AI-Powered Adjudication Assistant Streamlines Unemployment Claims Processing
Challenge
Unemployment Insurance (UI) is a joint state and federal program that provides economic stability to Utah’s workforce. Contributions are collected from Utah employers through the state unemployment program to exclusively pay benefits to unemployed workers.
However, their current adjudication process is often a reactive, slow process to gather information. Adjudicators spend the majority of their time chasing missing data points from claimants and employers rather than analyzing the details of a claim. This manual process is the root cause of the backlogs that leave thousands of citizens in financial uncertainty. When processing times lag, agencies fall out of compliance with Department of Labor (DOL) timeliness standards, risking federal intervention and damaging public trust.
In times of economic uncertainty, manual adjudication does not scale. When economic shifts cause a surge in claims, agencies are left with no way to maintain accuracy while increasing speed. This, unfortunately, leaves agencies with the hard decision between fast and accurate so that citizens are paid. The challenge is to transform a manual human-dependent workflow into a resilient and scalable adjudication process.
Solution
Novatio Solutions worked with the Utah team to implement the claimant fact finding portion of the AI Adjudication Assistant directly into the Utah Department of Workforce Services Unemployment Insurance claimant system creating a seamless experience for the claimant.
- Leveraging Google Gemini, the claimant is asked relevant questions and follow up questions according to their initial claim story and answers. The line of questioning shifts in real time using the claimant answers to generate new questions with the AI technology.
- Once the information is gathered, the AI summarizes the information gathered to present to the adjudicator. Next the AI creates a claim timeline, as well as identifies what law might be relevant to the separation.
We believe this project has the potential to help our UI adjudicators reduce the need for follow-up calls to claimants regarding their separations. We genuinely enjoyed working with Novatio Solutions and would certainly welcome the opportunity to collaborate again in the future.”
- Once all relevant information is compiled, the data is then presented to the adjudicator. The adjudicator is able to see the fact finding question and answer transcript along with the relevant law to assist in their decision.
- Every Novatio Solutions AI initiative is built on a foundation of Human-in-the-Loop oversight. Within the AI Adjudication Assistant, experts maintain full control by providing real-time validation of AI-generated insights—using a simple ‘thumbs up or down’ to calibrate and refine the system’s accuracy. With this feedback, the system allows the admin to continually train the model with real production data.
- Through Novatio’s Enhanced Enablement Services, the Utah team learned AI practices, how to support the application, and how to make enhancements.
Proof Points
- This 9 week proof of concept project was deployed on time to the Utah claims filing system for claimants to use. The Utah team developed the necessary components to integrate the AI Adjudication Assistant directly into the claims filing system. Novatio Solutions provided Enhanced Enablement Services to work with the Utah technical team on understanding the technology, as well as how to support and manage the system moving forward. Our go live was very successful all around.
- The fact finding gathered through this AI generated system is more robust and dynamic than typical standardized fact finding questions. Novatio Solutions collaborated with the Utah technical and business teams to identify the correct approach in training the AI to ask questions. Through this collaboration, the AI fact finding output is extremely successful in identifying the separation issue and then gathering the relevant information for that type of separation to assist adjudicators with their decisions. This robust fact finding decreases the need for additional fact finding, which therefore reduces the time adjudicators need in order to adjudicate a claim and reduces the amount of time for a decision.
About the Organization
Unemployment Insurance (UI) is a joint state and federal program that provides economic stability to Utah’s workforce. Through the program, individuals who are unemployed through no fault of their own may receive temporary cash benefits to help bridge the gap between jobs.
