Report of Responses to the UI Benefits Operations Self-Assessment Tool

Unemployment Insurance (UI) Benefit Operations Self-Assessment Tool: Adjudications and BTQ

Unemployment Insurance (UI) Benefit Operations
Self-Assessment Tool:

Adjudications and
Benefits Timeliness and Quality Reviews (BTQ)
This self-assessment review of the state’s Adjudications and Benefits Timeliness and Quality
Review (BTQ) functional areas will examine fact-finding, adjudications, and BTQ processes as
well as program performance. The reviewer will consult with appropriate staff in each
functional area, as necessary, to ensure accurate and complete information is reported. This will
include Unemployment Insurance (UI) administrators, IT managers, fiscal officers, office/call
center managers, adjudications supervisors, and the BTQ coordinator or reviewers.
The reviewer will provide information regarding the state’s performance for each calendar
quarter of the review period for non-monetary determination time lapse and non-monetary
determination quality for separation and non-separation issues. Use this link for more
information regarding UI PERFORMS ALPs/Performance Criteria: Acceptable Level of
Performance. Adjudications workload data will also be provided.
Upon completion of this review, the results should be shared with UI administrators, program
manager(s), and supervisors. The self-assessment findings, in conjunction with the state’s
quarterly BTQ scores, can provide a very good analysis of the state’s adjudications and BTQ
operations and performance. The results should be used to drive process and programimprovement initiatives.
A comments section is provided for each operational element, which the reviewer should use to
document any observations regarding issues identified related to that specific operational
element. This space may also be used to provide any additional information relating to a specific
question in this section. In doing so, the reviewer should reference the specific question by
number and insert the additional information related to that question.
In addition, a concluding comments section is provided at the end of the self-assessment
instrument to capture any strengths identified by the reviewer in this functional area which could
constitute a successful practice(s) to be shared with other states; any issues identified by the
reviewer in the functional area that adversely impacts the state’s performance and to identify any
possible corrective actions to address the issue; and general comments about this functional area
that are not covered elsewhere. The reviewer can provide information here that Federal
reviewers and state UI administrators can use to assess program operations and the state’s
effectiveness in providing quality services in this functional area.
Save your entries regularly as you complete the review and when you close the self-assessment
to ensure your answers are saved.

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Unemployment Insurance (UI) Benefit Operations Self-Assessment Tool: Adjudications and BTQ

SECTION 1:

Procedures, Policies, and Confidentiality

The purpose of this section is to review the policies and procedures provided by the agency for
staff to use in operating this functional area of the UI program. These are the written (in hardcopy, electronically, or both formats) standards, instructions, and guidelines that staff regularly
use in the operation of the program. The reviewer may utilize resources that include manuals,
handbooks, desk aids, computer help screens, training guides, organized collections of
procedures or policies, or other readily accessible instructions which can help staff do their work
correctly, including ETA Handbook No. 301 for guidance regarding adjudications and BTQ
reviews. Instructions will normally include general information such as compilations of relevant
laws and regulations, as well as detailed instructions for carrying out individual jobs in the
agency. Reviewers may need to look in many places to examine all relevant instructions and
consult with UI administrators, office/call center managers, adjudications supervisors and the
state’s BTQ coordinator.
The reviewer will document whether the state has policies and procedures sufficient to provide
guidance and instruction to staff that conduct fact-finding, adjudications, and the BTQ reviews.
Existing policies and procedures should be examined to determine whether they are up-to-date
and address all law changes, organizational changes and technology changes that occurred
during the review period.

Helpful Info.
Question 4: Document statutory changes only for this question, including any state and/or
Federal law changes impacting the state adjudication policies and procedures. Changes to
administrative regulations are usually the result of law changes and do not need to be
noted.
Question 7: Automated fact-finding systems the state may use are examined. Such
systems, if used, must be designed to meet BTQ standards for fact-finding.
Question 8: Obtaining a rebuttal statement when a controversy exists in the information
provided by an employer or claimant is a key element in BTQ reviews and for issuing a
quality determination, and should be addressed in the state’s policies and procedures.
Question 9: Data regarding issues created and adjudicated can be obtained from the
office/call center manager or Information Technology (IT) unit. Adjudicated issues data
should include only those cases where a valid non-monetary determination was issued.

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Helpful Info. (continued)
Question 14: The detection date of an issue may be the source of erroneous reporting; the
reviewer must determine whether the state is using the correct application of detection
date, whether it is done manually or automatically by the computer system as defined in
ETA Handbook No. 301 and ETA Handbook No. 401.
Question 15: The state’s policies and procedures must comply with Federal standards for
a “reasonable attempt” to obtain fact-finding information from claimants and employers.
Questions 16 and 17: The reviewer must determine whether the state is applying the
correct criteria for countable/non-countable determinations. To do so, it will be necessary
to ensure the criteria used by the IT unit adhere to Handbook 401.

SECTION 2:

Training

Managers/employees should possess and maintain a level of expertise which enables them to
accomplish their assigned duties. Training systems should be sufficient to ensure that personnel
understand and perform their duties properly. When reviewing training systems, the reviewer
should consult with the state’s training unit/staff and examine formal training procedures (e.g.,
the training is conducted using an established schedule and using set guidelines to make
judgments about the quality of work being produced). The state should have procedures for
identifying general and specific training needs, for developing a training curriculum and training
materials, and for delivering training as needs are identified. The reviewer must also examine
training methods used to ensure BTQ reviewers are adequately trained and that the results of
BTQ reviews are considered when determining training needs for staff that conduct fact-finding
and that adjudicate issues.
Helpful Info.
Question 7: The reviewer must determine whether the state’s training curriculum includes
training on the detection date of an issue and that the training correctly defines detection
date.
Question 8a: The reviewer may consult with the state agency’s Human Resources
department or their U.S. Department of Labor Regional Office for information regarding
merit staff regulations.

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Helpful Info. (continued)
Questions 9 and 10: These questions are asking similar questions, but about two distinct
matters. Question 9 is asking about changes in technology or operations affecting
adjudications or the BTQ review processes. Question 10 is asking about changes in laws,
program implementation, or policy and procedures affecting adjudications or the BTQ
review processes.
Question 14: The reviewer should consult with the BAM or BPC managers to determine
whether their staff adjudicates issues and, if so, whether those staff are provided formal
adjudications training.

SECTION 3:

Workload Analysis/Management Controls

The reviewer will examine the state’s ability to manage adjudications workloads, particularly
through periods of unforeseen spikes in workload, and will also review the methods used by the
state to mitigate backlogs, when they occur, to ensure the state’s ability to provide timely and
quality adjudications. The reviewer will document process-improvement initiatives aimed at
minimizing adjudications backlogs. The state must ensure that qualified staff is available to
conduct the quarterly BTQ reviews. The reviewer will interview office/call center managers,
adjudications supervisors, performance management staff, and the BTQ coordinator to
thoroughly document the state’s practices for managing its adjudications and BTQ workloads.
Helpful Info.
Question 4: If the state has a systematic plan to manage adjudications workload increases,
document the methods used and explain in the Training section how training is delivered to
supplemental staff, if used.
Question 5: If the state has a systematic plan to manage adjudications backlogs, document
the methods used and explain in the Training section how training is delivered to
supplemental staff, if used.
Question 6: The reviewer should not report backlogs caused by seasonal fluctuations in
workload, such as at the end of a school-year or an increase in construction-related claims
during winter months.

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Helpful Info. (continued)
Question 8a and 8b: Describe all business process analysis initiatives the state conducted
during the review period regarding its adjudications and/or BTQ processes, and what
operational changes have been implemented as a result of those initiatives and what
recommended changes were not implemented.
Question 9: The reviewer will report all staff classifications that conduct fact-finding for
adjudications. If the state’s processes for fact-finding are considered to be especially
effective and/or efficient, explain fully in the Comments area at the end of this section.

SECTION 4:

Performance Management

The reviewer will examine the state’s practices for monitoring program performance and
compliance with Federal and state law and regulations. Review the state’s practices for the
preparation and monitoring of corrective action plans to ensure timely and accurate submittal and
methods for continued monitoring of program performance in relation to designated milestones.
If the state has a performance management unit, the reviewer should consult with performance
management staff in addition to UI administrators, office/call center managers, and adjudications
supervisors when completing this section.
Helpful Info.
Question 2: The reviewer should consult with appropriate UI managers for information
regarding any Corrective Action Plan(s) or Narrative that the State Quality Service Plan
(SQSP) contained during the review period.
Question 3a: If the state did not meet designated milestones on its SQSP during any
quarter(s) during the review period, the reviewer will need to provide information about
why the milestones were not met from the UI administrators, office/call center managers,
adjudications supervisor(s), or performance management staff.
Question 4a: If the state has submitted multi-year CAP(s) the reviewer will document
progress made in meeting designated milestones based upon information obtained from UI
administrators, office/call center manager, adjudications supervisor(s) or performance
management staff.

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Helpful Info. (continued)
Question 5a: The reviewer will document the methods the state uses to monitor its
adjudications operations. If the state’s processes for monitoring its adjudications
performance are considered to be particularly effective and/or efficient, explain fully in the
Comments area at the end of this section.
Questions 6 and 6a: The reviewer will indicate whether the state monitors state activities
and performance in a manner or to an extent that is different than Federal requirement, for
example, pulling samples (beyond BTQ samples) of denials to review the fact-finding to
ensure staff are addressing the state requirements consistently; or, other types of activities
or other methods used to both help better inform claimants of their responsibilities and
prevent payment errors and overpayments.

SECTION 5:

Information Technology (IT)

When completing this section of the self-assessment the reviewer should consult with UI and IT
administrators and office/call center managers. IT projects relating to UI adjudications that were
completed during the review period and that are needed in the future will be detailed. The
reviewer will assess the state IT department’s delivery of programming and technical support to
the adjudications and BTQ functional areas.
Helpful Info.
Question 1a: The reviewer should describe any major IT projects that were conducted
during the review period and provide information regarding the project status, and if
completed, the success of the project. (If space is not adequate to fully respond to this
question, the reviewer may use space in the Comments area at the end of this Section.)
Question 3a: If the state had IT needs related to its adjudications or BTQ programs that
were not met, the reviewer should document the needs that were not met and the impact it
had on the timeliness and/or quality of adjudications, if any. (If space is not adequate to
fully respond to this question, the reviewer may use space in the Comments area at the end
of this section.)

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Helpful Info. (continued)
Question 4: The reviewer will report whether the state is using the SIDES system to
exchange claim and separation information with employers or employers’ third party
administrators (TPAs), and if not, why.
Question 6a: If the state uses a system to schedule and/or route claimant and employer
calls for fact-finding, describe the system being used and its features.

SECTION 6:

Claimant/Employer Access & Communication

The reviewer will examine the state’s methods for conducting fact-finding and issuing regular
and automated non-monetary determinations, if applicable. Methods used must comply with
requirements set forth in Federal law. The reviewer will consult with UI administrators,
office/call center managers, and adjudications supervisors when completing this section of the
self-assessment. The state’s methods for conducting fact-finding and issuing determinations will
be reviewed to ensure they meet Federal regulations and guidance regarding accessibility,
including UIPL No. 02-16.

Helpful Info.
Question 2: For each method the state uses for fact-finding (Internet, telephone, and inperson), the reviewer should indicate the means that are available to claimants and
employers to submit documentation for each method.
Question 3: For each method the state uses for fact-finding (Internet, telephone, and inperson), the reviewer should indicate the means that are available to provide forms to
claimants and employers for each method.
Question 4: For each method the state uses for fact-finding and adjudications (Internet,
telephone, and in-person), the reviewer should indicate the help resources that are available
to claimants and/or employers for each method.
Question 5: The reviewer will identify any issues that are adjudicated through automation
(e.g., by computer system) without human intervention.

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SECTION 7:

Operational Efficiency/Resource Allocation

Through interviews with UI administrators and office/call center managers the reviewer will
assess the staff, processes and operations supporting adjudications and BTQ reviews. The
reviewer will identify efficiencies and automation the state has used to improve operations and
provide better service to the public.
Helpful Info.
Question 1: The reviewer will provide the ratio of full-time employees (FTEs) allotted to
adjudications compared to the total FTEs of UI Benefits operations.
Question 2: The reviewer will document the methods the state uses to manage documents
submitted related to adjudications. If the state’s documents management systems or
processes are considered to be especially effective and/or efficient, explain fully in the
Comments area at the end of this section.
Question 5: If the state uses any automated processes for conducting fact-finding or
making a second attempt at gathering separation information, the reviewer should
document the methods used.
Question 6a: If the state does not have a dedicated unit that performs BTQ reviews,
explain how staff members are assigned this function to ensure reviews are conducted and
completed in a timely manner.

SECTION 8:

Staffing

The reviewer will examine organizational changes that occurred during the review period, if any,
and their effect on the state’s ability to manage its adjudications workload and to meet timeliness
and quality standards for non-monetary determinations. The reviewer should consult with UI
administrators, office/call center managers, and the state agency’s human resource manager
when completing this section of the self-assessment.

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Helpful Info.
Question 1: Staffing allocations are examined to determine whether an adequate number
of FTEs are allocated for fact-finding and adjudications.
Question 2: The reviewer will report the number of FTEs budgeted for adjudications, that
is, the positions budgeted by the state after Federal “base” allocations.
Question 3: The number of FTEs dedicated to adjudications impact the state’s ability to
meet Federal requirements for timeliness and quality of its adjudications. Dedicated FTEs
means the number of FTEs that were charged to the function.

SECTION 9:

Concluding Summary Comments

The reviewer will use the Concluding Summary Comments section to highlight the state’s
strengths and weaknesses that impact the adjudications and BTQ functional areas and to identify
issues that have not been addressed in any other section of the self-assessment. These comments
are intended to provide Federal reviewers and the state’s UI administrators with additional
insight into these program areas, focusing on methods that have proven to be successful and can
be capitalized upon, or areas where corrective measures may be needed.
The first comment area provides the reviewer an opportunity to share any examples of good
and/or exemplary operations in this functional area after reviewing each operational element.
The reviewer can use this space to identify any policy, procedure or operation that would
constitute a successful practice that can be shared with other states.
The second comment area provides the reviewer to document issues detected during the review
that are having an adverse impact on the functional area, affecting the state’s performance,
ability to meet performance standards or customer service. It is also a place to recommend
corrective actions for the agency’s leadership to consider implementing.
The final comment area in this section provides the reviewer space to share any additional
comments, concerns or observations regarding the state’s operations in this functional area.

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