PEGA

Industry - Healthcare & Life Sciences

Region – US

Digitized Federal and State-Funded Health Insurance Program: Streamlining US Health Insurance Access.

Core takeaways

Technology Strategy

Business challenge

Manual processing of federally and state-funded health insurance applications was prone to human inconsistencies, delays, and errors. The complexity of eligibility determinations and subsequent assessments required a robust system that could ensure 100% process efficiency while adhering to strict regulatory guidelines.

Solution overview

Eclatprime implemented an online system that digitized the entire health insurance application lifecycle. Customers submitted their applications digitally, which were then automatically assessed for eligibility. The system integrated with backend IT infrastructure to process renewals, trigger email notifications for updates, and create a fully traceable audit trail for each application.

Key success metrics