Business Issue

Amerigroup customer care centers were burdened by multiple isolated systems and complex workflows that drove up operating costs and hampered growth, innovation and consistent customer service.

Solution

Pega Customer Process Manager for Healthcare and Pega CTI both power an integrated desktop that eliminates the need to use multiple systems and automatically applies the appropriate regulations, thereby optimizing each customer interaction. The solution is being used by 700 customer care associates and nurses located in three sites for member and provider services, authorizations, claims research and issue resolution.

Benefits

Amerigroup has achieved real business value from its Pega solution.

Improvements include:

• 15% reduction in clinical AHT
• 12.5% reduction in nonclinical AHT
• The elimination of misrouted work
• Saving the downstream claims unit 4 hours of work per day
• New customer care associate ramp-up time on pace to drop by 50%