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Case Study

UnitedHealthcare: Automation Transforms Legacy Systems

Highlights

  • 150M claims automated across 25+ legacy systems
  • 500,000 claims adjudicated per day
  • Over 2,500 concurrent users at peak

The Business Issue

UnitedHealthcare’s legacy claims systems are large, complex and siloed, comprised of more than 25 disparate systems. Making changes to these systems was expensive and time consuming, with changes taking up to a year to implement. The company needed its claims systems to be flexible and quick to adapt to the ever-changing consumer and regulatory environment.

The Solution

Using Pega’s well-established technology, UnitedHealthcare created a high performance claim adjudication platform that lets business and IT work together more efficiently.

The platform gives UnitedHealthcare the ability to automate outside of its existing legacy systems and process the complex medical claims that the company was unable to handle. It also inexpensively supports the agility needed to keep up with the constantly changing dynamics in the healthcare marketplace.

The Results

  • Cost savings of more than $150 million
  • Auto-adjudication increase of 5% - 10%
  • Redeployed more than 200 claims examiner positions

Today, UnitedHealthcare can process claims for members and providers faster – and with higher accuracy – while strengthening its interactions with members by giving them the ability to resolve issues quickly. The result? Improved customer service scores and higher overall satisfaction.

  • Healthcare
  • Platform
Hear how UnitedHealthcare achieved $40M in claims operations savings with Pega’s Robotic Automation and BPM Automation. | 3:51

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  • Case Study

    Download the full UnitedHealthcare case study.

  • Whiteboard Video

    Pega’s Robotic Automation and Workforce Intelligence suite delivers rapid value to organizations by discovering and automating the manual tasks that impede employee productivity, impact the customer experience, and increase processing costs.

  • PegaWorld Video

    The business and information technology teams at UnitedHealth Group collaborate to leverage a combination of robotic automation and business process management (BPM) automation.