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:
- Key metrics were exceeded in four months
- Client is able to check the statuses of claims at any stage during the processes
- Completed Claims Intake Redesign was delivered in 3 releases
