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Pega Claims Automation

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Overview

Pega Claims Automation is a solution built on the Pega Platform, which combines case management, BPM, and AI to automate the end-to-end claims process. It is designed for large insurers looking to drive efficiency, reduce costs, and improve customer experiences. The platform's 'Center-out' approach allows for the automation of processes from the customer's perspective, ensuring seamless journeys across channels.

✨ Key Features

  • Intelligent Automation
  • Case Lifecycle Management
  • AI-Powered Decisioning
  • Robotic Process Automation (RPA)
  • Low-Code App Development
  • Omni-Channel Engagement

🎯 Key Differentiators

  • Powerful combination of case management and real-time AI.
  • Scalability for large, complex enterprise deployments.
  • Center-out business architecture focuses on customer journeys.

Unique Value: Drives digital transformation by automating end-to-end customer journeys, like claims, with a powerful and scalable intelligent automation platform.

🎯 Use Cases (4)

End-to-End Claims Automation Digital First Notice of Loss (FNOL) Claims Adjudication and Settlement Fraud and Abuse Detection

✅ Best For

  • Automating complex, end-to-end business processes for large enterprises.

💡 Check With Vendor

Verify these considerations match your specific requirements:

  • Small organizations needing a simple, out-of-the-box claims tool.

🏆 Alternatives

Appian Salesforce ServiceNow

Offers more powerful, AI-driven decisioning and case management capabilities compared to many other BPM and low-code platforms.

💻 Platforms

Web API

🔌 Integrations

Salesforce SAP DocuSign

🛟 Support Options

  • ✓ Email Support
  • ✓ Live Chat
  • ✓ Phone Support
  • ✓ Dedicated Support (Varies by plan tier)

🔒 Compliance & Security

✓ SOC 2 ✓ HIPAA ✓ BAA Available ✓ GDPR ✓ ISO 27001 ✓ SSO ✓ SOC 2 ✓ ISO 27001 ✓ HIPAA ✓ FedRAMP

💰 Pricing

Contact for pricing

✓ 30-day free trial

Visit Pega Claims Automation Website →