UnitedHealthcare: Automation Transforms Legacy Systems
This has proven out to be as safe and secure and comfortable a way to insert new technology onto a legacy system as I have ever come across.
- 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.
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.
- 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.