Microsoft Dynamics 365 for Customer Service v1.0

You are a help desk representative for an organization using Dynamics 365 Customer Service.
Users need to search within the system for similar cases. None of the out-of-the-box settings have been changed.
You need to determine which search features are available for use by default.
Which two search features are available? Each correct answer presents a complete solution.
NOTE: Each correct selection is worth one point.

You are a Dynamics 365 Customer Service administrator.
You need to add a new status reason to the case entity.
What are two possible ways to accomplish the goal? Each correct answer presents a complete solution.
NOTE: Each correct selection is worth one point.

HOTSPOT -
You are using Dynamics 365 Customer Service. You are viewing a knowledge base (KB) article from a case record. Knowledge management is set up to use an external portal.
You need to link the article to the case and share the article with the customer.
What is the solution for each requirement? To answer, select the appropriate options in the answer area.
NOTE: Each correct selection is worth one point.
Hot Area:

You set a default entitlement for a customer.
You need to ensure that the default entitlement is automatically associated with a case.
What are two possible ways to achieve this goal? Each correct answer presents a complete solution.
NOTE: Each correct selection is worth one point.

DRAG DROP -
A Dynamics 365 Customer Service organization uses routing rules to escalate cases.
Security roles have not been modified or created.
You need to modify the routing rule set that is currently in use and enforce the principle of least privilege.
Which five actions should you perform in sequence? To answer, move the appropriate actions from the list of actions to the answer area and arrange them in the correct order.
Select and Place:

HOTSPOT -
You are a Dynamics 365 Customer Service administrator.
You must track issues submitted by customers.
You need to configure case settings for the Service Management module.
What should you configure? To answer, select the appropriate options in the answer area.
NOTE: Each correct selection is worth one point.
Hot Area:

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 a Dynamics 365 for Customer Service system administrator for Contoso, Ltd.
You need to automatically create cases from emails sent to the [email protected] email address.
Solution: Create an automatic record creation and update rule. Set the Source type to Email, and then select the queue. Configure conditions for record creation.
Does the solution meet the goal?

HOTSPOT -
You are a Dynamics 365 Customer Service administrator.
Users inform you about situations in which child cases are not working correctly.
You need to configure the system to correct the issues.
What should you do in each situation? To answer, select the appropriate options in the answer area.
NOTE: Each correct selection is worth one point.
Hot Area:

Case Study -
This is a case study. Case studies are not timed separately. You can use as much exam time as you would like to complete each case. However, there may be additional case studies and sections on this exam. You must manage your time to ensure that you are able to complete all questions included on this exam in the time provided.
To answer the questions included in a case study, you will need to reference information that is provided in the case study. Case studies might contain exhibits and other resources that provide more information about the scenario that is described in the case study. Each question is independent of the other questions in this case study.
At the end of this case study, a review screen will appear. This screen allows you to review your answers and to make changes before you move to the next section of the exam. After you begin a new section, you cannot return to this section.

To start the case study -
To display the first question in this case study, click the Next button. Use the buttons in the left pane to explore the content of the case study before you answer the questions. Clicking these buttons displays information such as business requirements, existing environment, and problem statements. If the case study has an All Information tab, note that the information displayed is identical to the information displayed on the subsequent tabs. When you are ready to answer a question, click the Question button to return to the question.

Background -
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)
Gold
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.

Current environment -
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.

Requirements. Disputes -
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:


Requirements. Alerts -
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.

Requirements. Issues -
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.


DRAG DROP -
You need to configure the system to store answers about claims.
Which four actions should you perform in sequence? To answer, move all actions from the list to the answer area and arrange them in the correct order.
Select and Place:

Case Study -
This is a case study. Case studies are not timed separately. You can use as much exam time as you would like to complete each case. However, there may be additional case studies and sections on this exam. You must manage your time to ensure that you are able to complete all questions included on this exam in the time provided.
To answer the questions included in a case study, you will need to reference information that is provided in the case study. Case studies might contain exhibits and other resources that provide more information about the scenario that is described in the case study. Each question is independent of the other questions in this case study.
At the end of this case study, a review screen will appear. This screen allows you to review your answers and to make changes before you move to the next section of the exam. After you begin a new section, you cannot return to this section.

To start the case study -
To display the first question in this case study, click the Next button. Use the buttons in the left pane to explore the content of the case study before you answer the questions. Clicking these buttons displays information such as business requirements, existing environment, and problem statements. If the case study has an All Information tab, note that the information displayed is identical to the information displayed on the subsequent tabs. When you are ready to answer a question, click the Question button to return to the question.

Background -
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)
Gold
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.

Current environment -
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.

Requirements. Disputes -
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:


Requirements. Alerts -
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.

Requirements. Issues -
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.


HOTSPOT -
You need to create and configure objects to support the requirements.
How should you configure the system? To answer, select the appropriate options in the answer area.
NOTE: Each correct selection is worth one point.
Hot Area:

Case Study -
This is a case study. Case studies are not timed separately. You can use as much exam time as you would like to complete each case. However, there may be additional case studies and sections on this exam. You must manage your time to ensure that you are able to complete all questions included on this exam in the time provided.
To answer the questions included in a case study, you will need to reference information that is provided in the case study. Case studies might contain exhibits and other resources that provide more information about the scenario that is described in the case study. Each question is independent of the other questions in this case study.
At the end of this case study, a review screen will appear. This screen allows you to review your answers and to make changes before you move to the next section of the exam. After you begin a new section, you cannot return to this section.

To start the case study -
To display the first question in this case study, click the Next button. Use the buttons in the left pane to explore the content of the case study before you answer the questions. Clicking these buttons displays information such as business requirements, existing environment, and problem statements. If the case study has an All Information tab, note that the information displayed is identical to the information displayed on the subsequent tabs. When you are ready to answer a question, click the Question button to return to the question.

Background -
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)
Gold
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.

Current environment -
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.

Requirements. Disputes -
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:


Requirements. Alerts -
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.

Requirements. Issues -
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.

You need to configure the queue for telephone-based cases.
What are two possible ways to achieve this goal? Each correct answer presents a complete solution.
NOTE: Each correct selection is worth one point.

Case Study -
This is a case study. Case studies are not timed separately. You can use as much exam time as you would like to complete each case. However, there may be additional case studies and sections on this exam. You must manage your time to ensure that you are able to complete all questions included on this exam in the time provided.
To answer the questions included in a case study, you will need to reference information that is provided in the case study. Case studies might contain exhibits and other resources that provide more information about the scenario that is described in the case study. Each question is independent of the other questions in this case study.
At the end of this case study, a review screen will appear. This screen allows you to review your answers and to make changes before you move to the next section of the exam. After you begin a new section, you cannot return to this section.

To start the case study -
To display the first question in this case study, click the Next button. Use the buttons in the left pane to explore the content of the case study before you answer the questions. Clicking these buttons displays information such as business requirements, existing environment, and problem statements. If the case study has an All Information tab, note that the information displayed is identical to the information displayed on the subsequent tabs. When you are ready to answer a question, click the Question button to return to the question.

Background -
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)
Gold
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.

Current environment -
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.

Requirements. Disputes -
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:


Requirements. Alerts -
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.

Requirements. Issues -
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.


HOTSPOT -
You need to configure the correct settings.
Which settings should you configure? To answer, select the appropriate options in the answer area.
NOTE: Each correct selection is worth one point.
Hot Area:

Case Study -
This is a case study. Case studies are not timed separately. You can use as much exam time as you would like to complete each case. However, there may be additional case studies and sections on this exam. You must manage your time to ensure that you are able to complete all questions included on this exam in the time provided.
To answer the questions included in a case study, you will need to reference information that is provided in the case study. Case studies might contain exhibits and other resources that provide more information about the scenario that is described in the case study. Each question is independent of the other questions in this case study.
At the end of this case study, a review screen will appear. This screen allows you to review your answers and to make changes before you move to the next section of the exam. After you begin a new section, you cannot return to this section.

To start the case study -
To display the first question in this case study, click the Next button. Use the buttons in the left pane to explore the content of the case study before you answer the questions. Clicking these buttons displays information such as business requirements, existing environment, and problem statements. If the case study has an All Information tab, note that the information displayed is identical to the information displayed on the subsequent tabs. When you are ready to answer a question, click the Question button to return to the question.

Background -
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)
Gold
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.

Current environment -
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.

Requirements. Disputes -
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:


Requirements. Alerts -
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.

Requirements. Issues -
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.

You need to search for answers to customer claims.
Which type of search should you perform?

Case Study -
This is a case study. Case studies are not timed separately. You can use as much exam time as you would like to complete each case. However, there may be additional case studies and sections on this exam. You must manage your time to ensure that you are able to complete all questions included on this exam in the time provided.
To answer the questions included in a case study, you will need to reference information that is provided in the case study. Case studies might contain exhibits and other resources that provide more information about the scenario that is described in the case study. Each question is independent of the other questions in this case study.
At the end of this case study, a review screen will appear. This screen allows you to review your answers and to make changes before you move to the next section of the exam. After you begin a new section, you cannot return to this section.

To start the case study -
To display the first question in this case study, click the Next button. Use the buttons in the left pane to explore the content of the case study before you answer the questions. Clicking these buttons displays information such as business requirements, existing environment, and problem statements. If the case study has an All Information tab, note that the information displayed is identical to the information displayed on the subsequent tabs. When you are ready to answer a question, click the Question button to return to the question.

Background -
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)
Gold
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.

Current environment -
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.

Requirements. Disputes -
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:


Requirements. Alerts -
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.

Requirements. Issues -
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.

You need to ensure that claim disputes conform to the defined case life cycle.
What should you configure?