Elevate your claims process to new heights

Optimize claims with AI and automation

As you move toward a digital-first, customer-centric approach, so must your claims processing. With Pega, you can unify systems to seamlessly weave AI, automation, and analytics across the claims lifecycle to transform customer journeys while reducing expenses and increasing capacity.

Featured customers

Leading Latin American insurer modernizes claims

Learn how Zurich Santander used Pega to migrate 65% of their customers to a digital claims experience.

Check out the case study

Church Mutual doubles efficiency

Learn how Church Mutual leveraged the Pega Platform to break down silos and scale, generating over 2.5M in cost savings.

Check out the case study

Digital customer experience

Deepen relationships w/ modern experiences

Analyze claimant context and deliver the personalized, omni-channel experiences customers expect with real-time decisioning and insights. Deepen loyalty by meeting claimant needs proactively – before, during, and after a claim – to deliver peace of mind and drive customer lifetime value.

How we do it

• Unify your data, analytics, customer history, and channels into a single connected claimant experience  
• Leverage event-driven data to create claims automatically and proactively inform claimants that remediation is under way
• Strengthen growth and retention post settlement with AI-driven next best actions that nurture the relationship

Intelligent adjudication

Improve claims handling & outcomes

Boost claims handling capacity and improve claims outcomes with Pega’s unified platform. Connect data across departments, channels, and systems with complex business rules to provide intelligence and insights across the claims process – enabling AI-guided examiner experiences and automated workflows for straight-through processing.

How we do it

• Use a consolidated dashboard to help manage and prioritize work across multiple systems
• Leverage AI to predict complexity and assign claims to the appropriately skilled resource at the time of notification
• Utilize AI and analytics to augment examiners’ expertise and recommend next best actions for complicated claims