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Pega Customer Service for Healthcare

Engage patients, providers, members and prospects.

"Pega has been a flashlight for us in the darkness."
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Stellar service with
customer journey insights

Pega provides complete customer lifecycle management across sales, marketing, service, and care management. Customers experience a tailored journey as intelligent insights are delivered for every channel, every team, and every engagement setting.

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Drive staff success with
intelligent guidance

Pega anticipates what patients, providers, members, and prospects need based on context. During interactions, it intelligently suggests the next best action, guiding CSRs to deliver highly-personalized customer service in the contact center and beyond.

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Seamless transitions with
omni-channel experience

Pega equips you to meet the specific needs of patients, providers, members, and prospects by seamlessly transitioning across channels and devices without losing context of the engagement – whether it’s helping a senior checking eligibility or a provider get a prior authorization.

Optimize service with
real-time decision management

Provide consistently exceptional customer service, delivering intelligent, automated offers and next best actions based on context of the interaction and the needs of the patient, provider, member or prospect.

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Take charge with
on premise or on cloud

With Pega, you can develop a customer service capability that reflects your business while supporting HIPAA compliance. Choose traditional on-premise deployments or Pega’s cloud platform, which features a turnkey service providing immediate access to create, test, deploy, and manage applications.

Additional Product Features

Keep your promise to your customers: Pega connects all the people and systems for each engagement.

Serve your members with a robust set of member-specific services right out of the box.

Serve your providers with a robust set of provider-specific services right out of the box.

Automate intelligent appeals, grievances, and complaints management.

Automate intelligent appeals, grievances, and complaints management.

Highlight and direct customers to key information while training them to be self-sufficient.

One and Done Service Process Automation

Save time with automated issue resolution, including correspondence and service request audit trails.

Email and SMS Notifications

Keep customers informed via their preferred channel of communication with digital notifications.

Pega Social

Listen to social conversations, analyze customer sentiment, and give an appropriate response.

Satisfaction Surveys

Automatically send customer satisfaction surveys, including NPS, via SMS or email.

Comprehensive Audit Trail

Automatically track actions during customer interactions for clear insight and complete records.

Related Resources

Express Scripts: Transformation Journey PW17 Highlight

Watch highlights from Express Scripts with Bijal Parekh, Director, CRD, Express Scripts, discussing the journey of Coverage Reviews and Prior Authorization at PegaWorld 2017.

Pega Customer Service For Healthcare

Pega Customer Service for Healthcare delivers a unified platform for personalizing interactions, eliminating channel barriers, and automating processes.

Customer Case Studies

See how customers are using Pega Customer Service for Healthcare to transform their enterprises.

Case study

Kaiser Permanente: $100 Million in Savings

Kaiser achieved their goal of improving their First Call Resolution Rate to higher than 90%.

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Case study

MGEN’s Global Enterprise Transformation

MGEN used Pega’s Customer Service for Healthcare to provide a common customer service platform that improved service response, consistency, efficiency, reporting, and alignment across all channels.

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Case Study

OptumRx Safeguards Health and Eliminates Waste

OptumRx used Pega's Healthcare Industry Foundation on Pega Cloud to achieve decreased turnaround time and easier auditability.

See how Pega can help your business

Talk to an expert and see how Pega can transform your customer experiences with next-generation software applications and solutions.