Case Study: Molina Healthcare achieves $40M+ annual savings and streamlined authorizations with Pegasystems

Molina Healthcare redefines member and clinician experience

Molina Healthcare, which serves more than five million members across 22 U.S. states, faced siloed departments, manual workflows, and limited automation that made it difficult to manage authorizations, reporting, and benefit coverage. The organization turned to Pegasystems and its Pega platform to help digitize operations and create a more connected experience for clinicians and members.

Pegasystems helped Molina Healthcare build the Molina Enterprise framework, starting with appeals and grievances and then expanding to utilization management with automated intake, routing, and system integration. The result was a single application that eliminated “swivel chair” work, improved auditability and real-time reporting, and cut fax processing by 6–9 minutes per fax—driving more than $40M in annual savings, with 95% of transactions completed in real time.

Molina Healthcare

Pamela Sanborn

Senior Vice President