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Business Scenario

This scenario features sample tasks performed by a call center representative. Your company may follow a different workflow according to its business requirements.

In this scenario, a call center representative for a health plan or an insurance company is handling multiple calls each day from insurance agents and members.

Typically, members call to ask questions regarding their insurance coverage. The call center representative accesses this information in the Members screen, Summary view. To enroll members in a health program, she uses the Health Programs view. To handle a request for a change of primary care provider (PCP) or a primary network or independent practice association (IPA), she goes to the Benefits view. To look at the member's provider history, she uses the Primary Care Provider History view.

NOTE:  Do not add member records in the Members screen. Use the Group Policies screen or the Individual Health Policies screen to add member records. For more information, see Individual Health Policies or Group Policies.

Members often call to request information about providers. After the representative adds provider records in the Providers screen, she can view them in both the Providers screen and the Members screen. In the Members screen, a check mark appears in the Provider field of the record, indicating that the member is a provider.

NOTE:  Do not add healthcare provider records in the Members screen. Use the Providers screen to add provider records. For more information, see Providers.

In this scenario, end users are the call center representatives. They enter information to:


 Siebel eHealthcare Guide 
 Published: 04 June 2003