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Healthcare Success Stories

14 Mar 18

Process Automation for a Fortune 500 Healthcare Client

Automated work assignment and processing using Pega Robotics by integrating ML algorithm within Queue Management System to rate the complexity to simple, medium & complex from common queue and allocating it to agents according to their skills, experience and expertise rating. Bot directly processes work without any human intervention for straightforward cases. This helped in reducing the manpower and turnaround time for work assignment and processing.

Omni-channel Customer Service application for a Fortune 100 Healthcare Client

Designed and Developed a Customer Service application to reduce member and provider call processing times and to improve user efficiency. This application serves as a one stop shop for members and providers with inquiries, ID cards, material requests, eligibility, updates, enrollment, claims and billing.

Upgraded Appeals and Grievances system for a Fortune 500 Healthcare Client

Enhanced the member experience with regard to the Appeals and Grievances process. Re-Architected and Upgraded to the latest Pega version 7.x to improve performance and usability as well as to address existing shortcomings in the application.

Knowledge Management system for a Fortune 50 Healthcare Client

Implemented a comprehensive Knowledge Management system utilizing Pega PRPC platform and Pega Knowledge Management (PKM) framework to help customer service representatives in quickly accessing documents/content.

Group Sales Management system for a Fortune 500 Healthcare Client

Redesigned the Group Sales Management system by automating the new group enrollment, renewal, group contract changes, quote management and underwriting processes.

Pharmacy support system for a Fortune 50 Healthcare Client

Developed an end to end Pharmacy Home System to support, map and monitor a beneficiary to a particular pharmacy.

Product offering system for a Fortune 500 Healthcare Client

Enabled Cloud and Real time data integration for improved HealthCare service offerings and data usage points.

Appeals and Grievances system for a Fortune 100 Healthcare Client

Designed and developed a Case Management Solution to handle unique Appeals and Complaints process flows of different Lines Of Businesses. This eliminated the manual effort required to comply with Federal SLAs and ultimately avoid fines and penalties.

Upgraded customer service system for a Fortune 500 Healthcare Client

Enhanced the Omni channel customer service experience for current users and added new users as part of M & A. Integrated with new enterprise systems and upgraded to the latest Pega Customer Service Framework from their legacy Customer Process Framework.