Healthcare payer solutions
Put members first
Deliver a truly personalized, member-centric experience by using AI-powered customer engagement to meet members in their preferred channel and provide the information and programs members value.
Make wellness simple and engaging
Wellness programs should decrease costs, and be relevant and actionable. Enroll members, improve experiences, and keep them engaged – because engaged members are healthier members.
Proactively strengthen member relationships
Build trust in your brand. When an opportunity comes to introduce members to programs or add new members, Pega lets you arbitrate the right offer, at the right time, on the right channel.
Analyst ReportPega is a Leader in Healthcare CRM
Find out what makes Pega a Leader in the Forrester Wave™: Healthcare CRM Providers.
Resolve member inquiries on first contact
Your members deserve better. Address each member’s benefit, health, and financial inquires with simple, proactive, and personalized self-service experiences – all on the channel of their choice.
Meet your members in their moment of need
Chronic conditions and poor healthcare literacy can impact costs and customer experience. Intelligently engage your members across their entire healthcare journey with personalized interactions and care management.
Serve members with speed, accuracy, and empathy
Put members first using next best action to anticipate needs and deliver real-time insights to drive personalized experiences. Triage service volumes by extending across digital channels, making them members for life.
Deliver better service by getting more out of current systems
Your organization needs to be nimbler. Scale and reinforce your current customer service solution by building an agility layer on top of your systems of record using intelligent automation, case management, and a-healthcare-journey-at-a-time delivery model.
Automate claims to achieve operational excellence
Claims operations are the core of your business. Reduce manual touches, boost first-pass rates, and provide unprecedented administrative efficiencies – all by using smart claims management processes.
Refresh your product and benefits catalog to boost sales
Market pressures are creating opportunities for benefit design that can unlock value and deliver alignment. Enable innovative and responsive benefit designs in your product catalog with intelligent automation.
Realize services and revenue faster with targeted automation
Automate group installation, member enrollment, and provider onboarding across channels and systems. Use our packaged EDI X12 transaction tools to simplify data maintenance and reconciliation.
Enhance your legacy systems
Drive innovation, reduce transformation costs, and deliver increased ROI – using intelligent automation, robotics, and AI-powered workflows to enhance Healthcare operations.
On-demand WebinarProviding a personalized, proactive healthcare experience
Discover how your organization can personalize experiences to drive better health outcomes.
Proven solutions. Flawless healthcare consumer experiences.
Pega Customer Decision Hub
Get AI-powered, real-time, omni-channel engagement across the healthcare continuum – with software that reads the billions of signals your members generate and anticipates what they’ll need next.
Pega Customer Service for Healthcare
Serve members proactively with the personalized interactions they want, on any channel.
Pega Care Management
Enable personalized care planning and care team coordination to drive optimal outcomes across all settings – all with AI-powered, real-time, omni-channel care management.
Pega Smart Claims Engine for Healthcare
Deliver modern, intelligent automation for claims management.
Pega Product Composer for Healthcare
Simplify benefit, product development, and maintenance to quickly meet changing business needs and regulatory requirements.
Pega Sales Automation for Healthcare
Boost sales effectiveness and win rates across health insurance sales channels – with context-aware process automation and intelligent guidance.