Download Guidewire ClaimCenter Professional Exam 2025 | Accurate and Verified Questions and more Exams Business Systems in PDF only on Docsity!
Guidewire ClaimCenter Professional Exam 2025 |
Accurate and Verified Questions Covering Core Claims
Handling Processes, System Configuration, Data Model,
User Interface Customization, Workflow Design | Latest
Version
What happens when a vendor manager adds documents to a vendor that has a role on a claim? ---------CORRECT ANSWER-----------------Those documents become available on that claim What happens when a newly created vendor contact is approved in CM? --------- CORRECT ANSWER-----------------A notification is sent to CC, vendor will show as in sync with CM What differentiates CC vendor contacts from CC non-vendor contacts? --------- CORRECT ANSWER-----------------In CC, vendor contacts that are edited require approval from a vendor manager on the CM side What is a shared contact? ---------CORRECT ANSWER-----------------A contact that exists in CC and CM
When can an invoice be automatically paid? ---------CORRECT ANSWER----------------
- When an invoice is entered for a service that is marked complete and there is a reserve line that CC can match the service to What is one thing that will prevent a service from being marked completed? ------- --CORRECT ANSWER-----------------If a service is quote and perform service, it cannot be marked complete without a quote being received and approved Can two different claims that use the same security profile can have two completely different access control lists? ---------CORRECT ANSWER----------------- Yes, The security profile generates a list of users based on the criteria, the users who meet the criteria vary from claim to claim A security profile can specify criteria for three types of access, what are they? ----- ----CORRECT ANSWER-----------------Own access, view access, edit access A user appears on the access control list for claim A but that user cannot view or edit the claim, how? ---------CORRECT ANSWER-----------------The user probably lacks the system permission to view/edit claims How could you easily determine the number of roles that enable users to create matters? ---------CORRECT ANSWER-----------------View the create matter permission in the security dictionary
- what is the users startup page What is the purpose of an exposure? ---------CORRECT ANSWER-----------------Used to track potential payments on one coverage for one claimant What are two mechanisms used to determine if a payment requires approval? ---- -----CORRECT ANSWER-----------------1. Authority Limits
- Transaction Approval Rules What two mechanisms are referred to as a check? ---------CORRECT ANSWER-------- ---------A physical paper check and an EFT What is a set of activities on a claim called? ---------CORRECT ANSWER----------------- A workplan What are the three types of service requests? ---------CORRECT ANSWER------------- ----1. Service only
- Quote only 3 Quote and service
What is an incident? ---------CORRECT ANSWER-----------------The 'what" that was lost or damaged What are the six assignable objects in CC base configuration? ---------CORRECT ANSWER-----------------1. Claims
- Exposures
- Activities
- Service requests
- Matter (litigation)
- Subrogation When does object assignment happen? ---------CORRECT ANSWER----------------- Object creation and manual object reassignment What are the two basic building blocks of the CC org structure ---------CORRECT ANSWER-----------------Users and groups What is the difference between a policy and a PolicyType in CC? ---------CORRECT ANSWER-----------------Policy - a product that is sold to customers, promises to pay money for specified loss types. Contract between insured and insurer
- External application (Imported by FNOL system) What are the highest and lowest levels of maturity of a claim and exposure? ------- --CORRECT ANSWER-----------------Ability to pay and New loss completion What are two attributes of a group used in determining assignment? --------- CORRECT ANSWER-----------------Group type and group region Ex. Type is kind of work the group cover like WC. Region identifies the location where the group has responsibilities What is the purpose of assignment in automated claim setup? ---------CORRECT ANSWER-----------------To determines the owner of the claim and exposures What are the 3 steps of automated claim setup? ---------CORRECT ANSWER---------- -------1. Segmentation
- Assignment
- Workplan (activities) How does CC manage a contact that has multiple relationships to a claim? --------- CORRECT ANSWER-----------------through the ClaimContact entity
What is the purpose of a reserve line? ---------CORRECT ANSWER-----------------The amount of money set aside for expected payments related to a given exposure. defined by exposure, cost type and cost category What is the main goal of adjudication? ---------CORRECT ANSWER-----------------To determine if the claim should be paid or not and if so, how much What is the total paid? ---------CORRECT ANSWER-----------------Sum of all approved payments with scheduled send date today or earlier What is the total incurred gross? ---------CORRECT ANSWER-----------------Open reserves + total payments The total of all approved reserves minus any eroding payments plus all submitted payments with a scheduled date before or on the current date What uniquely identifies a reserve line? ---------CORRECT ANSWER----------------- exposure, cost type, cost category
How many CHECK SETS are created when the payment wizard is used 1 time to pay 3 people? ---------CORRECT ANSWER-----------------One, one checkset per use of the payment wizard How many PAYMENT TRANSACTIONS are created when the payment wizard is used 1 time to pay 3 people? ---------CORRECT ANSWER-----------------Unable to determine, the number of transactions is not tied to the number of payees Does a transaction require approval if it is NOT flagged by the transaction approval rules but exceeds the users authority limits? ---------CORRECT ANSWER--- --------------Yes Does a transaction require approval if it does NOT exceed the users authority limits but is flagged by the transaction approval rules? ---------CORRECT ANSWER-- ---------------Yes Does a transaction require approval if it does exceed the users authority limits and is flagged by the transaction approval rules? ---------CORRECT ANSWER---------- -------Yes An authority limit consist of criteria and an amount. What three values can optionally be specified to create the condition? ---------CORRECT ANSWER----------- ------1. Payment type
- coverage type
- cost type What two things does CC do when it determines that a transaction requires approval? ---------CORRECT ANSWER-----------------Create and assigns an approval activity to the supervisor, sets the payment status as pending approval If you reset the value that caused the CIQ (coverage in question), is the CIQ removed? ---------CORRECT ANSWER-----------------No. only a supervisor or a user with the right permissions can remove it What is constrained if a policy is under financial holds? ---------CORRECT ANSWER- ----------------Cost type payments, expense payments can be made What are some conditions that result in CIQ? ---------CORRECT ANSWER-------------- ---- Loss date is before policy effective date
- Loss date is after policy expiration date
- The policy status is anything but in force or archived What are some conditions that cause an unverified policy? ---------CORRECT ANSWER------------------ The policy is created in CC
If Tire Town is in the address book and is associated with three claims, how many contacts have the name Tire Town? ---------CORRECT ANSWER-----------------four, one for each claim in CC and one for the entry in CM What is one of the benefits or advantages of defining services for a vendor? --------
- CORRECT ANSWER-----------------Enables better search capability from CC What is the system of record for vendors? ---------CORRECT ANSWER----------------- CM What are the 3 C's of the CC value proposition? ---------CORRECT ANSWER----------- ------Claim centric, collaborative, controlled What are the five areas of configuration in CC? ---------CORRECT ANSWER------------ -----1. Rules
- UI
- Entity names
- Data model (type lists)
- Integration
Where can you find detailed info about the CC data model? ---------CORRECT ANSWER-----------------Data dictionary What are two major benefits of minimizing configurations and using the base application? ---------CORRECT ANSWER-----------------1. shorter, less expensive, less complex projects
- A code that is easier to maintain List 3 best practices for documenting requirements ---------CORRECT ANSWER------ ------------ Create testable requirements
- Write the test after you write the requirements
- Write clear acceptance criteria
- Always review a requirement with the team before implementation Name the fields in the user story card that a BA should complete ---------CORRECT ANSWER------------------ Customer estimate assumptions
- Customer description
- Business value of modification
- User story owner
- Document control history
- Acceptance criteria
When should LOB mapping occur? ---------CORRECT ANSWER-----------------First dev sprint What are two purposes of the LOB model? ---------CORRECT ANSWER-----------------
- Data collection in CC (screen flow)
- Data roll up for reporting Name three differences between gosu and business rules ---------CORRECT ANSWER-----------------1. Business rules can be configured in the UI, gosu is configured in studio
- Business rules are limited to creation of activities, history records and changing entity fields, gosu rules can do anything
- Gosu rules are written by devs, business rules are written by BAs and administrators What is the difference between round robin and weighted workload assignment? ---------CORRECT ANSWER-----------------Round robin - assigns work the the next user in a cyclical fashion without regard to the quantity or complexity of the users workload Weighted workload - calculates a value for the current workload of each user in the group and assigns new work to the user with the lightest workload What does CC automatically assign in the base configuration? ---------CORRECT ANSWER-----------------1. claims
- exposures
- activities
- matters (litigation)
- subrogation
- service requests Organizational Structure - What are groups? ---------CORRECT ANSWER--------------- --Groups organize an insurer's employees Ex. Main office department that contains divisional offices that control local offices Organizational Structure - What are users? - --------CORRECT ANSWER----------------- Users are people permitted to log into ClaimCenter (belongs to at least one group) Organizational Structure - What are users characterized by? ---------CORRECT ANSWER-----------------Credentials, roles, authority limits, location information, group membership, experience level LOB Model is defined in what six types? ---------CORRECT ANSWER----------------- LossType, Line of Business, PolicyType, CoverageType, CoverageSubtype, ExposureType
How to constrain payments? ---------CORRECT ANSWER-----------------Authority limits Constraints defined to require approval above a set amount. What to constrain for payments? ---------CORRECT ANSWER-----------------Any transaction (payment, reserve, and so on) What is an authority limit? ---------CORRECT ANSWER-----------------Restricts the transactions an adjuster can create without approval Ex. limit type, policy type, coverage, cost type, payment amount What do transaction rules use? ---------CORRECT ANSWER-----------------Gosu code and a configuration level solution What three conditions result in financial holds? ---------CORRECT ANSWER----------- ------Coverage in question (CIG), claim incident only, claim policy unverified What is a vendor tag? ---------CORRECT ANSWER-----------------Helps identify contacts as vendors in ContactManager What are the five security types each with its own profile? ---------CORRECT ANSWER-----------------Unsecured claim (requires no special restriction), employee
claim (has been filed by an employee of the carrier), fraud risk (high risk of being fraudulent), sensitive claim (considered sensitive), and under litigation claim (currently under litigation). Value proposition of ClaimCenter (3 things) ---------CORRECT ANSWER----------------- Claim-centric, collaborative, controlled What is configuration? ---------CORRECT ANSWER-----------------Modifying the base application behavior to support specific business requirements What should a business requirement have? ---------CORRECT ANSWER-----------------
- Be stated in a way that clearly communicates what the business is trying to achieve
- Have acceptance criteria to verify that the requirement has been met
- Be a detailed description of how a business needs CC to handle claims
- Have a clear value to the business
- Be business focused not system or implementation oriented How is value alignment achieved? ---------CORRECT ANSWER-----------------1) Prioritizing value
- Map value to scope
- Deliver value
