Automating the Claims Reporting System of an Insurance Company

Client: One of the largest global financial services companies with business lines in life, vehicle, travel, and health. It is also amongst the top health insurance brands on the basis of customer loyalty.

Business Problem: The client’s legacy claim storage system was unable to show linking between multiple claims. This lack of linking between claims caused inaccurate reporting and created the need for an involved and cumbersome manual process to cross-reference related claims to create accurate reports.

Our Solution: To meet this challenge, an application was built on Pega 7 that created linkages between related claims. With this solution in place, the reporting process was streamlined and improved by removing the need for manual human interaction. This application also monitored the existing claim storage system, and automatically created files and stored them in the system of record (SOR) whenever a configurable threshold limit for files was reached.

Benefits: The solution helped in developing an efficient and accurate reporting system that gave a better view on payments and loss. Replacing existing Excel spreadsheets with an automated claims processing systems led to better auditing and tracking.