Not-For-Profit Health Insurance Company

When our client came to Rulesware, they needed to transform their expensive, unscalable, error-intensive manual processes with digital automation. This client specialized in underinsured, mostly Medicaid participants, and needed to strengthen their relationships with their Provider network(s).

The Problem

The client’s legacy tools were opaque and difficult to modify, had slow processing times, needed too much manual intervention and greatly reduced their claims processing efficiency. They wanted help to transform their existing expensive, unscalable, error-intensive manual processes with digital automation.

The Solution

Using the Pega rules and case management capabilities, Rulesware redesigned the Claims Intake and Provider Creation Processes into an efficient and scalable solution.

The Result

The collaborative new solution was designed with the following results:

For more information on how Rulesware and how we can help your company achieve its goals, please contact us.