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Case Study

Blue Shield of California: Transforming healthcare through personalized customer service

  • Pega Customer Service for Healthcare software went live in 90 days
  • Staff training reduced to just two days
  • Member satisfaction increased in first 100 days

“This is our North Star. It’s our journey of how we’re going to transform our business and become our members’ customer-trusted advisor.”

The Business Issue

Blue Shield of California, a member of the Blue Cross Blue Shield Association, is a not-for-profit mission-driven company with over 4,000 customers and 6,000 employees. This organization strives to transform a dysfunctional healthcare system into one that is worthy of family and friends.

Blue Shield of California will achieve its mission through digital transformation and with re-engineering efforts around their unified desktop, powered by Pega’s Customer Service for Healthcare.

The Solution

Designing the unified customer desktop with built-in knowledge for the employees and automated workflows for next best actions is the first step in creating a member-centric service center. The unified desktop, named Shield Advisor, is mainly used by frontline staff.

Blue Shield of California customers will be given personalized experiences and proactive next best actions tailored to their specific health benefits and needs. They will have an improved self-service experience powered by a customer 360 database that contains in-context data from Pega’s AI-powered Customer Decision Hub.

The Results

By leveraging a unified desktop, Blue Shield of California has:

  • Increased agent efficiency by integrating over 10 applications – agents no longer need to toggle between applications or log into numerous systems
  • Created a consolidated 360 member view using real-time APIs to claims and other back-end source systems
  • Achieved higher member and agent satisfaction

Related Resources

Customer Service for Healthcare

Pega Customer Service for Healthcare

Pega Customer Service

Create a simple, consistent customer experience anywhere.
Learn more

Etiqueta

Desafío: Engagement del cliente Desafío: Modernización empresarial Industry: Sector de la salud Área de producto: Atención al cliente
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