TRANSFORMED TO A NEXT-GEN CLAIMS MANAGEMENT SYSTEM THROUGH AUTOMATION

Know More

THE CLIENT

 

A leading Excess and Surplus insurance company providing insurance and risk management solutions to the energy and utilities industry

THE CHALLENGE / REQUIREMENT

The client's legacy system for claims administration with inconsistent and workflow processes were manually handled and had the following limitations

  • The line of authority escalation and approval for claims was cumbersome and time-consuming
  • There was an inability to enforce SLAs and handle foreign claims
  • Implementing minor changes experienced huge turnaround times
  • Most of the data were being entered manually by referring to details outside the system, with minimal business rule validation
  • Integration with other downstream system was not seamless and required manual handoffs in some cases
  • Transaction data reports were manually prepared by CDA (claims divisional administrator) on accessing claims database
  • The settlement was completely handled in spreadsheets and was offline with the claims system

The client was looking to achieve an end-to-end core claims system that would integrate with various lines of business - such as property, workers compensation, DAO etc.

THE SOLUTION

 

We proposed a migration from a PowerBuilder claims workstation to a next-gen and BPM-Pega driven end-to-end core claims system. We incorporated the following services:

  • Application development and production support
  • Data migration
  • Interfaces with data warehouse and reinsurance
  • Integration with BPM policy admin system and legacy system

We leveraged Pega PRPC’s BPM capabilities to build an enterprise class policy admin system with workflow and process automation capabilities. Work lists and task lists enabled better work assignment, auditing and diary setup. Reports related to transactional data could be generated from the out-of-box system. We deployed the following tools and technologies:

  • Pega PRPC Version 6.12SP2
  • Oracle 11
  • WebSphere 7.0
  • XML

 

THE OUTCOME / BENEFITS

We achieved a seamless transformation from legacy systems to a next-generation platform using BPM-Pega. Our end-to-end claims solution achieved the following outcomes:

 

Total automation of FNOL and Claims Setup processes

Quick turnaround and cost optimization using Agile methodology like Pega BPM (SmartBPM)

Streamlining and automation of manual processes in FNOL and claims handling

Improved work assignment and diary setup through work list and task list

Ability to track history and auditing

Efficient interfaces to pull in necessary data as pre-fill to claims system – including structured settlement with claims system

Generation of reports related to transactional data from the out of box system

Efficient handling of SLA reminders and foreign claims based on captured requirements