Updated Manual
What page is document review located
Page 4
Page 18
What color are the managers highlighted on the new tracker?
Blue
The time located in RED with a black bar around it, means what?
When the next report will be pulled
When do you NOT document a note within Pega?
NEVER - every claim you work should have a corresponding Pega note (Approved or Denied)
How many claims is required for the account to be escalated for potential claim abuse?
2 or more within a 12 month period
(True or False) Map search are not required to validate if Card Present transactions occurred within reasonable Cardholder radius (activity within the same state)
False
What is the priority number for Authorization Log Review
6 - Located on the Ref Sheet
If unable to action a claim due to waiting for assistance, which Decision drop down would you select within the Master file?
Escalated
What is the process once completed with your claims assigned?
Ensure all data is uploaded and inform in the chat list has been completed
Details regarding potential Claim Abuse can be utilized as evidence to link to the CH. (True or False)
True - page 15
Where can you locate Airline and Hotel criteria?
Page 15
Which rejection category does this belong to? Investigation Summary missing/inaccurate details
Decision Summary
(True or False) The pending transaction date should be listed as 10 days from the transaction date in Pega?
True
If you are rejecting a denial for 2nd time for the same reason, what is the rejection process?
Full rejection process, complete a second PDF form and ensure screenshots illustrate no changes.
(True or False) If there is history with the merchant in a different location than the Cardholder’s typical shopping pattern, the agent must be sure to provide the different store characteristics (ex: store number, location, city and state, etc)
True
What page is Fraud Guidance located on?
Page 6
Name all the Rejection Categories
Incorrect Decision
Decision Summary
Representment Summary
Merchant Credits
Document Review
Authorization Log Review
Prior Claims & Prevs Statements Review Cardholder/Merhcant Contact
Additional Research
Case Notes
What is the template utilized to ask a question within the chat?
Claim ID:
Question:
What you see/What you think the answer is:
If an agent does not upload Mapsearch to PEGA, but includes all the information from the Mapsearch, is this considered agent feedback or a rejection? What can be done to correct the issue immediately?
Feedback, upload mapsearch to PEGA and approve
What is the process if we are unable to locate a call needing review?
Call out via chat to inform assistance is needed, ensure to document within the excel
If the investigator missed Merchant credits, what details are required to be placed within the rejection?
Merchant name, amount and date
SRT agent is unsure if they should reject or approve a denial. The correction needed falls in a gray area but nonetheless corrections are needed. What is the proper Rejection Category?
Pending Review - NO ACTION IN PEGA
What two categories were updated on the tracker
Denial Decision and Rejection Category
What is the process when you see a rejection you submitted has now been written off?
Send an email to Stephanie CC Len for further review