Streamlining Claims Process: A PEGA-Powered Transformation for Global Insurer

Challenges

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• Inefficient Legacy Systems: Multiple, outdated legacy systems across various countries made it difficult to standardize processes and access data efficiently.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

The ‘Impact’ section summarizes the achieved results and improvements resulting from the solution in a tabular form. It includes both qualitative benefits experienced by the client and the relevant quantitative metrics (e.g., percentage improvements, time saved).