Overview

The Benefit Inquiry Agent enables customer service teams to instantly retrieve member and plan details to answer benefit-related questions quickly and accurately. By connecting with policy administrative platforms such as Facets and integrating with Dynamics 365 Customer Service, the agent consolidates relevant data and delivers real-time responses during member interactions.

Designed for customer service representatives and member services teams, the agent eliminates the need to navigate multiple systems. It automatically retrieves contextual member and plan information, allowing agents to respond to benefit inquiries faster while improving accuracy and consistency.

Challenges

Customer service representatives navigate multiple screens to find member and plan details, slowing inquiries
Lack of automatic context increases errors
Large datasets cause slow query responses
Failures lead to missing or incomplete data

Key capabilities

Seamless initiation: Launches directly from the Dynamics 365 Customer Service interface
Automatic contextualization: Instantly retrieves member and plan profiles from D365 and external policy administrative platforms
Dynamic indexing: Creates session-based index for rapid plan summary queries
Robust fallback: Uses a pre-existing plan summary query as backup for data availability

How it works

Agent launch: The Benefit Inquiry Copilot is launched directly from the Dynamics 365 customer service interface for quick access.
Context retrieval: The agent automatically retrieves the relevant member profile and plan details from Dynamics 365 and connects to policy administration platforms such as Facets to fetch real-time benefit and plan data.
Dynamic indexing: After retrieving data from Dynamics 365 and Facets, the agent creates a temporary, session-based index table for plan summary data to enable rapid query responses.
Query handling: The agent processes benefit-related questions and provides instant, accurate answers using indexed data.
Fallback mechanism: If indexing fails, the agent uses the pre-existing plan summary query as a backup to ensure data availability.
Response delivery: The agent delivers clear, actionable benefit information back to the user in real time.

Business impact

Provides instant access to member and plan details, reducing navigation time.
Automatically applies context, minimizing errors and improving accuracy.
Speeds up responses with session-based indexing for large datasets.
Ensures uninterrupted data availability through a reliable fallback mechanism.

Who benefits

Members
Customer service representatives
Member services agents
Supervisors and team leads
Support analysts

Benefit Inquiry Agent

di Sonata Software Ltd.