Streamlining Claims Process: A PEGA-Powered Transformation for Global Insurer
Overview.
A leading global insurer and reinsurer, burdened by manual processes, multiple legacy systems, high volumes of claims and customer dissatisfaction, sought to transform its claims management system through automation to improve profitability, efficiency, and customer satisfaction. The client partnered with Coforge to implement a Pega-powered claims management solution. This transformation resulted in a significant improvement in claims processing efficiency with a 40-50% reduction in settlement times and 42% of claims settled automatically. The engagement also included a cloud migration strategy led by the Cloud CoE, successful performance/load testing led by Performance Management team, Data Migration from Genelco to Wynsure, and building and migrating pipelines in Azure Cloud led by DevOps CoE.
The global insurer faced several challenges that hindered their claims processing:
Inefficient Legacy Systems: Multiple, outdated legacy systems across various countries made it difficult to standardize processes and access data efficiently.
Manual Processes & Limited Resources: A reliance on manual tasks slowed down claim settlement and limited staff capacity.
Lack of Digital Channels: The absence of digital claim submission options frustrated customers and hindered convenience.
High Claim Volumes: The high volume of claims further strained the existing system's capacity.
These challenges combined to create a slow, resource-intensive, and customer-unfriendly claims process.
Solution
Coforge designed a comprehensive solution to address the insurer's needs:
Pega-Based Automation: A Pega-powered claims management platform automated claim investigation and settlement processes, boosting efficiency.
Dynamic Business Rules: Dynamic rules within the Pega platform ensured consistent and transparent claim handling for all customers.
Digital Claim Submission: New digital channels were introduced, allowing customers to submit claims conveniently.
Cloud Migration Strategy: Coforge's Cloud COE developed a roadmap for cloud migration based on priority applications or business functions, aiming to further optimize costs.
Data Migration from Genelco to Wynsure. Large groups with the highest annual premium of 12.6$ million migrated in one 3/1 MED.
Global Monitoring - End to End monitoring setup completed for Client Central and MAX, an extremely critical program for the client. Digital Availability Dashboard completed with top 15 Applications including Smart Claims and MAX application. Migration completed from Sitescope to ThousandEyes.
The Impact
40-50% Reduction In average Claim Settlement Time
42% Of Claims resolved through Automated Claim Resolution
Improved Customer Satisfaction through Faster Resolution & Digital Access.
50% Azure Cost Reduction on Virtual Machines by removing unused Virtual Machines and EBIA AWS Migration.
Over $34K Saved from termination of underutilized EC2 instances.
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