Dancing with the Stars: How United Healthcare Partnered with Pega for a Five Star Rating

Dancing with the Stars: How United Healthcare Partnered with Pega for a Five Star Rating

Breakout
UnitedHealthcare logo
  • Laura Ciavola, SVP Medicare and Retirement, UnitedHealthcare

Healthcare appeals and grievances are arguably one of the most stressful areas of the business to be in because there's so much at stake, and they involve very complex cases, across multiple functions. Judged on their success in this area by CMS in a one to five star rating, United Healthcare was failing with only 37% of their membership at four-plus stars. Listen to Laura Ciavola discuss how she and her team used Pega to fix appeals and grievances, and get these operational measures performing at 5 STARS and how achieving 5 STARS on your operational measures can lift your entire Health Plan’s bottom line.