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Pega Claims Optimization at a Glance

Power claims with intelligent workflows and AI decisioning. Modernize customer journeys, reduce expenses, and increase capacity through AI-driven insights and process automation.


[Narrator] What if you could modernize all aspects of claim handling without having to replace your existing claims technology? What's that, you say? You'd like to provide the modern-day, personalized omni-channel experience insureds have come to expect? Pega's got this and more. Proactively engage with insureds before, during, and after a claim, such as pre-weather event messaging of care and safety, loss avoidance, and links to file a claim if damage occurs. You also don't have to wait for customer satisfaction surveys to tell you how you're doing. Pega can monitor all customer experiences in-flight enabling carriers to act on bad experiences as they're occurring. You'd like to boost claim handling capacity and improve outcomes? How about being armed with predictors of claims complexity or having the ability to provide adjusters claim handling guidance in tough situations? Pega does that too.

Pega's machine learning looks for patterns occurring across claims. Claims that appear low complex at the time of notification, but have the propensity to escalate in complexity can be assigned directly to the appropriate skilled adjuster. We also partner humans and technology by enabling claims to plug into any exception handling model and provide the next best action guidance to adjusters in real-time across the claims lifecycle. You'd like to straight-through process more claims, but are not sure where to start? Pega's proven AI predicts claim outcomes to identify opportunities for straight-through processing. You can test your models and ideas with live production data until you reach the desired level of confidence. Pega provides intelligent automation and personalization to help you delight customers, increase retention, and improve claims outcomes. To learn more about Pega's claims optimization, contact your Pega account team or visit us at


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