Case Study: UnitedHealthcare achieves $150M in savings and 5-10% higher auto-adjudication with Pegasystems

United Healthcare - Customer Case Study

UnitedHealthcare, part of UnitedHealth Group, faced a sprawling legacy claims environment of more than 25 siloed systems and rising volume (over 2 billion claims/year) that made even small changes costly and slow—taking up to a year—and required expensive manual processing that risked lost Medicare bonuses and customer-service fines.

By deploying Pega robotic process automation and a non‑core auto‑adjudication platform, UnitedHealthcare replaced hard‑coding with configurable rules to automate claims outside its legacy stack. The program has automated 150 million claims (about 500,000/day across 25+ systems), delivered more than $150 million in savings, increased auto‑adjudication rates 5–10%, redeployed 200+ claims examiners, and improved customer service and satisfaction.

UnitedHealthcare

John Silva

Director, Information Technology