LTI Disability Claims Management Solution

While processing disability claims requires diligence and compassion, claim examiners often must search multiple legacy systems for relevant information while working under intense regulatory scrutiny. The result is a tedious process involving many workarounds ripe for errors and data inconsistencies.

Our solution Disability Claims Management focuses on the human-centric aspect of processes by providing an omni-channel customer service for intake, eligibility determination, and physician interactions. Powered by Pega's dynamic case management and suite of out-of-the-box calculators and integration, our solution can drastically reduce claims processing times, save costs, and transform the entire customer experience.

Scalable architecture

• Flexible design to support multi-country roll-out
• Extend framework to other lines of business
• Using the latest features of Pega Platform 8
• Utilizing the customer services strategic application to support easy extension to other services

• Pre-built disability intake, physician verification, employment validation, and return-to-work business processes
• Omni-channel customer service: text, chat, email
• Hierarchical case management for managing the entire claims process
• System-driven correspondence and document generation using DocuSign
• Multiple payout options including PayPal for faster payouts
• Customer 360: Integration with key data sources so examiners can make informed decisions with all information available in one system
• Automated red flags based on disability duration guidelines
• Workflow-based calendaring and scheduling of appointments and follow-ups
• Early intervention and follow up leads to early return to work, hence lower payout
• Compliant with ODG guidelines (ICD and RTW)