Case Study: Health Alliance Plan achieves doubled productivity and improved timeliness and accuracy with Pegasystems

HAP Gives Itself a Health Boost

Health Alliance Plan (HAP), a regional health insurer, faced a highly manual, labor-intensive appeals and grievances process that made it difficult to meet changing state and federal regulations, accurately track cases, and keep error rates low.

Pega implemented a configurable process automation framework to streamline the full appeals lifecycle across web, email, fax and walk-ins, using a smart rules engine to prioritize urgent cases and enable skill-based routing for faster assignment. The changes delivered immediate gains — HAP saw improvements in timeliness, accuracy and productivity (13% timeliness, 33% accuracy, 66% productivity) and improved service for members and providers.

Health Alliance Plan

Garima Aggarwal

Director Customer Experience