Fortune 500 Insurer Reimagines Customer Experience with Digital Transformation

Challenges

• Limited Customer Self-Service: Their current system lacked comprehensive self-service options across multiple channels (web, mobile, social media). This restricted customer convenience and limited their ability to manage policies and access information independently.
• Manual and Time-Consuming Processes: Customer inquiries relied heavily on manual agent intervention. Agents had to gather data from various systems and manually draft responses for each email, leading to slow resolution times and high operational costs.
• Lack of Customer Journey Insights: The existing system didn't provide visibility into the customer journey. It lacked empathy-based metrics and relied on traditional methods, making it difficult to understand and improve the customer experience holistically.
• Limited Engagement with New Customer Segments: Their traditional approach couldn't cater to the growing tech-savvy demographics like Millennials who prefer digital channels and self-service options.

Solution

Coforge designed a comprehensive Pega-powered solution to address the insurer's customer service challenges:

• Omnichannel Self-Service Portal:
  • A customer service framework application was created to read emails and automatically convert them into cases within the Pega platform.
  • Integration with Policy and Claims Systems (SORs) enabled seamless retrieval of relevant policy and claim information for CSRs to resolve inquiries efficiently.
• AI-Powered Automation:
  • Pega AI capabilities were leveraged for text analysis to understand the nature of customer inquiries in emails, sentiment analysis to gauge customer emotions and prioritize responses, and text extraction to automatically populate relevant data fields within cases.
  • Based on this analysis, the system could send automated responses for frequently asked questions or simple requests, and route complex inquiries to the appropriate work queue for efficient agent handling.
• Intelligent Virtual Assistant (IVA):
  • The solution introduced an IVA accessible via web and social media channels.
  • Policyholders and account administrators could interact with the IVA to seek information about policies and claims, and fulfill requests such as policy updates or basic transactions.
• Unified Customer View:
  • A 360-degree customer UI was developed within the Pega platform.
  • This UI displayed consolidated policy and claim data from various systems, providing CSRs with a holistic view of each customer for personalized service.
• Seamless Integration:
  • A robust API architecture was implemented using a 3-layer approach:
  • Experience APIs facilitated interaction between the IVA and customer touchpoints.
  • Process APIs streamlined workflows within the Pega platform.
  • System APIs ensured smooth data exchange between Pega and external systems like Policy/Claims SORs, Document Management (FileNet), and BI/Analytics (Pega Analytics).
• Additionally, an API gateway (MuleSoft/EIB) managed API interactions for efficient data flow.

This comprehensive solution empowered customers with self-service options, automated responses, and real-time support through the IVA. It also equipped agents with efficient tools and a unified customer view to deliver exceptional service.

The Impact

• Improved Customer Experience Omnichannel self-service and AI automation provided greater control and convenience.
• Enhanced Efficiency Reduced manual tasks and improved agent productivity.
• Faster Resolution Time Automated responses and intelligent routing expedited issue resolution.
• Reduced Operational Costs Streamlined operations led to lower operational costs.