Solutions

Pega Smart Claims Engine

Transform how you process claims and unleash productivity

Pega Smart Claims Engine (SCE) is a platform that can replace your legacy claims platforms to move away from rigid and inflexible systems, high operational costs, and poor user experience. With Pega SCE, your organization benefits from enhanced straight through processing, transparency and visibility, and business flexibility.

Virtusa is an experienced service provider in claims modernization with Pega SCE. We guide our clients through the complete journey – Discovery, Strategy, Design, Build, and Go-Live – to ensure that they’re unlocking value at every point in their claims process.

With Virtusa as your engineering partner in claims transformation with Pega SCE, your organization will be empowered with:

Easily configurable next-gen claims platform
Cost efficiency
Optimized business processes
Guided and automated workflows
Superior user experience

Features and benefits

Virtusa’s product engineering and innovation expertise ensures your organization gets the best out of Pega SCE

  • Cognitive Computing and Machine Learning: Payers can offer personalized solutions for everyday consumers.
  • Blockchain: Helps in reducing red tape, increasing interoperability, and improving consumer relationships within the healthcare payer community.
  • Analytics: Improve patient satisfaction and patient flow, reduce avoidable readmissions, and adverse events.
  • Microservices: Create new ways to connect and engage with patients.
  • Everything-as-a-service: Combination of data science, mobile applications and big data to manage chronic diseases, reduce cost, and increase reach of healthcare.

With Pega SCE, your organization benefits from enhanced straight through processing, transparency and visibility, and business flexibility.

Straight through processing (STP)
Reduces the overall per-claim processing cost and improves operational efficiency. It also lays the foundation for processing potential point-of-care, real-time submissions in the future.

Transparency and visibility
Increases engagement and provides claims operations users and policy managers with a sense of ownership of the adjudication system that results in active contributions to continuous improvement.

Business flexibility
Optimizes network contracts by enabling appropriate reimbursements and improving implementation plan for upcoming regulations. Also, helps teams avoid repetitive, low-value tasks and focus on higher-value work effort.

Download the brochure to learn how Virtusa can help you transform your claims modernization journey with Pega SCE

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