Claims Processing

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Leveraging Policyholder Intelligence to Elevate the Claims Experience

Drive Up Operating Margins with High-Efficiency Claims Processing

The Challenge: Claims organizations struggle to manage claims costs and deliver exceptional service in an environment of rigid, disconnected systems that consistently produce poor quality, inefficient manual processes and costly workarounds.

Pega’s claims processing software provides the strategic capabilities carriers need to deliver an optimized claims-processing environment from notice of loss through to claim closure. Pega leverages process automation to guide adjusters through the claims processes designed to expedite the claim adjudication, settlement and service outcomes that drive competitive differentiation. By combining rules and process with intelligent case management, insurers can easily track and manage the orchestration of complex pieces of work across operations, channels or claims functions. In addition, insurers can make claim insight actionable, leveraging embedded analytics and decisioning to automatically drive the next best action throughout claims process. These robust capabilities offer the most complete claims solution available on the market today, making it possible for carriers to dramatically reduce expenses while optimizing an adjuster’s ability to focus on speed, accuracy, fairness and compliance throughout the lifecycle of a claim.

Pegasystems — Delivering Real-World Results

  • International property and casualty insurer Chartis is standardizing its propriety claims process in over a hundred jurisdictions around the globe using Pega solutions.
  • New York Life, as part of its customer success strategy, selected Pega to automate its new business and claims processes. Starting from a totally manual approach, the company is building business processes and rules that will easily scale upward as volume grows. Using Pegasystems SmartBPM, New York Life is creating enhanced capabilities to empower the entire organization, enable more efficient business processes that can easily be customized, changed and/or reused, and to automate manual and tedious work.

Tab 1

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Pega Claims for Life Insurance

Pega Claims for Life Insurance

Key Capabilities

Gain exceptional efficiency, higher asset retention and greater compliance with intelligent, best-practice processes that deliver consistency and control.

  • Reduce processing time and costs. Automate simple claims from end-to-end with holistic case management and seamless integration to back-office and third-party systems.
  • Increase asset retention. Deliver the right offer at the right time to claimants with real-time decisioning that makes dynamic recommendations based on business driven factors such as the claimant’s asset position, responses to dynamic Q&A, projected lifetime customer value and actuarial risk.
  • Eliminate manual claims research. Automatically interrogate all policy, agent and document systems with intelligent processes that identify and assemble the required documentation.
  • Easily integrate with third-party and legacy systems to automatically gather required data and dynamically apply rules that accurately and fairly calculate the policy benefit.

Tab 2

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Pega Claims for Property and Casualty

Pega Claims 3.0 For Property And Casualty Insurers

Cut claims time, costs, leakage and fraud with dynamic, rules-driven processes that power smart claims servicing from FNOL to recovery.

Key Capabilities

  • Optimize claims handling. Ensure the application of best practices and right resources at the right time by applying rules-driven processes across lines of business, products and geographies.
  • Improve adjuster productivity. Automate core claim processes with intelligent case management so that claims operations function at the highest level of efficiency.
  • Differentiate claims service. Drive policyholder retention through intent-driven processes that adapt and respond dynamically to each claimant interaction to deliver the best outcome.