Pega Customer Service for Insurance PRODUCT OVERVIEW 7.31

Transcription

1 Pega Customer Service for Insurance PRODUCT OVERVIEW 7.31

2 2017 Pegasystems Inc., Cambridge, MA All rights reserved. Trademarks For Pegasystems Inc. trademarks and registered trademarks, all rights reserved. All other trademarks or service marks are property of their respective holders. For information about the third-party software that is delivered with the product, refer to the thirdparty license file on your installation media that is specific to your release. Notices This publication describes and/or represents products and services of Pegasystems Inc. It may contain trade secrets and proprietary information that are protected by various federal, state, and international laws, and distributed under licenses restricting their use, copying, modification, distribution, or transmittal in any form without prior written authorization of Pegasystems Inc. This publication is current as of the date of publication only. Changes to the publication may be made from time to time at the discretion of Pegasystems Inc. This publication remains the property of Pegasystems Inc. and must be returned to it upon request. This publication does not imply any commitment to offer or deliver the products or services described herein. This publication may include references to Pegasystems Inc. product features that have not been licensed by you or your company. If you have questions about whether a particular capability is included in your installation, please consult your Pegasystems Inc. services consultant. Although Pegasystems Inc. strives for accuracy in its publications, any publication may contain inaccuracies or typographical errors, as well as technical inaccuracies. Pegasystems Inc. shall not be liable for technical or editorial errors or omissions contained herein. Pegasystems Inc. may make improvements and/or changes to the publication at any time without notice. Any references in this publication to non-pegasystems websites are provided for convenience only and do not serve as an endorsement of these websites. The materials at these websites are not part of the material for Pegasystems products, and use of those websites is at your own risk. Information concerning non-pegasystems products was obtained from the suppliers of those products, their publications, or other publicly available sources. Address questions about non-pegasystems products to the suppliers of those products. This publication may contain examples used in daily business operations that include the names of people, companies, products, and other third-party publications. Such examples are fictitious and any similarity to the names or other data used by an actual business enterprise or individual is coincidental. This information is the property of: Pegasystems Inc. One Rogers Street Cambridge, MA USA Phone: (617) Fax: (617) Pega Customer Service for Insurance Document: Product Overview Software Version: 7.31 Updated: November 2017

3 Contents Product Overview... 1 High Level Functionality... 3 Omni-channel Interactions... 3 Inbound and Outbound Phone Calls... 3 Pega Chat*... 4 Mobile Interactions*... 6 Self-Service Interactions... 6 Decisioning/AI Driven Channel Personalization Social Channels Back Office Interactions Cross-Channel Customer History Inbound Correspondence ( , Fax, White mail) Customer Engagement and Support Operator Presence Pega Knowledge Management* Guided, Intent-Driven Processing Next Best Action Suggestions* Composite View Customer Inquiry Pega Co-Browse* Satisfaction and Net Promoter Surveys Search Anonymous Customer Support One-and-Done Service Process Automation Notifications (SMS, Push, ) Comprehensive Audit Trail Service Level Management Wrap Up Dialog Coaching Tag and Follow Cases... 21

4 Unified CRMI* Support for B2C, B2B, B2B2C, and B2B2B Interactions Role-based Features & Manager Tools Reporting and Analytics Manager Tools Pega Pulse Implementation and Configuration Tools Express for Customer Service Business Rules Case Management Pega Live Data Situational Layer Cake Localization / Language Packs* Accessibility Deployment Options Pega Cloud On-premise deployment Customer Service Requests Standard Service Requests Insurance Service Requests..32 Examples of Service Requests Data Model Pega Foundation for Insurance Data Model Roles Customer Service Roles... 38

5 Product Overview Curious about the Pega Customer Service for Insurance application? This document summarizes what you get out of the box with Pega Customer Service for Insurance: its features and benefits, it s out of the box list of service cases, data model options, and the various pre-configured roles and portals. Pega Customer Service for Insurance is an enterprise customer service application that is part of the Pega Customer Relationship Management for Insurance family of products. It consists of separate but complementary front-office (i.e. the customer engagement center) and back-office portals allowing customer service representatives (CSRs) to manage customer service cases and interactions. Depending on the licensed Pega Customer Service for Insurance edition, the application could also include powerful capabilities for chat, social engagement, knowledge management (both curated knowledge and community interactions), self-service web and mobile experiences via mashup, Insurancespecific processes and data models, and other capabilities and supporting features that will be outlined within this overview document. The Pega Customer Relationship Management for Insurance application suite provides a single, unified, familiar interface for customer service employees, addressing both key customer service functions and through our unified CRM model, sales and marketing tasks that can be initiated within the Contact Center. It anticipates customer needs, and automates or intelligently guides each step of a customer interaction in any channel, to quickly address individual questions and needs while also rapidly and continuously evolving the broader customer service experience. Pega Customer Service for Insurance helps you address key tenets driving Customer Service excellence. Increase Customer Satisfaction & Customer Engagement Reduce customer effort by meeting the expectations of customers in a single, consistent conversation across the entire customer journey. Make Employees More Productive Bring information from all interaction channels into a unified desktop application so employees can work faster. Pega can also guide users through service processes based on customer context to provide a personalized service experience, solving customer issues the first time. Empowering your employees to be more productive leads to reduced agent attrition. Drive Revenue & Retention By powering your Pega Customer Service for Insurance solution with the power of the Artificial Intelligence-based Pega Customer Decision Hub, you can guide agents in real-time Pega Customer Service for Insurance 7.31 Product Overview 1

6 with contextual recommendations on the Next-Best-Action during live interactions including the right marketing offer or the best retention strategy meeting each individual circumstance. This makes even novice CSRs as good as your brightest and best. Rapidly Deploy and Continuously Adapt Pega is easier and faster than traditional CRMI applications to change and adapt to changing business requirements, such as new products, channels, devices, policies, and procedures. Pega Customer Service for Insurance 7.31 Product Overview 2

7 High Level Functionality Pega Customer Service for Insurance provides a rich set of features designed to enhance the customer experience, improve user productivity and increase customer satisfaction. Key capabilities and features of the application are described below. Omni-channel interactions Pega Customer Service for Insurance includes integrated, multi-channel support for customer interactions on telephone (inbound and outbound), web and mobile chat, cobrowse, , various social channels, web self-service, fax, and white mail service interactions. We deliver capabilities for many of those interactions to cross channels without loss of context, getting your end-customer to resolution faster, without fuss or friction. Inbound and Outbound Phone Calls Pega Customer Service for Insurance provides support for inbound and outbound phone call interactions. Inbound calls can be initiated manually, or through integration with telephony applications your existing CTI providers using Pega Call. Outbound interactions can be initiated manually, or outbound call cases can be created by other processes. For example, in case of proactive customer retention we will automatically queue outbound cases that can be pushed to users and initiate outbound call interactions to negotiate retention. Telephony Integration using Pega Call* Pega Call provides Computer Telephony Integration features (CTI) to make contact center users more efficient by enabling them to easily control and manage calls from a single application. Pega Call enables seamless transfer of call information and events from telephony applications (including IVRs) to Pega Customer Service for Insurance. CSRs receive contextual notifications (screen pops), can manage their own availability, and can manage calls (hold, transfer, conference, make calls, etc.) all from functionality embedded in their user portal. Pega Customer Service for Insurance 7.31 Product Overview 3

8 Pega Call integrates with the most popular CTI options on the market, and newer cloud based CTI options like Amazon Connect. Pega Chat* Pega Chat broadens omni-channel customer engagement by providing effective and efficient customer service on the web and on mobile devices. Chat has become a key channel of preference for many end-customers given its frequent close proximity to selfservice options within the online experience, making it an attractive and low friction escalation channel. Chat allows customer service representatives to interact with customers from your web site by engaging in a text conversation to address one or more questions. Pega Customer Service for Insurance 7.31 Product Overview 4

9 Pega Chat is integrated seamlessly into the Interaction Portal providing CSRs with the capabilities needed for engaging with a customer. Pega Chat includes a number of rolebased features that help deliver an efficient and effective experience for all parties: Initiation options: Supports the ability to serve both reactive (end customer initiated) or pro-active (Pega invites the end customer into an engagement) chat. Document sharing: End users can share attachments with a CSR, potentially shortening the length of an interaction by providing details that cannot be otherwise easily clarified through text. Live spelling correction: Both end users and CSRs can benefit from in-browser spelling corrections. Pega Chat provides CSR facing tools that help make responses consistent and efficient: Dynamic response pre-fill: Dynamic common phrases allow CSRs to quickly respond to customer specific questions with highly personalized responses, without time-lengthy and error-prone rekeying of information. URL Page Push: Page push allows CSRs to direct customers to sources of content that may help address their questions. Dialog prompts: Dialog prompts (scripting) can be added to the conversation on the click of a button. We ll cover dialog and coaching tips in more detail later. Express History selections: Customer enquiries on information shared to the CSR in the Composite view can be shared with end-customers and captured for auditing purposes through a single click. AI Augmented Agent suggestions: Save time on each Chat interaction by suggesting content (knowledge articles, common phrases and page push links) to the CSR as they interact with a customer, reducing the amount of time spent researching and preparing responses. Shortcut keys: Allow the CSRs to accept, decline and send messages quickly via predefined shortcut keys. Queue or CSR Transfer: Allows the CSR to transfer chats to other queues or to selected, available CSRs for specialist assistance. One-click Co-Browse Initiation: Integrated co-browse features allow CSRs to initiate co-browse requests right from the chat UI. Pega Customer Service for Insurance 7.31 Product Overview 5

10 Real-time Sentiment Summary: Real-time sentiment detection gives CSRs visibility to real-time indicators on customer sentiment and sentiment trends.** Chat Supervisor Monitoring: Allows supervisors to monitor and take action when required (see the later role-based features for details). In addition to features that are enabled for different users, another key feature that has a big impact on the usability of the Pega Chat solution is its ability to preserve chat state across pages. As long as the pages being navigated are tagged for Pega Chat, any page push to a different page on the site, or customer initiated navigation out of the page where Chat was initiated, will allow the chat to continue across different web pages. Mobile Interactions* Pega Customer Service for Insurance includes support for tablet devices, to serve customers in person, or to enable supervisors and managers to be mobile and provide assistance to users in the contact center. When accessed from a mobile web browser, Pega Customer Service for Insurance provides a touch-friendly mobile portal that provides access to customer history and relationship detail, customer interactions and service processes. Self-Service Interactions Web/Mobile Mashup* With Pega Web Mashup, you can easily add a Pega-built process to an existing mobile or web app. By embedding capabilities such as a service request case within your self-service experience, you can deliver a consistent customer experience without needing to make process changes in multiple places. Self-Service Advisor Drive Greater Engagement while Deflecting Inbound Service Events Self-Service Advisor combines a number of customer facing self and assisted service options (Pega Knowledge, Pega self-service cases, Pega Chat and Co-Browse and Customer Decision Hub (CDH)) in order to provide contextual, inline help throughout the customer s online journey across your web and mobile experience. This has the benefit of providing service in context to what the end-customer is attempting to do, reducing the likelihood of abandonment and inbound calls to your contact center. When an end-customer interacts with a Self-Service Advisor, it displays in an in-line window in a manner similar to Pega Chat. Pega Customer Service for Insurance 7.31 Product Overview 6

11 The Pega Self-Service Advisor capability uses the Pega artificial intelligence engine that is proven to surface service information that a customer needs at the moment of need, all in one contextual widget that can be added easily to your online journey. The Advisor supports a myriad of options for accessing the content it provides. Customers can simply click a Need Help button or tab from any web or mobile page to launch a dynamic screen overlay that presents customized links and actions. If you are looking to provide a more proactive service experience, you can also choose to open the Advisor through an API call direct from the page, or invoke the Advisor via the Customer Decision Hub. Customers can then browse this information and take immediate action such as pay a bill or buy a product all without leaving the page. For example, the Pega Self-Service Advisor can sense a customer need and surface oneclick access for: A customer seeking a Policy Loan where depending upon the amount of the loan, business rules determine whether the loan qualifies for straight through processing or whether a more complex approval process, including a thorough verification of the required form, is required. A customer looking forward to update billing option, including its frequency and method, on one or more policies, added flexibility of requesting the customer to make a payment while conducting this process, if the customer desires. This eliminates the need to initiate a separate service case for this process. Pega Customer Service for Insurance 7.31 Product Overview 7

12 Have a marketing offer that you want to present to the customer instead of a service case? You can do that too. Any self-service cases (quick actions) started but not completed in Self-Service Advisor can be transferred to a CSR, if escalated. For example, a CSR could take an incomplete selfservice case and drive it to completion if the end customer requests to chat. CSRs also have visibility to knowledge articles viewed by an end-customer during their advisor session. Knowledge Self-Service Portals* Pega Knowledge provides a self-service site, supporting a mashup with your existing selfservice web pages. Help sites can be quickly configured, styled, and branded using the configuration tools in the authoring portal. The configuration tool automatically generates the HTML needed to quickly integrate the help site with your self-service pages, and SEO capabilities can be enabled to allow for quick indexing by your preferred external search engines. Both official curated knowledge (articles) and/or community functionality (discussions) can be delivered through Pega Knowledge. REST APIs are also available for customers who want to extract and display content external for display outside of mashups. Pega Communities* Pega Communities (a component feature set of Pega Knowledge) allows your customers, partners, and employees to collaborate and to explore and discuss solutions to common questions and issues. Pega Community members can leverage not only the expertise of their fellow customers and contact center experts, but also have access to your Pega Pega Customer Service for Insurance 7.31 Product Overview 8

13 Knowledge articles alongside community discussions, further helping customers help themselves. The community capability comes pre-packaged with functionality that allows customers to follow and participate in conversations (or flag content they don t feel meets community standards). Extensive moderator facing functionality enables community owners to properly enforce community standards of behavior. A moderator can edit, quarantine or remove discussions and lock, ban or community members involved in an infringement. The moderator can also enable profanity checker functionality that can read every discussion entry, and warn users and mask content that doesn t meet community standards. The Moderator also has workbasket functionality for posts and responses flagged by community members. Pega customers also have the ability, if they so wish, to appoint external Moderators from their pool of super-users, who can perform the role without using Pega portals or licenses. Community functionality extends from your community web pages back into the Interaction Portal. CSRs can see the activity of active community members, when they reach into the Contact Center for assistance, and even respond to a community thread if needed and mark it as a best answer if appropriate. Pega Customer Service for Insurance 7.31 Product Overview 9

14 Finally, Knowledge authors can also benefit from community interactions through content harvesting of community threads. Community replies that are marked as "best answer" are automatically routed to the knowledge authors as a content candidate. Authors determine if the best answer would be of value to other customers or employees as a knowledge article and can promote the best answer as a draft article that can be edited and published to the enterprise and knowledge help sites. Decisioning/AI Driven Channel Personalization Pega Customer Service for Insurance provides a number of capabilities that deliver highly personalized self-service interactions through voice and text channels. Next Best Action APIs for IVR personalization If your business has a modern Interactive Voice Response (IVR) capability that allows for dynamic menu personalization and you would like to deliver tailored IVR scripting to different customer segments, then Pega Customer Service for Insurance can be used to meet those needs. Pega provides the ability to take intelligent guidance (the next best Pega Customer Service for Insurance 7.31 Product Overview 10

15 action to take with a specific customer), along with customer data from Pega Customer Service for Insurance and feed that into an IVR in real-time, delivering a personalized experience and increasing the likelihood that the customers question can be answered before they are escalated. This capability is packaged as APIs enabling Pega and modern IVR solutions to talk to each other and build dynamic experiences personalized to every customer. Pega, through Customer Decision Hub, provides a UI for designing the next best action strategies you wish to use specifically for IVR interactions. Facebook Messenger and Web Chatbot Pega Customer Service for Insurance provides the ability to automate your service cases for deployment into either Facebook Messenger or your web-site, to deliver a conversational self-service experience to customers. Regardless of the delivery point, each conversation is treated as its own interaction. All dialog and selections made through the conversational interface are logged as part of case history. Natural Language processing is utilized to determine what the customer wants to accomplish and directs them to the correct case interaction or knowledge article. What happens when a customer can t self-serve? In circumstances where a customer interaction is not executing successfully, negative sentiment is detected, or a customer asks to interact with a live agent, the interaction can be transferred into a CSR-enabled Pega Customer Service for Insurance 7.31 Product Overview 11

16 interaction through Pega Chat. As with other channels, any partially completed cases and the full transcript of the self-service interaction get shared with the assigned CSR. Social Channels Social Engagement* With Pega Social Engagement, customer service teams can work together to engage and respond to customers on social media sites like Facebook and Twitter, through public posts and responses or using private messages (or a combination of both). Pega uses advanced text analytics to cut through social media noise and extract only those conversations that matter. The harvesting and filtering technology of Pega Platform detects key elements from social posts, such as sentiment**, topics and even the influence of the social customer. That way your team can listen for meaningful social posts and offer timely and appropriate responses. Back Office Interactions In many situations, omni-channel interactions that reach your contact center also need to extend beyond the front-office for fulfilment and resolution. The Back Office Portal in Pega Customer Service for Insurance provides administration and management for back office service case operations with key features shared with front-office operations activities performed in the Interaction Portal. The Back Office portal provides all the features of Customer Service that are required for back-office including followed cases, tagged cases and advanced search. Integrated natively & seamlessly with its front-office equivalent, transactions can be handed off from back-office to front-office service personnel and viceversa. Pega Customer Service for Insurance 7.31 Product Overview 12

17 Cross-Channel Customer History Pega Customer Service for Insurance automatically records detailed interaction history to provide users insight into what actions were taken on behalf of a customer during an interaction, what the status and outcome was on any service request, as well as visibility to self-service actions that the end-customer has taken. The omni-channel capabilities of Pega Customer Service for Insurance ensure visibility of these customer interactions regardless of channel. Whether your customers are getting answers on a web self-service site, a mobile device, or working directly with your CSRs via one of our assisted service channel options, users always have full visibility to customer interaction history. When interactions cross channels (from self-service to assisted service for example) cases started in one channel can be continued in other channels, without loss of context. CSRs even have the ability to see upcoming events for an end-customer, like a scheduled marketing event or service renewal. Inbound correspondence ( , Fax, White mail) interactions** Pega Customer Service for Insurance can receive, route and process interactions from customers. We support threading, private note capabilities and templated responses. Pega Customer Service for Insurance 7.31 Product Overview 13

18 Pega supports advanced NLP analysis of each and every incoming , removing the need for CSRs to read, triage and manually route . This enables automated routing based on content categorization or by sentiment (so that frustrated customers can be handled by specialist teams, as appropriate). In addition to routing, we also support the ability to suggest cases based on analysis of the contents of the to assigned CSRs. If a suggestion is taken, the contents of the that apply to the case can be automatically extracted and filled into relevant case fields with a single button press. Fax and White mail interactions Integration points are also available for other correspondence options for inbound (for example, fax) and outbound (for example, white mail etc.) communications. Customer engagement and support Delivering smart, timely and personalized assisted service interactions from the Contact Center relies on doing a number of things well, including providing the right tools to CSRs. Pega Customer Service for Insurance 7.31 Product Overview 14

19 Operator presence Pega allows you to track the real-time availability of CSRs across channels. Record agent availability for phone and chat channels and leverage real-time data for actionable insight. Operator presence architecture also supports integration with other presence sources. Pega Knowledge* Pega Knowledge, in addition to its web self-service portal/mashup and Self-Service Advisor use cases noted earlier, can also be used by CSRs within the Interaction Portal in order to help ensure that high quality, consistent responses are available for CSRs to deliver to customers across every touch point and channel interaction. CSRs need knowledge at their fingertips when dealing with customer questions. Knowledge can be displayed within an expandable/retractable header within the Interaction Portal, or, if the article review requires it and the CSR has the desktop real-estate, in a separate browser window that can be resized and displayed alongside the Interaction Portal. While CSRs can search at any time, we also provide the ability for suggested articles to be displayed that map directly onto the service cases that the CSR is working, reducing the research investment for the CSR and the length of the resulting interaction. Suitably privileged CSRs can suggest new articles through the same knowledge viewer. CSRs working on text channel interactions can also share links or article text through those channels with end-customers. Guided, Intent-Driven Processing With Pega Customer Service for Insurance, intent-driven processing guides users through every customer interaction reducing training time and ensuring service consistency. Service processes can be specialized to the customer and circumstance, enabling personalized service for customers, but without compromising efficiency. Pega Customer Service for Insurance 7.31 Product Overview 15

20 Next Best Action Suggestions* During self or assisted service interactions, Pega can suggest the next-best-action to take, intelligently guiding users step-by-step through a personalized service experience. To anticipate what each customer needs Pega uses a combination of business rules and the interaction s context. Customers can personalize customer strategies by leveraging the Pega Customer Decision Hub to intelligently present the right offer or next-best-action suggestion at the right time. It can even use predictive analytics and self-learning adaptive models, leveraging both small and big data. Predictive analytics enables Pega customers to design and execute marketing strategies with campaigns, inbound and outbound, and accurately predict customer behaviors to ensure the optimal offer or action is suggested for each customer. Next Best Action within Pega Customer Service for Insurance can recommend service requests, campaigns, case reviews, or upsell, cross-sell, and retention offers. With its intelligent offer management capabilities, Pega Customer Service for Insurance helps you deliver the right offer to the right customer at the right time. Pega Customer Service for Insurance 7.31 Product Overview 16

21 Composite View Pega Customer Service for Insurance consolidates relevant customer information from your legacy systems, interaction data, and service requests into a composite view of the customer relationship showing all the information that a CSR may need to act on. Customer composites provide relevant policy detail, interaction history across channels, open and recent service requests and display it dynamically based on the customer context and current situation. Customer Inquiry In some customer scenarios, the CSR needs to keep track of information that has been shared with an end-customer. Traditionally, this was done using manually typed notes during wrap-up, adding time to every interaction and reducing available time. The Customer Inquiry feature in the Composite View, allows CSRs to simply mark information to confirm that it has been shared with a simple click, so that the inquiry and delivery of that information is recorded in the audit log for the Interaction and available for subsequent review. CSRs can also select any tagged data elements as the reason for the contact when dispositioning the interaction at wrap up. Pega Customer Service for Insurance 7.31 Product Overview 17

22 Pega Co-Browse* Depending on the question being asked and addressed, there are scenarios where enabling the user to see what the customer is experiencing online can significantly accelerate issue resolution. While Co-Browse can be used both to enrich interactions with end-customers and internally (for interactions with other employees in the Back Office etc.), in this section, we ll primarily talk to how co-browse is used in engagements with endcustomers. Pega Co-Browse lets customers share their web-browser with a CSR, enabling the CSR to provide instruction, coaching and guidance to help the customer navigate a self-service portal, a complex website or complete an unfamiliar task (first auto quote etc.). The benefits of Co-Browse extend beyond issue resolution. The CSR can use highlighting or control features to show the customer how to resolve an issue themselves, and train the end customer to be more self-sufficient in the future. Co-Browse Recording: Pega Co-Browse includes recording capabilities allowing both CSRs and Managers to review co-browse sessions after the fact for quality review and training purposes. Co-Browse recordings capture highlight and control events, any page changes during a co-browse session and feature play and pause controls. Highlight and control events are also marked on the timeline. Users can click on the timeline to fast forward or rewind to key portions of the recording. This capability does NOT rely upon massive video files that eat up storage capability. Instead, the solution uses JavaScript streaming to capture changes in the UI over the course of the recorded session, keeping the recording size as small as possible. While experiences will vary depending on the complexity of the site being co-browsed, a 10-minute co-browse recording may take up as little as 100 to 200k of storage. Pega Customer Service for Insurance 7.31 Product Overview 18

23 Visual Masking; Another key feature of the Pega Co-Browse solution is its visual masking editor for removing sensitive or private content from the end-users browser in terms of what is shared with a CSR. The editor can be used to quickly hide or mask content from a CSR and is a task that is straightforward enough for a business user to perform and maintain. Masking changes and decisions are honored by the Co-Browse recording feature (anything masked or hidden on a site will honor those visibility settings when subsequently recorded). Browse Sub domains and third party content: Modern web sites can be complex animals with a lot of content splintered across different URLs and embedded from different sites in iframes. Pega Co-Browse handles these complexities seamlessly, allowing a single co-browse session to extend across sub-domain URLs and embedded iframes without the need for customization, or worse for some businesses, requiring changes to the architecture of the website. Satisfaction and Net Promoter Surveys Pega Customer Service for Insurance can automatically send satisfaction and Net Promoter surveys to customers via chat, Self-Service Advisor, SMS or at the end of an interaction, providing insight into your organization s effectiveness from the eyes of your customers. Pega Customer Service for Insurance automatically generates and assigns follow-up cases based on survey results if the scores are below a configured threshold value, offering a closed-loop feedback process with your customers. Search CSRs can quickly search for contacts, sales prospects, policies, service requests (cases), and knowledge articles through Interaction Portal search. Anonymous Customer Support For Insurance industry, many customer service use cases can be for interactions with people who are prospective rather than current customers. Maybe they ll become a customer during the service interaction, for example, if they called to sign up for a service. Or maybe they re simply looking for general information and may never become a customer. CSRs don t necessarily need to pull up a contact record for everyone they engage with in order to help. This feature makes it easy for CSRs to provide service via phone, chat, or social channels to people who don t have contact records. One-and-Done Service Process Automation Through automated best-practice service requests that are directly integrated with your legacy and back-end systems, you can resolve customer issues in real time without transferring or calling back customers, and without passing service fulfillment to the back Pega Customer Service for Insurance 7.31 Product Overview 19

24 office. That way, you deliver more efficient and effective service. Other capabilities such as automatic correspondence and service request audit trails minimize manual work and reduce time-consuming work transfer. Notifications (SMS, Push, ) Pega Customer Service for Insurance supports a number of notification options, the three most common being SMS, Push and notifications. You can send SMS notifications to your customer s preferred mobile device for service request updates such as a change in status, or include other information such as a satisfaction or Net Promoter survey link. Pega Customer Service for Insurance ships with a sample integration with Twilio as the SMS gateway interface (requires a separate Twilio account and license). You can also configure SMS notifications to interface with other SMS gateways providers. Pega Customer Service for Insurance utilizes SMS correspondence templates that you can configure, style, and brand to meet your corporate standards. In addition to SMS, the Pega platform also supports the ability to send Push Notifications. While the differences between SMS and Push are subtle, Push allows you to skip the SMS gateway and send messages direct to the mobile device. The final option for outbound notifications is . Pega allows you to send notifications to customers keeping them informed of status updates, or send satisfaction or Net Promoter surveys. correspondence templates allow you to configure, style, and brand s to meet your corporate standards and outbound communication needs. Comprehensive Audit Trail Pega cases include detailed audit trail features to record the complete life-cycle of interactions and service cases. During case processing, Pega Customer Service for Insurance automatically tracks user actions, actions by other applications on the case, and other history of the case. Audit trails can be configured to capture specific details of case processing. Audit trails provide clear, objective insight into what actions were taken on behalf of a customer during an interaction and related service cases, and any actions that move cases from the front-office to back-office. Service Level Management To help you meet important performance objectives, Pega Customer Service for Insurance provides sophisticated facilities for managing value-based service level agreements (SLA). You can assign and monitor work, ensuring that tasks are completed according to both business priority and customer value. Wrap Up Each Interaction comes with functionality allowing the CSR to wrap up the interaction. Wrap up encompasses a number of post-interaction activities. It ends the timer counting the Pega Customer Service for Insurance 7.31 Product Overview 20

25 length of an interaction, and allows the CSR to record the primary reason for the interaction, whether the interaction was related to a previous interaction, to share a copy of the interaction record with the end-customer and, optionally, to complete a proxy survey response in the case of phone interactions. Dialog The Interaction Portal comes with embedded scripting on interactions and cases, allowing the CSR to vocalize the dialog to be read, or select that dialog for display to the endcustomer when working in text interaction channels like Pega Chat. Dialog can be written to be specific to a delivery channel, skill or assignment group, making Dialog a flexible tool for personalizing each interaction to customer circumstances and CSR skill levels. Coaching Some interactions with end-customers can be on sensitive topics that need to be very carefully managed or subject to some degree of guidance on how they are handled by the individual CSR. What is communicated, how it is executed and what is not said can be points where explicit guidance is given to the individual CSR. Dialog and coaching can be offered simultaneously to a CSR if warranted. Tag and Follow Cases CSRs can tag cases and follow/unfollow the majority of cases that come out of the box with Pega Customer Service for Insurance. A tagged case allows an agent to apply a tag phrase for a case that they can subsequently search on, without having to know details on the case type, case number or customer. Saved tags can be found on the home tab in the Interaction Portal and other CSR facing portals. Follow functionality allows a CSR to keep track of a case and have it visible in their My Work list, without being the assigned operator. Once the service case has progressed beyond the point that the CSR is interested in, they can quickly unfollow the case to remove it from their My Work lists. CSRs can also unfollow cases in-bulk once all the pending activities associated to their favorite customers or accounts are completed. Unified CRMI* As one of the component applications in the Pega Customer Relationship Management for Insurance suite, Pega Customer Service for Insurance enables a rich set of CRM capabilities that include features from Pega Marketing, Customer Decision Hub and Sales Automation for Insurance applications. Pega Customer Service for Insurance 7.31 Product Overview 21

26 Key capabilities include: Customer contact and organization data synchronized automatically between sales and service on any update. Removal of artificial barriers on task access. CSRs are able to create sales leads and opportunities, for example, from the Pega Customer Service for Insurance Interaction Portal. CSRs can view the sales rep calendars and schedule appointments for customers. CSRs have rich upsell, cross-sell and retention tools from Pega Marketing. Sales reps and CSRs have a complete view of customer engagement throughout the life cycle, including marketing engagements, sales leads, opportunities and other activities, as well as customer service cases and interactions across all channels. Support for B2C, B2B, B2B2C, and B2B2B Interactions Pega Customer Service for Insurance has built-in support to manage not only Business to Consumer and Business to Business interactions, but also agent-based service scenarios like Business to Business to Consumer/Business. That way, CSRs can see the appropriate context and view of the customer, even when they are supporting multiple clients. Pega Customer Service for Insurance 7.31 Product Overview 22

27 Role-based features & manager tools Pega Customer Service for Insurance provides a rich set of capabilities outside of individual interaction and case management to measure Contact Center performance and to easily manage your Pega Customer Service for Insurance environment as business needs change. Reporting and analytics Pega Customer Service for Insurance includes a wide variety of standard reports and graphs providing real-time information regarding processes, work, assignments, and historical data for analyzing contact center KPIs over time. In Pega Customer Service for Insurance, there are two distinct report types, dashboard widgets, and analytics reports. With dashboard widgets, you can summarize bite sized snapshots of operational performance data ideal for providing quick summaries to decision makers. As a manager, you can build and publish dashboards for both your personal use and for the use of your team. The same dashboards that are exposed to Managers are also available to individual CSRs. Role-based dashboards can be published to applicable roles/access groups. CSRs, if given the privileges to do so, can even modify their own dashboards to more closely track the data points they need to be aware when performing their day to day roles. Pega Customer Service for Insurance 7.31 Product Overview 23

28 Within the Pega comprehensive reporting capabilities, powerful drill-down capabilities enable you to navigate from a summary view of your entire operation down, if needed, to the details of a single service-request case. The Contact center can also very easily create their own reports to measure business specific key performance indicators. Pega Customer Service for Insurance comes with dozens of pre-built dashboard widgets and several hundred operational reports out of the box. Manager tools Chat Queue Monitoring Pega Customer Service for Insurance provides the ability for Managers or supervisors to monitor the performance of their Chat queues, to supervise individual chat sessions or even join in and contribute to a chat. The manager will see chat activity across Chat servers and queue totals for chat, overall chat load and longest wait time. They will also be alerted if Chat wait time is outside of SLAs for the channel. After drilling into a queue, they can see activity per agent, overall chat time, and sentiment indicators for both participants in the chat. Drilling in further to monitor gives them the ability to watch the chat evolve in real time and observe any on-going co-browse interactions, if co-browse is being utilized. In cases where intervention is needed, the Chat Supervisor can join the chat as an active participant. Bulk Processing In some cases, cases may pile up with common underlying causes, or CSRs may leave the business or be unavailable and their cases need to be reassigned. Manually going in and responding or reassigning work can be a repetitive task that does not aid contact center Pega Customer Service for Insurance 7.31 Product Overview 24

29 efficiency. Managers can use the bulk processing feature to very quickly make bulk update changes. The process for making changes is straightforward. A Manager can specify filter criteria to identify the scenarios to search for and the case types to target. In the resulting list of matches, they can check the boxes on items to process. Finally, they can choose the action to perform from the possible actions provided (depending on the case type selected.). Transfers, cancellations and bulk updates are all potential outcomes based on the cases selected. Workforce Intelligence* Gain actionable insights on your teams activity inside Pega and other desktop or browser applications. Unifying Pega Workforce Intelligence within the Pega Customer Service for Insurance application, Call Centers can uncover hidden patterns of inefficiency by analyzing millions of daily interactions from any agent desktop in a dashboard view. These insights unlock the full potential of the organization s people, processes, and technology by revealing previously unseen opportunities to improve the overall customer experience, agent productivity and coach new behaviors that boost the bottom line. Quality Performance Management Pega Customer Service for Insurance provides comprehensive quality review management capabilities to evaluate and monitor employee performance against your company s quality criteria. Managers can select a sample of cases, review and score the work, and share feedback and coaching with CSRs. They can also add dynamic coaching tips to improve productivity and reduce training time by delivering real-time advice and instructions to individual employees while they are interacting with customers. Pega Customer Service for Insurance 7.31 Product Overview 25

30 Portal Co-Browsing. Managers can co-browse within the contact center with other team members to observe activities from the CSRs desktop and provide guidance. Even if they are not a co-browse enabled agent the CSR can invoke a co-browse session. When the resulting key is shared with the Manager, the Manager can quickly view the CSRs portal screen and help them to resolution. Messages and Alerts Managers and other authorized users can also send out messages and alerts. These can be configured to be system wide or to specific workgroups, marked as urgent or to be active for a specific window of time. Manager Configuration Tools Managers can adjust dialogs, coaching tips and suggested articles on a service case by service case basis. This is accessed via a manager visible drop-down on the tools menu on each case when opened. Pega Pulse In a number of situations, collaboration is needed within the business to help resolve the unexpected, to share information that improves the quality of service and also to note upcoming changes that might impact the way that work is performed. That collaboration becomes both more critical and more challenging when Contact Center members are not all physically co-located. Pega Pulse provides the ability to send notifications and collaborate around higher level business challenges within the contact center. Pulse notes are saved and preserved, and can also be tagged for easy navigation. Implementation and configuration tools Express for Customer Service Pega Express empowers business users to implement and maintain their applications through easy-to-use wizards and landing pages. Through Express, application behaviors, cases, data models, SLAs and other features can be configured easily, without writing code. Business users can model cases and interactions using business-friendly tools and execute them instantly to see the results and refine to meet the business need. Pega Customer Service for Insurance 7.31 Product Overview 26

31 Business Rules The Pega Business Process Management streamlines your operations so you can reduce costs and improve business agility, particularly when business processes extend beyond your Contact Center into other parts of the business. Pega is recognized by leading analyst firms as the most comprehensive and unified BPM platform on the market. Rules and processes automatically resolve work wherever possible. Case Management The Pega Case Management capability helps simplify and automate work. Case management helps you keep your promise to your customers, connecting all the people and systems required to resolve each customer inquiry. It tracks related information, automates and assigns outstanding tasks, and connects front- and back-office activity, for end-to-end resolution. Pega Live Data Integration with your existing systems of record are a key part of any CRM implementation. Pega customers can choose to use Pega as the system of record or information, or orchestrate that data from multiple sources for delivery through the Pega Customer Service for Insurance application. In the case of the second option, Pega Live Data simplifies the use of data in business processes by delivering the right data, in the right place, at the right time. It manages data requests behind the scenes so that data flows to Pega Customer Service for Insurance 7.31 Product Overview 27

32 the right process steps. It is easy to change and adapt for new data sources and new applications, across thousands of users. In addition, Pega has a comprehensive suite of technology-level adapters that allow Pega applications to fit seamlessly into an enterprise ecosystem. Pega supports transport or protocol-level adapters with form-based integration options, so that no custom code is required to connect to an external system. Situational Layer Cake Using the Pega Situational Layer Cake, you can automatically tailor applications to the business context in which they operate. Variation of scale is all handled in one version of the application, using a coherent layered architecture. Pega efficiently delivers repeatable, differentiated solutions by re-using common policies and procedures in multiple business units, channels, geographies, and customer segments. Localization / Language Packs* Language packs support localization of applications through use of translated field values for buttons, prompts, and labels. Language packs are available for Pega Customer Service for Insurance in Italian, French, Japanese, and German. Pega also offers a Localization wizard capability to enable customers to localize Pegabased applications, including custom fields and screens quickly and easily, and in any language. Accessibility Pega Customer Service for Insurance provides support to enable your applications to comply with requirements required by legislation like the Americans with Disabilities Act (ADA). This includes features like keyboard navigation, and the ability to support assistive technologies such as screen-readers. Pega offers the Pega 7 Web Accessibility rule set, which, when included with your applications, generates appropriate markup that is compatible with common screen readers and accessibility devices. Deployment options Pega Cloud Pega Customer Service for Insurance is available on Pega Cloud as well as on-premise, or in other configurations (either third-party cloud or private cloud etc.) through Pega hosting partners. Pega Cloud provides industry-leading infrastructure, enterprise-grade services, and operational excellence. Realize a faster time-to-value for your Pega investments and take advantage of the complete range of Pega Cloud services, from development and testing Pega Customer Service for Insurance 7.31 Product Overview 28

33 sandbox environments to fully managed production environments. You can even migrate applications from the cloud to your data centers as needed. On-premise deployment Pega supports a range of on-premise deployment options, including a number of supported database, application and web server deployment options. Please see for details. * Note: Represents a feature that may be packaged as part of one of the Pega cloud pricing editions, and not available in all pricing packages or separately licensed. Additional license fees may apply. See for details. ** Note: Pega Chat, and Social Engagement include features that leverage the Text Analytics/Natural Language Processing features of the Pega 7 Platform. If you have licensed these features, you may use Text Analytics/Natural Language features solely with Pega Customer Service for Insurance unless you have also licensed these features separately for other purposes. Contact your Pega Account Executive if you require a license to use the Text Analytics/Natural Language Processing features for other purposes. Pega Customer Service for Insurance 7.31 Product Overview 29

34 Customer Service Requests Standard Service Requests This table lists the standard service requests (SRs) available with Pega Customer Service for Insurance. Your company may choose to implement additional or alternate business processes. Service Request Add New Organization Co-Browsing Session Create Lead Create Opportunity Complaint or Compliment Dispute Transaction General Service Request Make Offer** Modify Policy Links Modify Organization Links Modify Contact Links Modify Contact to Organization Links New Contact Offer Negotiator** Description Add a new organization and have it linked to a parent organization. Collaborate in real-time with a customer through sharing a browser session and providing visual guidance on how to navigate a web site. The co-browse case maintains a history of the co-browse session, including a recording of the session (when the cobrowsing recording feature is enabled) that can be viewed as part of the customer history. Create a sales lead during a customer service interaction, both Business to Consumer and Business to Business, and route to a sales rep. Add, view, and modify sales opportunities during a customer service interaction, both Business to Consumer and Business to Business. Enter a complaint or compliment regarding a policy, product, or other issue, distributing the feedback according to the feedback type and recipient (potentially into the back office). Dispute a transaction if there are any discrepancies in charges or services. Is used to address a customer issue when there are no service request types more suitable for handling the situation. CSRs can select where to route the SR to facilitate resolution. Upsell or cross-sell to the current customer, with an offer generated by Pega Marketing. View and maintain a list of policies associated with a contact. View and maintain a list of organizations associated with a contact or policy. View and modify the contacts associated with a policy. View and modify the contacts associated with an organization. Add a new contact and authorized role to a policy. Negotiate a retention offer with a customer. Enables users to bundle multiple products together to create a custom retention Pega Customer Service for Insurance 7.31 Product Overview 30

35 Service Request Quality Review Sales Negotiator** Schedule Activity Send Correspondence Schedule Appointment Statement Copy Suggested Item Review Suggested Offers Update Contact Profile Update Organization Profile Update Organization Address Details Update Organization Communication Details **Requires Pega Marketing license Description offer, and guides them to stay within a set budget for each offer. Review customer service interactions, score the quality of the case and provide feedback to CSRs and supervisors. Negotiate a sale by upsell or cross-sell. CSRs can upsell or crosssell the bundled products to retain and increase business with a customer. Schedule an activity such as a follow-up conference call for a customer, including the start/end date, Topic, location and specify an owner or route to a Workbasket. Send correspondence via to a customer (contact or policyholder). CSRs can facilitate interactions between customers and sales reps by scheduling appointments on the sales reps behalf. CSRs can view available appointment times on the sales reps Outlook calendar. Submit a statement copy request on behalf of a contact. Review open service requests for a customer, as suggested by the system (service requests to review are configurable). Select and present cross-sell and other offers to a customer. Update contact profile information such as first, middle, and last name, date of birth, including verification settings such as SSN and security questions, and Marketing preferences. View and maintain information associated with an organization including name, tax ID, and so on. View and maintain address information associated with an organization. View and maintain communication information associated with an organization. Requires Pega Sales Automation for Insurance license Insurance service requests This table lists the Insurance service requests (SRs) available with Pega Customer Service for Insurance. These service requests are created in our Pega Service Cases for Insurance application and may be initiated in your front office or your back office. More complex service request processes that are initiated in the front office are ultimately routed to the back office for form verification, triage, approval, and resolution. Pega Customer Service for Insurance 7.31 Product Overview 31

36 Service Request Change Beneficiary Change Dividend Report a Death Claim Go Paperless Make Payment Mid-Term Amendment Personal Auto Claim Policy Loan Description A guided process for beneficiary changes on a life insurance policy that can be initiated in the front or the back office. This process includes a thorough verification of the required form, which is conducted in the back office. Note: DocuSign is implemented for this service request. A simple process that updates the current and secondary dividend options on a Whole Life policy. A claim process that enables the claimant to report the death of the policy owner. This process is built so that the claim data is passed via an API to the Pega Claims for Insurance application in which the claim is adjudicated and settled. For qualifying claims, it includes a courtesy call to the claimant regarding Express Death Claim benefits via the Outbound Call feature. A simple process that facilitates the ability to receive standard policy documents for the selected policies electronically versus by standard mail. A guided process that facilitates making a payment on one or more policies. The CSR is also provided the added flexibility of updating billing options while conducting this process if the customer desires. This eliminates the need to initiate a separate service case for this process. A guided process created in the Pega Underwriting for Insurance application, which is made available in Pega Customer Service for Insurance via Federated Case Management. It enables the user to initiate a Mid-Term Amendment for changes to the policy including its Drivers, Coverages, Vehicles, Named Insureds and its Cancellation. Policy updates are passed to the Policy System of Record for additional rating and issuance. A quick claim process that enables the insured to easily report an incident. This process is built so that the claim data is passed via an API to the Pega Claims for Insurance application where the claim is adjudicated and settled. A guided process for a policy loan which can be initiated in the front or back office. Depending upon the amount of the loan, business rules determine whether the loan qualifies for straight through processing or whether a more complex approval process, including a thorough verification of the required form, is required. Both the form verification and the approval process are conducted in the back-office. Pega Customer Service for Insurance 7.31 Product Overview 32

37 Service Request Proof of Insurance Surrender Policy Update Billing Options Update Customer Name Update Lienholder Description A simple, guided process that delivers Proof of Insurance cards for the selected vehicles on a policy to the policyholder. A guided process that surrenders a life insurance policy. It can be initiated in the front or back office, and requires a thorough verification of the required form which is conducted in the backoffice. A guided process that facilitates updating billing options, including its frequency and method, on one or more policies. The CSR is also provided the added flexibility of requesting the customer to make a payment while conducting this process, if the customer desires. This eliminates the need to initiate a separate service case for this process. A guided process that updates the customer s name. It can be initiated in the front or back office, and requires a thorough verification of the required form, which is conducted in the back office. A simple process that updates the current lien-holder information on an auto policy so that claims can be processed accordingly. Update Policy Address A guided process which updates the policyholder s various addresses (excluding insured locations) and applies any changes to the selected policies. Add Driver A simple process to support adding a new driver or editing an existing driver for an auto policy. The service case promotes the good student discount for drivers who are less than 21 years old, and supports negotiation of a lower premium by selecting a higher deductible amount. Auto Quote A guided process created in the Pega Underwriting for Insurance application, which is made available in Pega Customer Service for Insurance via Federated Case Management. It enables the user to initiate a simple auto quote. If accepted, the quote information is passed to the Policy System of Record for additional rating and issuance. Send Policy Values A guided process to send a PDF document that contains the policy information from the composite for a Whole or Term Life policy. To initiate the service case, a customer service representative (CSR) clicks the Send values button in the policy composite. The CSR can send either a printed copy of the PDF by mail or an electronic copy by . The service case automatically populates the policyholder s mailing or Pega Customer Service for Insurance 7.31 Product Overview 33

38 Service Request Com. Certificate of Insurance Description address based on their policy information, but the CSR can send the document to a different mailing address (by using an express action) or address. A guided process, in a Business to Business interaction, to download or a PDF document that contains the policy information for a Commercial Property or General Liability policy. Examples of service requests Death Claim Send policy values Pega Customer Service for Insurance 7.31 Product Overview 34

39 Update lienholder Pega Customer Service for Insurance 7.31 Product Overview 35

40 Data Model Pega Customer Service for Insurance provides common data objects to manage customer data. Some of the object types, such as Policy, expect data to be sourced from an external System of Record, others provide the choice of using Pega or an external System of Record for data storage and management. The following matrix provides the key objects used in the Pega Customer Service for Insurance and their respective Data Pages. You can use the Data Explorer in the Designer Studio to review all Pega Customer Service for Insurance Data Pages. Asterisks represent key object types that can be stored and managed using Pega as your System of Record. Object Type Contact* Insurance Policy Organization* Agent Agency Preferred Repair Shop Description The individual associated with an interaction. This could be a person associated with a business or individual policy. This object type requires data from an external System of Record. The data representing an Insurance policy. A policy is a document detailing the terms and conditions of a contract of insurance and generally has one-to-many contacts, each with different authorized roles. This object type requires data from an external System of Record. A profit center focused on product offerings and services in a market segment, which is either a stand-alone business or company entity, or part of a larger hierarchy. This object type requires data from an external System of Record. The person representing the Insurance agency that sold the insurance policy to the policyholder/owner. This object type requires data from an external System of Record. The insurance agency that sold the insurance policy to the policyholder. This object type requires data from an external system of record. The preferred repair shop within the vicinity of the policyholder. This object type requires data from an external system of record. Pega Customer Service for Insurance 7.31 Product Overview 36

41 Pega Customer Service data model For more information, see the Logical Data Relationship Model in the Pega Customer Service 7.31 Product Overview on the Pega Customer Service product page. Pega Foundation for Insurance data model The Pega Foundation for Insurance Data Model provides a starting point for organizations that are running Pega applications. The typical data that is usually referenced to external databases is provided in the Sample Data Model. Much of the data shown on the Pega Object Model will not be visible in the Sample Data Model because the best practice is for Pega to store this information within the Pega Work Item. All of the data tables represented here are also represented as standard Pega Classes. For more information, see the Pega Foundation for Insurance 7.31 User Guide on the Pega Foundation for Insurance product page. Pega Customer Service for Insurance 7.31 Product Overview 37

42 Roles Customer Service roles Pega Customer Service for Insurance supports key roles associated with contact centers. The table below describes the key roles shipped with the Pega Customer Service for Insurance application. Role CSR Manager Account Manager Advisor Admin Advisor User Web Chatbot Admin Web Chatbot User Back Office Manager Back Office User Description CSRs handle customer inquiries and service requests by phone, , chat, mail, fax or other channel, leveraging the Interaction Portal. Managers manage teams of CSRs, monitoring overall performance and operations of the contact center, leveraging the Interaction Portal. The Account Manager is responsible for specific customer accounts and utilizes the Account Manager portal in a traditional back-office role. Role and operator for configuring Self-Service Advisor through the Self-Service Advisor Configuration Portal. Role and operator for end-customer Advisor users (cases escalated into the Contact Center are initially created/owned by this role). Role and operator for configuring the Web Chatbot widget through the Web Chatbot Configuration Portal. Role and operator for end-customer Chatbot users (cases escalated into the Contact Center are initially created/owned by this role). A Back Office Manager manages team(s) of Back Office Portal users. Primary user of the Back Office Portal, responsible for processing and completing cases Role details for the Pega Knowledge product are defined separately in a Pega Knowledge specific Product Overview. Pega Customer Service for Insurance 7.31 Product Overview 38