Applications for 'EDDNext - Integrated Claims Management System' are closed

EDDNext - Integrated Claims Management System

The Employment Development Department (EDD) is seeking a Request for Information (RFI) for the planning and future procurement of a modernized solution to deliver efficient workforce insurance programs and services. The goal of the solution is to provide for our customer exceptional experiences while empowering EDD to make informed and effective decisions all while maintaining federal and state regulatory compliance.

Applications are closed
Employment Development Department

Challenge

The Employment Development Department (EDD) is seeking a Request for Information (RFI) for the planning and future procurement of a modernized solution to deliver efficient workforce insurance programs and services. The goal of the solution is to provide for our customer exceptional experiences while empowering EDD to make informed and effective decisions all while maintaining federal and state regulatory compliance.


*Disclaimer
This RFI is issued for information and planning purposes only and does not constitute a solicitation.  A response to this RFI is not an offer and cannot be accepted by the State to form a binding contract.
Responders are solely responsible for all expenses associated with responding to this RFI.
Participants are advised that the responses to this RFI may be subject to the Public Records Act.  Please do not include any proprietary information in response to this RFI.
Responding to this RFI creates no obligation on the part of any Respondent to the State.  Conversely, issuing this RFI and considering the responses creates no obligation on the part of the State to any Respondent.
Submitting a response to this RFI will not enhance the review of that Respondent’s proposal(s) to any future solicitations.  Not submitting a response to this RFI will not prohibit a response to any future solicitation, nor disadvantage the evaluation of a response to any future solicitation.  By submitting a response to this RFI a Respondent is implicitly agreeing with these conditions. 


  • EDD: RFI Released_________________________09/12/2023
  • EDD: RFI Vendor Conference______________09/21/2023 2-4 pm (PT)
  • Vendor Questions__________________________09/26/2023 @ 4:00 pm (PT) 
  • Response to Questions____________________10/03/2023
  • RFI Due____________________________________10/25/2023 @ 4:00 pm (PT)
  • EDD: Evaluation of the RFI_________________11/08/2023 
 
EDD: RFI Vendor Conference
Join Online: https://us06web.zoom.us/j/83959059476?pwd=ZlhwelpKWW5QRWRPNHlBN0tJN2Z0Zz09
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Or Telephone:
    Dial: USA 636 651 3141
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    Conference code: 516343

Background

The Employment Development Department (EDD) administers several multi-billion-dollar benefit programs, including the Unemployment Insurance (UI) and State Disability Insurance (SDI) programs that provide financial stability to workers and communities. EDD enhances California's economic growth and prosperity by collaboratively delivering valuable and innovative services to meet the evolving needs of employers, workers, and job seekers. 

The EDD connects employers with job seekers, administers Unemployment Insurance, Disability Insurance, and Paid Family Leave programs, and provides employment and training programs under the federal Workforce Innovation and Opportunity Act. Additionally, the EDD collects various employment payroll taxes including the personal income tax, and collects and provides comprehensive economic, occupational, and socio-demographic labor market information concerning California's workforce. 

  • The UI Branch (UIB) administers the employer-funded UI program to provide unemployment benefits to individuals who lost their job or became partially unemployed and meet the eligibility requirements to receive benefits.  The mission of the UIB is to provide comprehensive UI services to California's workers and employers. These services sustain economic prosperity in California communities, provide partial wage replacement benefits, and offer a range of employment and training services to assist in the re-employment of workers. 
  • The Disability Insurance Branch (DIB) administers the SDI program which provides partial wage replacement benefits for California workers. The SDI program is comprised of the following components: Disability Insurance (DI), Paid Family Leave (PFL), Voluntary Plan (VP), Non-Industrial Disability Insurance (NDI), and Disability Insurance Elective Coverage (DIEC). 
  • The Tax Branch administers employer accounts, maintains tax, wages, and monetary information, and determines employer tax rates. The Tax Branch also ensures that employers promptly and accurately report data and pay revenues necessary to support services and benefits provided by the UI, SDI, Employment Training Tax (ETT), and Personal Income Tax Withholding (PIT) withholding programs. 

EDD is planning to modernize all UI, DI, and PFL business program operations. This effort is part of the EDDNext solution. EDD is seeking input from vendors for overall solutions related to the Integrated Claims Management Solution (ICMS), which will manage all aspects of claims determination, processing, payment, overpayment recovery, and claimant communications, and the Integrated Data Management (IDM) platform.

1.0 Current State:

The details about the current state capability model and technologies that support the current business operations are provided in the section below.

1.1 As-Is Capability Model:

Capabilities are defined as the combination of people, processes, and technologies necessary to produce required outputs and achieve targeted outcomes. Processes and people involved may span multiple organizational units, levels of staff, and different technology may be utilized along the way. The capability model below (Figure 1) represents the major as-is capabilities required to deliver the UI, DI, and PFL programs, inclusive of Tax Branch operations that serve and work with the benefits systems programs. Each capability falls into one of four top-level capability areas, from the back-office Resource Management capabilities, to the front-office Relationship Management capabilities, to the more hybrid Program and Service Management Capability group and the Delivery Capability group. An example is documented below.

 

 

Hierarchy Description  Example
Top-Level Classification of core business functions Relationship Management
Capability Group Identifies a family of capabilities that can be further decomposed to a set of related capabilities  Customer Service
Capability Subgroup   Identifies a group of capabilities that can be further decomposed to a more detailed set of related capabilities  Claims/Application Intake

 

Figure 1: Current State Business Capability Map

 

1.2 Technology:

The EDD possesses three independent, non-integrated benefit systems that rely, to varying degrees, on the mainframe system, as well as external sub-systems and components. EDD’s Information Technology Branch (ITB) maintains the existing benefit systems for the Unemployment Insurance Branch (UIB) and Disability Insurance Branch (DIB) which includes the UI Online System, the SDI Online System, the Paid Family Leave (PFL) application, the Voluntary Plan (VP) application, the Non-Industrial Disability Insurance (NDI) application, the Single Client Database, the UI and DI mainframe applications and related supporting applications. The ITB also supports the Tax Branch’s Accounting and Compliance Enterprise System (ACES), which interfaces with the Benefit Systems. 

In addition to the challenges of maintaining EDD’s current multiple benefits systems, the record number of claimants during the COVID-19 Pandemic has presented logistics, capacity, systems, and human resource challenges for EDD. The demand for EDD programs and the policy changes implemented during the pandemic has highlighted the need for innovative operations and system models for EDD to improve customer service while also addressing unprecedented levels of fraudulent activity. 

 

The number of interfaces relative to EDD's existing claims systems is listed below:

 

Interface Direction Relative to EDD

Number of Interfaces

Bi-Directional

61

Inbound

31

Outbound

32

Total

124

 

The number of existing systems identified to be replaced by the proposed solution to be procured are listed below:
 

Target System

Number of Existing Systems Identified to be replaced

Integrated Data Management

5

Integrated Claims Management

13

Employer Portal

4

Shared Online Claimant / Medical Provider Portal

5

Total

27

 

The existing metrics related to EDD claims and benefits paid are made available as part of the EDD Data Library (*Please use Google Chrome while opening this link). The specific data libraries related to UI and DI programs are provided below:

 

2.0 Vision:

EDD is currently undertaking a transformative modernization, the EDDNext project, to address the need for innovative operations and system models for EDD to improve customer service while also addressing unprecedented levels of fraudulent activity experienced at the height of the COVID-19 pandemic. The vision for the EDDNext project is to deliver efficient workforce insurance programs and services that provide exceptional claimant experiences and empower the Department to make informed and effective decisions while maintaining Federal and State compliance. 

Figure 2: EDDNext Vision, Strategic Objectives and Guiding Principles


2.1 Customer and User Experience

A journey map is a visual depiction of the interactions or touchpoints the claimant takes when engaging with EDD, highlighting rich insights such as channels of communication, emotional journey, and pain points captured. Upon completion of all the workstreams for EDDNext, EDD envisions the claimant having a unified experience with UI and DI programs. The intended frictionless experience is detailed in Attachment E Future State Journey Map (future state mapping will be updated in anticipation of an end-state solution).

 

2.2 Proposed Technical Architecture

One of the most significant realizations from EDD’s response to the COVID-19 Pandemic is the need to react with enough speed to implement the changes required by new policies and scale up fast enough to meet sudden spikes in demand through business and technical operations. Many of the current inflexibilities are grounded in legacy technologies that are not readily adaptable or reconfigurable to accommodate new rules. Additionally, adapting quickly to outbound notifications, onboarding, and training staff has also proven to be challenging. 

A high-level conceptual architecture was developed (image below) to depict the future state vision of EDDNext. The desired high-level solution components are listed below:

  • Integrated Data Management (IDM) platform will serve as the enterprise integration platform that will need to integrate with several investments in modern technology and capabilities that EDD has implemented or will be implementing.
  • Integrated Claims Management Solution (ICMS) will be implemented to manage all aspects of claims processing, payment, overpayment recovery, and claimant communications. 
  • Document Management System (DMS) will be implemented by EDD to improve document scanning and optical character recognition (OCR) capabilities. 
  • myEDD Portal will be leveraged by claimants from all programs, employers, and medical providers and it is currently underway.  
  • ACES is a core system the EDD Tax Branch leverages for daily operations. 
  • Integrated Contact Center (ICC) including interactive voice response (IVR), automated call distribution (ACD), and customer relationship management (CRM) is currently undergoing modernization efforts.   
  • Additional Internal and External System interfaces exist within the EDD enterprise which will need to integrate with the IDM platform.
 

 

Figure 3: High Level Architecture for ICMS, IDM, and related systems included in the EDDNext modernization

 

EDD envisions that the functionality and features of the solutions will be implemented incrementally over time following the Attachment G Hybrid Agile Framework methodology for all the EDDNext initiatives. 

EDD has successfully replaced the Tax Branch legacy systems with a modernized Commercial Off the Shelf (COTS) system known as the ACES.  The ACES system will remain in place and interface where necessary with the EDDNext solution.

2.3 Procurement Scope

 EDD desires to procure 

  • a modern, cloud-based integration platform that will leverage industry-leading practices in Data Management, Enterprise Content Management, Enterprise Integration, and Identity and Access Management to enable business process improvements across all EDD programs. 
  • a modern, cloud-based solution that will support industry-leading practices in claims management and enable business process improvements across all EDD programs. EDD intends to procure an ICMS solution that can be configured to meet the program's business needs and does not require complex coding or technical customizations.

The desired solution components that have been identified to be procured as part of this Request for Information (RFI) are detailed below:

2.3.1 Integration Platform - Integrated Data Management

Implementing a modern Integrated Data Management platform is a key component of the EDDNext project to deliver the future state vision for EDD. The technology products and services within the IDM platform will support the Integrated Claims Management solution that EDD is also building as part of EDDNext. It will also establish integrations with various internal and external systems, including data sources for real-time identity verification, portals for claimant and employer information, and the EDD tax system - ACES for employer information. 

The scope of the desired IDM solution components and functions are detailed in the Attachment B IDM Desired System Components. The system future state diagrams depict the potential future state system interactions, potential technology component options, and recommendations to be implemented as part of the EDDNext project.

The existing tools and technologies EDD might intend to use for IDM are provided as a guiding principle below for reference.  EDD is open to seeking alternatives through this RFI.

 

Existing Tools and Technologies Description 
OKTA  OKTA is the EDD standard tool for identity and access management 
Red Hat 3Scale  and API Management Red Hat 3Scale and OpenShift Container Platform are EDD’s standard tools for API management 
EDD DataCenter  EDD DataCenter is the ingress and egress point for all cloud services access 
AWS / Azure  AWS and Azure are EDD’s cloud providers 
SAS SAS is EDD’s current data analysis tool 
SQL Server (on-premise)  SQL Server is EDD’s current data warehouse database 
SSIS  SSIS is EDD’s standard Extract / Transform / Load tool 

 

EDD continues to refine the architecture to refine the solution components that reside within ICMS and IDM (e.g., future depictions may reflect shifting of components within the solution).

2.3.2 Integrated Claims Management Solution 

Implementing a modern Integrated Claims Management System is a key component of the EDDNext project to deliver on the future state vision for EDD. The ICMS will be the core claims system for EDD and will include functionality to support intake and eligibility, payments and overpayments, appeals, management of claims and claimant information, and workflow and rules to support the overall claims management process. In the future state, the ICMS components will be integrated across the UI, DI, and PFL program areas.

As such, the EDD Logical Component Model represents a structured representation of the set of functions required to fulfill EDD’s objectives and operate its business. The ICMS High-Level Logical Component Model is depicted below, which:  

  • Provides an overview of the solution functionality in scope  
  • Identifies the technical functionality needed to support business processes
  • Identifies solution interactions to support business processes

    Figure 4 ICM Module Function
    Modules: A high-level grouping of standalone functionality. This can be considered a system/sub system within the ICMS solution that could be implemented itself. 
    Functions: A specific action or capability the module will be able to perform, generate, retain, etc. These functions represent functionality and processes within each module. 

 

 

The proposed capabilities are further detailed as part of the Attachment C - ICMS Logical Component Model.

 

Figure 5: ICMS Logical Component Model A

 

The scope of the desired ICMS solution components and functions are detailed in the Attachment D ICMS Desired System Components. The system future state diagrams depict the potential future state system interactions, potential technology component options, and recommendations to be implemented as part of the EDDNext project.

EDD continues to refine the architecture to refine the solution components that reside within ICMS and IDM (e.g., future depictions may reflect shifting of components within the solution).

 

 

 

Requirements & Outcome

The mid-level requirements identified for IDM and ICMS are provided as part of the Attachment F Mid-Level Requirements. The IT and Security Guidelines are provided as part of the Attachment A - IT and Security Guidelines and Standards.

 

 

Categories

Data Collection

Budget

Budget Not Determined Yet

Application Period

September 7 through March 12, 2024 at 11:59 PM (GMT-08:00) Pacific Time (US & Canada)

Q&A Period

September 7 through March 12, 2024 at 5:00 PM (GMT-08:00) Pacific Time (US & Canada)

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