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Pegasystems [NASDAQ:PEGA]: Automating Claim Management Processes

Alan Trefler, Founder & CEO, PegasystemsAlan Trefler, Founder & CEO
Being a passionate chess player, Alan Trefler correlates the moves in a game of chess with benefits that technology brings for its user. The Founder and CEO of Pegasystems says, “In chess you recognize the pattern to get a feel for the position. A lot of providing good service is really about pattern recognition. With technology today, you cannot just understand one or two aspects about a customer. You can understand a whole collection of aspects which can make you better positioned to make them a better offer.” With this idea in mind, the team at Pegasystems works towards automating the claim management process, which is a tedious job for life insurers as they have to search multiple legacy systems for relevant information while working under intense regulatory scrutiny. This automation will relieve the examiners from manually researching years of policy information and values, while reducing errors and data inconsistencies. Pegasystems [NASDAQ:PEGA]—a company that develops strategic applications for sales, marketing, service and operations, offers Pega Claims for Life Insurance that empowers examiners to focus on claimant needs while streamlining the flow of claims across the organization. Pega’s unique process-driven approach for claim settlement simplifies and orchestrates insurers’ complex life claims processes by automating them.

Pegasystems leverages its deep experience with insurance carriers to deliver an end to-end solution that manages a loss event from initial notice of loss to claims payment and closure. Utilizing Pega’s Case Management and rules-driven processes, examiners are enabled to intelligently address individual needs of each claimant while maintaining a comprehensive view of the claims process across multiple policies and claimants. Examiners can view and take the necessary action upon the current status of any case, including correspondence and items associated with the claimant. With Pega’s real-time reporting of activities, and automatic alerts and service level reporting, identification of current status of work-in-process and avoiding delays has become instantaneous.


Pega’s unique process-driven approach for claim settlement simplifies and orchestrates insurers’ complex life claims processes by automating them


The company leverages sophisticated analytics to empower insurers to automate the process of determining the most relevant offer for a specific claimant, increasing their asset retention and optimizing the customer experience.

Pega Claims Management for Life controls all aspects of the claim process, enabling insurers to automate and streamline operations across people, systems and channels. In an instance, Aegon, an insurance company, sought to create a world-class customer service experience for its customers. To accomplish this, as the first step the company needed to simplify and streamline manual legacy business processes that included multiple steps to verify information regarding user identities, policies, compliance, and checklist requirements. Aegon associated with Pegasystems and implemented its technology to manage and automate an array of internal systems, including claims management, payroll payment, and transfer quotes and transfer settlements across 120 core business processes. Using Pega’s technology, Aegon was able to create a library of business services that can be re-used across all processes, optimizing efficiency and speed to the market. Today, Aegon agents are able to quickly access all relevant customer information, resulting in reduced processing time while settling claims, increased total savings from improved claims management operations and improvements in Net Promoter Score (NPS) for customer and employee experience.

Insurance firms can connect to their customers everywhere through Pega’s omni-channel management service. It enables the claimant to choose options to interact with the insurance company, transparently transitioning interactions across channels and devices, such as the web, contact center, mobile devices or social media. Insurance carriers get the needed assistance from Pegasystems in addressing their customer needs while increasing profits, decreasing expense ratios and mitigating risk. “By simplifying our user experience, by building out applications that are much richer, we can now bring that power to companies that are smaller,” concludes Trefler.