Case Studies

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. Wi...

Client: One of the largest pharmacy benefit management organizations (PBM) providing pharmacy benefit management services including network-pharmacy claims processing, industry-leading home delivery and specialty pharmacy services. Business Problem: The client wanted to drastically improve the way services were managed across the enterprise. The key challenge was replacing a manual processing approach that was error-prone, time intensive and frustrating to the staff. People had to call a variety of numbers to make enquiries. Processing was often paper-driven and disjointed wh...

Client: A global health services organization, with insurance subsidiaries that are major providers of dental, medical, Medicaid and Medicare plans. The organization provides health insurance plans to individuals, and through governmental and non-governmental organizations, unions and other associations Business Problem: With the drastic and continuous changes to Healthcare in the US, antiquated claims adjudication systems in place are not able to meet the needs of today’s Healthcare Payers. In addition, a main concern in new claims systems is flexibility and configurability...

Client: The client provides prescriptive analytics solutions to its customers across a diverse set of industries. Their solution can be used by end customers to enhance their decisioning capabilities as well as partners who can embed the client’s solutions into their strategy, operational planning and analytics solution offerings. Business Problem: The client’s prescriptive analytics solution is extremely robust with a very powerful optimization engine at its core. However, the client as well as its customers felt that the optimization engine was not very user friendly. Any cust...