How can you use Pega to automate claims processing?

1 What is Pega?

Pega is a software company that provides a low-code platform for building and running enterprise applications. Pega's platform combines business process management (BPM), case management, robotic process automation (RPA), artificial intelligence (AI), and cloud services to enable users to create and deploy solutions that automate end-to-end processes, optimize decisions, and enhance customer experiences. Pega's platform is designed to be agile, adaptable, and scalable, allowing users to change and improve their applications as their business needs evolve.

2 How does Pega automate claims processing?

Pega automates claims processing by using a case-based approach that breaks down the process into smaller, manageable tasks that can be assigned, executed, and tracked by humans or bots. Pega's platform allows users to define the logic, rules, data, and interfaces for each task, as well as the conditions, triggers, and actions that govern the flow of the case. Pega also leverages AI and RPA to automate tasks that are repetitive, rule-based, or data-intensive, such as data extraction, validation, calculation, and integration. Pega's automation capabilities can reduce manual work, errors, and delays, and increase productivity, quality, and compliance.

3 What are the benefits of using Pega for claims processing?

Using Pega for claims processing can bring several benefits to insurers and customers, such as faster claims resolution, greater flexibility and adaptability, and smarter decision making. Pega can accelerate the claims process by automating tasks, routing cases to the right resources, and providing real-time visibility and alerts. This can improve customer satisfaction and retention, as well as reduce operational costs and risks. It can also enable users to customize and modify their claims workflows according to their specific business requirements, regulations, and best practices. Additionally, Pega can support users in making better decisions throughout the claims process by using AI and analytics to provide insights, recommendations, and predictions. This can improve customer service and satisfaction, as well as operational efficiency and effectiveness.

4 How can you get started with Pega for claims processing?

To get started with Pega for claims processing, you can explore their industry solutions and accelerators, which provide pre-built templates and components to reduce development time and effort. You can also learn Pega's low-code platform and tools to design, build, and manage claims applications without writing a lot of code. Additionally, you can apply Pega's intelligent automation capabilities to enhance your claims applications with AI and RPA features. You can explore Pega's solutions and tools on their website or academy by taking online courses, watching videos, reading documentation, or joining community forums. Furthermore, you can follow the guides, tutorials, and examples on their website or academy to apply their intelligent automation capabilities.

5 What are some best practices for using Pega for claims processing?

Pega claims processing can be used effectively and efficiently by following certain best practices. Firstly, you should define your business goals and outcomes to ensure that your claims workflows, data, rules, and interfaces are aligned with your objectives and priorities. Secondly, you should design your claims processes from the customer’s perspective to create customer-centric experiences. Pega's tools such as Journey Centric Delivery and Customer Journey Analytics can be used to map and analyze customer journeys and touchpoints. Lastly, you should optimize the level and mix of automation that suits your business needs and capabilities. It is important to balance the benefits of automation with human factors such as judgment, empathy, and creativity. AI and RPA can be leveraged for optimal results alongside human-bot collaboration.

6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?