Pega Claims Automation Suite

KEY CHALLENGE

Health plans must improve operational performance in a world of consumerism, reform mandates, increasingly complex risk-sharing agreements and incented health management strategies. In the reforming market, poor first pass rates and inefficient manual claims processing will thwart health plan competitive edge, growth and compliance.

THE SOLUTION

The Pega Claims Automation for Healthcare application suite provides unprecedented flexibility to rapidly automate claims repair and boost first pass rates. Leveraging the market’s industry leading workflow, business rules and case management tools, the Pega claims workstation enables demonstrable improvements in operational efficiencies, complex processing and pend management.