Canada
Puerto Rico
USA
Belgium
France
UK
India
Client Background
As the largest customer-owned health insurance company in the United States, the organization delivers operational excellence and innovation across group, government, and retail business segments.
Client Need
Spread across multiple geographies and relying on different systems and processes for claims management, the client faced significant challenges, including:
Fragmented claims management systems that hindered efficiency
A pressing need for smooth, streamlined, and efficient operations
Solution
To address these challenges, our experts executed a strategy that included:
Process Automation: Automated and streamlined claims management processes
Unified Platform: Deployed the Pega workflow platform, consolidating multiple mid-office systems into a single front end
Enhanced Reporting: Provided accurate and improved customer reporting for actionable insights
Realized Benefits
The transformation yielded remarkable results, including:
Improved data quality and performance while reducing maintenance costs
A seamless claims processing experience for claim handlers
Simplified management of claims processes across different geographies and systems
Reduced customer response time from 5 days to 4 hours
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