End to End Claims Transformation with Pega

The Client

  • Leading global insurer and reinsurer, sought to transform its claims management system through automation to improve profitability, efficiency, and customer satisfaction.
  • To achieve this, the company decided to simplify and streamline its claims management processes. However, they were faced with the challenge of multiple legacy systems across different countries, inconsistent and largely manual processes, and no single source of the truth. They were also experiencing high volumes of claims and customer dissatisfaction with the lack of digital channels available to support the submission of claims.

Solution

By leveraging the Pega platform and working with the Coforge team, they were able to build and deploy an automated end-to-end claims process management solution that standardizes processes and uses dynamic business rules to ensure claims are investigated and settled with complete transparency internally and for the customer. The solution also enables customers to submit claims through new digital channels and ensures claims can be settled quickly, without any manual intervention.

Results

Significant improvements have been achieved through automation, resulting in increased efficiency and customer satisfaction.

  • 40-50% improvement on the average time taken to settle & close a claim.
  • 42% of claims settled without manual intervention, enabling staff to work on other high-priority tasks.


Project Spotlights:

The client is on a journey to migrate its business applications to the cloud.  There are thousands of applications in the client ecosystem from core business applications (e.g. product development, underwriting, claims) to support applications such as finance, HR, and IT.  The Cloud COE has been focused on building out the cloud foundational capabilities for access, security, network, and governance in preparation for a mass migration over the next 3 years.  All new applications are expected to go directly to the cloud and some existing applications have already been migrated.  Currently, there is a strategic initiative to create a roadmap based on priority applications or business functions.  The Cloud COE will take these inputs and perform detailed discovery, determine the migration method, and execute the migration.  Coforge is highly engaged in the Cloud COE and has supported the client in delivering the following recent value:

 

  • $14,457 saved from termination of underutilized EC2 instances in Mar-21
  • Overall, $34,766 saved from termination of underutilized EC2 instances till Mar-21
  • 50% Azure Cost Reduction on Virtual Machines by removing unused Virtual Machines and EBIA AWS Migration

 

The client and Coforge’s Performance Management team have six projects initiated application testing for performance/load.  The teams have been successful with MAX which is an extremely critical program for the client.

 

Global Monitoring

  • End to End monitoring setup completed for MAX and Client Central
  • Digital Availability Dashboard completed with top 15 Applications including Smart Claims and MAX application
  • Migration completed from Sitescope to ThousandEyes

 

 

Data Migration – Genelco to Wynsure

  • Large groups with the highest annual premium of 12.6$ million migrated in one 3/1 MED

 

 

DevOps COE

  • The team is helping in building and migrating pipelines in Azure Cloud:
  • 59 New Pipelines Onboarded
  • 82 New users onboarded on GitHub
  • 14 New Team migrated to Artifactory
  • 5 New APIs created in AKANA

 

 

Minerva Testing Strategy

  • The testing strategy is in progress and on schedule
  • Completed one workshop with all stakeholders

 

Let’s engage