programs (generally known as Federal Reporting). The first of these is the Quarterly Reporting process. The determination of a claimant s eligibility for unemployment insurance (UI) benefits is a critical UI program function. When issues arise that may affect a claimant s past, present, or future benefits, the adjudicator is responsible for determining the claimant s eligibility for those benefits. Such determinations may also affect an employer s liability for benefit charges, depending on the type of issues adjudicated. The adjudicator s work impacts the rights of both claimants and employers. The BTQ unit is responsible to report quarterly to the U.S. Department of Labor (DOL) for nonmonetary claims. UC has instituted an internal quality review process under the auspices of the BTQ unit to perform periodic assessments of adjudicators in each Adjudication Hub known as the Non-Monetary Review. The information gathered through the reviews provides insight to existing or potential issues that may be causing difficulties in particular adjudication areas (e.g., separation issues). Managers can use that information to take corrective action which may include arranging for remedial training, modifying policies and procedures, and/or suggesting changes to the automated system(s) to address less than satisfactory performance. Finally, the BTQ unit is responsible for the annual Data Validation process. The comprehensive Federal data validation program is necessary to ensure the accuracy of Unemployment Insurance Required Reports (UIRR) data. UIRR data are used for economic statistics, to allocate UI administrative funding based on state workload, to measure state claimant eligibility criteria and performance in providing benefits, and to account for fund utilization. It is therefore essential that states report UIRR data accurately and uniformly. States report to DOL on a monthly and quarterly basis under the Unemployment Insurance Required Reports system. Page 29

33 11.2. SYSTEM USE CASE CONTEXT DIAGRAM Audit BAM Unit Investigator Investigate Week Intake Authorize Item BAM Supervisor Exhibit 29 Audit BAM Unit Context Diagram Review Determination Audit BTQ Unit Reviewer Validator Validate Population Download Population BTQ Supervisor Upload Population Exhibit 30 Audit BTQ Unit Context Diagram Page 30

34 12. SYSTEM USE CASES FOR CUSTOMER INFORMATION REQUESTS (CIR) OVERVIEW The Agency for Workforce Innovation (AWI) receives unemployment compensation-related requests from a diverse clientele ranging from Claimants who want to know where their payments are to highly detailed data requests from the Governor and the Legislature. These requests come to the Central Office, including the Unemployment Compensation Customer Support Center, the Claims Communications Center, the Claims Information Center, the Benefit Records and Data Release Center, as well the two call centers in Orlando (the Orlando Call Center, and the Faneuil Call Center). In the future system, customers will request information either by using the self-service portal or by using any of the other currently available methods (phone, , mail, or fax). An AWI Customer Service Agent (or the AWI Records Custodian or Designee) will assist those who need it by receiving the request and obtaining appropriate information for that customer from the Unemployment Compensation Claims and Benefits Information System (UCCBIS). The CIR use case Request Confidential Records is the only CIR use case which has defined interaction with the system. All other CIR process attributes are documented within the common or core process use cases, CIR business processes, and/or requirements SYSTEM USE CASE CONTEXT DIAGRAM Request Confidential Records Special Payments Examiner Request Confidential Records Intake Exhibit 31 Customer Information Requests (CIR) Context Diagram Page 31