Case Study

Better Service for the U.S. Military

Serving nearly 3 million of the American Military and their Families, this Tricare benefit administrator embarked on a service transformation journey to better meet the needs of its beneficiaries. Broadly distributed across 21 states, and massively complex, the government contractor targeted gains in consistency, efficiency, personalized service, pro-active care, and one-contact resolution, and committed to providing its staff with the best tools to deliver on its promises.

Looking for technology that would accelerate innovation and deliver quality amid mounting business complexity, the Tricare administrator selected Pega Customer Service for Healthcare as its new customer care application.

Pega Customer Service for Healthcare delivered on the Tricare administrator’s goals for new efficiency and improved access, reducing time to answer member eligibility inquiries by 30% and completing authorization and referral changes three times faster. Program enrollment processing times has been slashed by 80% impacting 35 – 40 thousand beneficiaries each month. What’s more, service is consistent across and within channels with an average 4 second variation in handling time across the roughly 200,000 monthly authorization calls fielded each month.

The organization received its 5th consecutive annual contact center certification from J.D. Power and has tracked record level first call resolution rates. Most important, beneficiary satisfaction rates continue to climb as this government contractor delivers new programs and improves service leveraging Pega Customer Service for Healthcare.


  • Industry: Healthcare & Life Sciences

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