The Challenge

Time consuming claims processing.

There was significant time required to complete end-to-end claims processing, and a very manual process involved with assigning claims to respective specialists to complete. They also struggled to have visibility on the settlement process for claims.

The Solution

Transformation through the Pega platform.

A solution was envisioned that utilized the Pega Claims Management Tool, which provides the seamless data-flow from one system to another and provides the clear visibility of each step involved in workflow.

The Credera team spearheaded the Pega Claims module, which forms the face of the application and provides process visibility, control, and business validation. Credera leveraged Pega 8.4.3 customer service framework to manage the claims process, incorporating business validation and integration with other systems (ECC & LeverEdge).

The project was built using Pega Customer Service, SAP-ECC Module, and LeverEdge.

The Results

Enhancing visibility and enabling data-driven decision-making.

Several benefits of the project included:

• Significant improvement in slashing SLA process time from 1 month to 1 week.

• High volume claims management systems with vertical and horizontal scaling.

• Intelligent routing for DT/MT customers based on a configurable matrix.

• Enhanced process visibility and control throughout the claims management lifecycle.

• Enhanced control and validations for robust data propagation to upstream and downstream systems.

• Timely notification / communication to internal and external stakeholders.