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Healthcare payer solutions

Transform member experience and work smarter

Connect with members deeply while reducing costs

Success today is about the quality of the member experience. Pega’s next-best-action capabilities help you understand members better and deliver personalized experiences – in real time, for every interaction. It all adds up to delivering proactive member engagement and loyalty.
Improve member engagement

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.

Personalize wellness

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.

Get the Healthcare engagement report
Make wellness simple and engaging
Deepen relationships

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.

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Analyst Report

Pega is a Leader in Healthcare CRM

Find out what makes Pega a Leader in the Forrester Wave™: Healthcare CRM Providers.

Deliver proactive service and care

Members want service and care simplified, yet proactive and personalized. Make every touch point the right one, at the right time. Pega helps you solve problems, recommend the right actions, and have preemptive conversations while continuously learning and optimizing – all in real time, across any channel.
Simplify service

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.

Personalize care

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.

Deliver excellence

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.

Turbocharge legacy systems

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.

Achieve operational and administrative excellence

Global events, market pressures, and heightened regulations require more efficient operations and improved performance. Use intelligent automation via a Center-out™ architecture to streamline, simplify, and deliver digital transformation of your operations and improved business results.
Modernize claims

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.

Manage modern benefits

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.

Transform data management

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.

Deliver operational efficiency

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.

Make healthcare less confusing

On-demand Webinar

Providing 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.

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Pega Customer Service for Healthcare

Serve members proactively with the personalized interactions they want, on any channel.

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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.

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Pega Smart Claims Engine for Healthcare

Deliver modern, intelligent automation for claims management.

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Pega Product Composer for Healthcare

Simplify benefit, product development, and maintenance to quickly meet changing business needs and regulatory requirements.

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Pega Sales Automation for Healthcare

Boost sales effectiveness and win rates across health insurance sales channels – with context-aware process automation and intelligent guidance.

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Ready to get started? We can’t wait to show you what’s possible with Pega. Request a demo