Finding New Efficiencies and Opportunities in Workers’ Compensation Claims

We’ve just had a significant go-live with one of the largest insurance organizations in the world, which adds to many other successes in the same company. BPM grows from one group to the next, as more people see that they can generate tangible and significant results quickly.

In this case, our advanced BPM technology is being used to enable hundreds of the insurer’s workers compensation adjusters to accurately determine the appropriate payments for claimants. This is far from small potatoes given the volume the organization handles: approximately 50,000 current workers’ compensation claims from insured policyholders are affected. These claims represent the power of SmartBPM at its best. The technology is helping people by managing the complexity of these long-running cases while bringing together the information and rules that provide responsiveness and prevent fraud.

Our client offers comprehensive and reliable coverage for millions of people and corporations. They in turn depend on Pegasystems to help transform key strategic growth areas, such as tackling the tough but important problems which include bringing more efficiency into workers’ compensation claims management. At a time when the insurance industry has become more competitive and consumers have more choice than ever, organizations are increasingly looking for best practices that differentiate themselves from their peers. Exemplary customer service and evaluating policyholders’ claims in a timely, cost-effective manner are two cornerstones to continued success. Workers’ compensation is a complex industry where controlling medical costs and outcomes will always be a key challenge. But when an organization is armed with SmartBPM, it gets a head start – and some would say an unfair advantage – in turning complexities into opportunities.

As is the case with the lion’s share of our implementations, this worldwide insurer will see Tens of Millions in savings (at a time when that is ever more important). With the long-term success of our several implementations, other areas in the organization are quickly becoming interested in BPM for their areas.