Healthcare insurance operations get more complex every year.
Rulesware reduces the cost and complexity – and elevates your performance with personalized service and digital efficiencies. From automating enrollment and managing unruly claims, simplifying authorizations and superior customer service, to easy appeals, provider management and more, our solutions empower payers to streamline back-end processes while providing a superior customer journey.
Streamline the flow of content, reduce costs, and enhance service quality:
"Our milestones could not have been achieved without Rulesware’s significant contributions.”
Health Insurance Client
Smarter data management improves the precision of your quotes, while automation accelerates enrollment processes across all channels and prevents improper claims payments and denials.
Your business rules are consistently applied to every customer the proper way every time. The decisioning capabilities should reside in the Pega rules logic, not on sticky notes or knowledge management systems that support typical authorization applications. Approve or deny authorizations in minutes, do it consistently and do it right every time, the first time.
Expedite the automated repair of claims during the pre-adjudication and post-adjudication process while always having clear insight to your claims inventory and management processes. Pega’s natural adaptability helps you continually sync your rules to pay all your claims right the first time – reducing the administrative burden of reprocessing or incorrectly paying claims.
Apply AI-driven decisioning to attracting, enrolling, and servicing members. Support your call center by recommending next best actions to agents at every step of a member’s journey. Generate 1:1 personalized communications, issued at the right time, via their desired channel and with empathy.
Pega’s AI-driven engagement engine simplifies operating and regulatory requirements. By automatically selecting the best action to take, Rulesware optimizes the relevance and value of each interaction. The result: seamless customer service across all transactions and channels.