Training and Onboarding > Quest

Quest

Quest is the DIAMOND Claim Exception workflow tool and contact manager. The Quest tool uses a PowerBuilder front-end connecting to Tuxedo and Pro*C middleware, which connects to an Oracle backend. Claim exceptions inserted into Quest are triggered based on preset rules, and each exception “case” is inserted into a queue based on the type of exception encountered and the priority.

High Level Process

  • Receive errors from claim service
    NEEDS INFO
  • Extract exception/errors from front-end
    NEEDS INFO
  • Route cases to queues
    NEEDS INFO
  • Assign priority to cases
    NEEDS INFO
  • Send information to external systems and/or databases
    NEEDS INFO
  • Autoclose cases
    NEEDS INFO
  • We are the main area for procession claims.
  • We receive enrollment, opl, member and provider data.
  • We reports out claim exceptions.
  • We support over 15 business areas.
  • We have designed 7 user interfaces for business users.