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success story

How a leading U.S. life insurer transformed insurance claims

Digitizing claims for speed, clarity, and human connection

A leading U.S. mutual life insurance company wanted to transform its claims experience to better serve policyholders and beneficiaries during difficult times. The goal was to make the process more intuitive, digital, and empathetic so that clients could feel supported while service representatives could focus on people instead of paperwork. Working in partnership with Virtusa and using Pega Customer Service, the insurer introduced digital-first capabilities, streamlined processes, and created a more human-centered journey.

KEY SERVICES AND TECHNOLOGIES

Domain and strategic advisory
Experience design
Technology and process engineering
Agile delivery and automation

TECHNOLOGY HIGHLIGHTS

Pega Customer Service low-code platform
Case types for varied claims journeys
Decision tables for adjudication rules
Microservices & APIs
Reusable correspondence engine
Modular UI components
Situational Layer Cake architecture
DevOps CI/CD pipeline

Why the claims experience needed a rethink

Filing a claim had long been a complicated, stressful process. For policyholders and beneficiaries, this often meant filling out paper forms, waiting days or weeks for updates, and calling repeatedly to get an update on the status of a claim. There was no digital option to start or track progress, leaving clients feeling uncertain at a time when clarity and reassurance were required.

Service representatives also faced a challenging experience. To answer even basic questions, they had to switch between nine different systems, each holding separate data. Manual, paper-heavy workflows slowed them down, increased the chances of errors, and raised costs. Outdated mainframe systems added to the complexity, limiting both speed and flexibility.

The impact was more than just operational inefficiency. It left clients feeling anxious and unsupported during some of the hardest moments in their lives, while service representatives struggled to provide the empathy and guidance they wanted to offer. The organization realized it was time for change, not just to modernize technology but to improve the way claims were handled.

A seamless claims ecosystem

The insurer partnered with Virtusa to transform its claims journey into a digital-first experience that would serve both clients and service representatives better. The partnership set a clear vision to create a streamlined, unified platform that could reduce manual work, improve transparency, and bring empathy back into the claims process.

Using Pega as the foundation, the teams defined case types for varied claim scenarios, automated complex adjudication rules, and connected existing systems through APIs and microservices. They built modular UI components to give service representatives a single, easy-to-use interface. The layered architecture allowed for scalability and reuse across products and states.

Key elements of the approach included:

Agile, incremental delivery with continuous feedback

Rapid prototyping to validate concepts early

Reusable components to accelerate build and reduce duplication

Automated testing and DevOps pipelines for stable releases

Pilot programs and UAT to test real-world scenarios

Role-based training to prepare service representatives for adoption

The outcome of this collaboration was Claims Central—a modern platform that replaced nine disconnected systems with one unified experience. For representatives, it meant faster navigation and fewer administrative burdens. For claimants, it introduced digital self-service, real-time updates, and quicker resolutions.

Faster, clearer, more compassionate claims

The transformation brought significant improvements in both efficiency and customer experience. Claims were processed faster, representatives felt more confident with better tools, and clients received clearer, timely support.

Business impact included:

3–4 minutes faster claims handling time

10% reduction in effort through automation of manual tasks

Lower operational overhead and reduced errors

9 systems consolidated into a single platform

Real-time updates and digital self-service for claimants

Improved client engagement and representative confidence

Most importantly, the changes impacted people's lives in ways that numbers alone can't show. After losing his wife, one beneficiary completed his claim easily and was told his payment would arrive within three business days. He described it as “the easiest thing that happened since my wife passed away.” This story highlighted the heart of the transformation, making difficult moments less burdensome.

The road ahead

With the foundation in place, the insurer is now looking to make further improvements using analytics for deeper insights, applying AI to support decision-making, and continuously refining the client and representative experience.

For Virtusa, being part of this journey has been more than just modernizing a system. It has been about working with the insurer to restore confidence, reduce complexity, and center empathy in claims. This collaboration has created a strong foundation where technology makes the process easier and more reassuring for clients when they need it most.