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NEW QUESTION 20
Case Study 1 – Humongous Insurance
Humongous Insurance is contracted to process all insurance claims for a health facility that accepts the following types of health insurance:
* Health maintenance organization (HMO)
* Preferred-provider organization (PPO)
Cases are classified as new claims, claim disputes, and follow-ups. Each insured person is entitled to open 25 new cases each calendar year.
Support representatives specialize by and process claims by insurance type.
Humongous Insurance currently accepts claims only by telephone. The call center is open from
06:00 GMT to 24:00 GMT daily. Call center staff work one of the following shifts: 06:00 GMT to
12:00 GMT, 12:00 GMT to 18:00 GMT, and 18:00 GMT to 24:00 GMT.
When a case is received by email, a staff member categorizes the case as email and closes the case immediately.
* Humongous Insurance has three departments to handle claim types: HMO, PPO, and Gold.
* The company uses handwritten forms to send claims information to the correct department.
* Each department maintains a workbook to record calls received.
Requirements. Support desk
* Configure the system to track the number of insurance claims filed each year.
* Categorize claims by type as they are opened.
* Configure the system to track staff responsiveness to service-level agreements (SLAs).
* Ensure that business hours reflect the hours that support staff are scheduled.
Requirements. Case handling
* All new cases must be automatically placed into a queue based on insurance type after the type is selected.
* All insurance types need to be automatically moved to the proper queue when the subject is picked.
* All cases must be created and closed immediately when received.
* The status reason must be set to Email Sent or Phone Call.
* Information must be restricted by insurance and phone call type.
* Managers must be alerted when customers reach their limit of 25 cases for the year.
* Changes to cases must not be counted against entitlements until the case is closed.
* Claim disputes must be categorized as low priority.
* The status for all disputed cases must be set to Review by a Manager before a disputed case may be closed.
Requirements. Knowledge base
* A knowledge base must be used as a repository for all answers.
* Representatives must be able to search the knowledge base when opening a new case for similar claims.
* Representatives must be able to search across all entities at all times.
* Searches must check any field in the entity for matches in a single search.
* Searches must return results in a single list and sort the list so that the most relevant results appear at the top of the list.
* Representatives must be able to link the knowledge base to cases when applicable.
* Representatives must create a new knowledge base article if an answer is not found in the existing knowledge base.
* Representatives must be able to use SQL-like syntax to search the knowledge base.
Requirements. Service-level agreements
When a customer calls to open a claim, the company must respond to the caller within the following time frames:
* Cases must be flagged when they are past the SLA threshold.
* An email alert must be sent to the manager to indicate an SLA noncompliance.
* An email alert must be sent to representatives for SLA violations as follows: HMO 2 hours prior and PPO 1 hour prior.
* Send an email alert to support managers when disputes are ready to be closed.
* Send an email alert to customers when cases are closed.
* The current process is all manual and not efficient.
* There is no easy way to determine whether the company is meeting its SLAs.
* Representatives are often inconsistent regarding how they handle customers and answer customer questions.
* There is no accountability for any of the representatives who take calls.
A customer has three cases in process and two cases for the current calendar year.
You need to determine how many cases the customer has left on their entitlement.
How many cases are left?
- A. 0
- B. 1
- C. 2
- D. 3
NEW QUESTION 21
Note: This question is part of a series of questions that present the same scenario. Each question in the series contains a unique solution that might meet the stated goals. Some question sets might have more than one correct solution, while others might not have a correct solution.
After you answer a question in this section, you will NOT be able to return to it. As a result, these questions will not appear in the review screen.
You are implementing Dynamics 365 Customer Service for a call center. There are separate queues for level1 and level2.
You need to set up the queues to meet the following requirements:
– Users must have their own queues that no one else can access.
– Users must not be able to view each other’s queue.
– Users must be able to work from the support queue.
– Set up each user queue to be private.
– Set up level1 and level2 queues to be public and add applicable members.
– Set up the support queue to be private.
Does the solution meet the goal?
- A. No
- B. Yes
NEW QUESTION 22
You need to select which setting needs to be configured for each setup.
Which settings should you select? To answer, select the appropriate options in the answer area.
NOTE: Each correct selection is worth one point.
Graphical user interface, text, application, email Description automatically generated
NEW QUESTION 23
A company is evaluating Dynamics 365 Customer Service Insights.
The company decides to use the sample data environment to expedite the evaluation process.
You need to recommend a dashboard.
Which dashboard should you recommend? To answer, select the appropriate options in the answer area.
NOTE: Each correct selection is worth one point.
NEW QUESTION 24
You make a phone call regarding an existing case record.
You need to create a phone call activity that appears on the case record timeline.
Which three actions should you perform in sequence? Toanswer, move the appropriate actions from the list of actions to the answer area and arrange them in the correct order.
NEW QUESTION 25
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