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Presentation

PW 2014 Presentation: SBPASC Leverages Pega to Provide Claims Processing Specialization to End Users

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ZHIHONG ZOU, CHIEF ARCHITECT, SBPASC
JANET KOCHERT, BUSINESS ARCHITECT, SBPASC

As the operations center for Blue Cross and Blue Shield’s Federal Employee Program, the Service Benefit Plan Administrative Services Corporation (SBPASC), an affiliate of CareFirst, Inc., makes benefit decisions for claims submitted via 37 different Blue Cross and Blue Shield plans. Learn how Pega enabled SBPASC to implement an automated deferral resolution capability that allows each plan to choose which actions they wish the system to perform on their behalf; resulting in significant savings.

In this session you will learn:

  • Where Pega was leveraged to automate previously manual activities and reduce operational costs
  • How Pega’s flexibility and ability to support complex rules has satisfied differing needs of numerous customers
  • About the challenges related to integrating with legacy systems and how to prepare for them


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