Our client is a leading mutual insurance company
THE CHALLENGE / REQUIREMENT
The client’s legacy system for policy and claims administration was inconsistent with manual workflow processes, and time-consuming and cumbersome line of authority escalation and approval for claims. It further lacked the ability to enforce SLAs and handle foreign claims.
Most of the data was being entered manually by referring to details outside the system, with minimal business rule validation - and implementing even minor changes involved huge turnaround times. Additionally, integration with other downstream system required manual handoffs in some cases, thereby lacking seamless efficiency.
The CDA (claims divisional administrator) had to manually prepare transaction data reports by accessing the claims database, and settlements were computed in spreadsheets that were offline wth the claims system.
The need was an end-to-end core policy administration and claims system that would integrate with the different lines of business.
We leveraged Pega PRPC's BPM capabilities to build an enterprise class policy admin system with workflow and process automation capabilities. Through this next-generation claims management system, we provided:
We deployed the following tools and technologies
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.
Our end-to-end claims solution and seamless transformation from legacy systems to a next-generation platform using BPM-Pega achieved the following outcomes:
Complete 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