Case Study: Elevance Health achieves faster, more accurate claims processing with Pegasystems Pega AI

Elevance Health delivers personalized customer experiences with Pega

Elevance Health, which serves 118 million members and processes about 40 million claims each month, was struggling with a complex claims workflow that forced nearly 5,000 examiners to move between multiple legacy systems and green screens. The company turned to Pegasystems and Pega AI to improve the claims examiner experience, reduce training burden, and deliver faster, more accurate service.

Pegasystems implemented Claim Intake Workflow (CIW) using Pega Smart Claims Engine to unify claims processing in one interface, automate manual validation, and enable skills-based routing and real-time guidance. The results included a single end-to-end claims platform, reduced processing time, improved accuracy, faster reimbursement, better customer satisfaction, and more effective workforce planning through AI-driven forecasting and simulations.

Elevance Health