HCLTech ADvantage Pega D.I.C.E. Solution

Insurance fraud is any act committed to defraud an insurance process. This occurs when a claimant attempts to obtain some benefit or advantage they are not entitled to, or when an insurer knowingly denies some benefit that is due. Insurance Fraud is no longer a victim-less crime, instead it has a cascading impact on all the stakeholders bearing the fraud-loss. Hence there is a great urge & demand to develop a system that can identify potential frauds with accuracy and arrest it at the very initial stage for detailed scrutinization. Some of the key problems faced by Insurance Organizations:

• Paper-forms that are manual & error-prone
• Multiple Handoffs with limited transparency
• Limited Input Channel Support
• Data stored in pockets across various legacy systems
• Reactive Detection of Fraudulent claims
• Speed of Settlement is slow, impacting customer experience
• Limited personalization or 1:1 engagement
• Increased Operational Expenditure / Cost

A solution for NextGen Insurance Platform, built leveraging Robotic Process Automation, Pega Case Management, AWS Machine Learning & the HCLTech ADvantageTM Azure Intelligent Assistant. It helps customers embarking on a digital journey and how the seamless interlock across the products can be achieved.

Why build a solution with Pega + other Ecosystem Partners, when Pega Infinity Platform can address them all?

Pega Infinity Platform's enterprise blueprint and cutting edge offering it can put a tick in a box for many areas (CRM, Case Management, Decisioning, AI/ML, Marketing, RPA, IVA to name a few). With this offering we want to create a pathway for ensuring how malleable & flexible Pega can be in a heterogeneous ecosystem. It also helps in creating a "better-together" strategy for addressing a customer landscape with diversified investment & complementing ecosystem products.

Business Benefits:

• Improve Productivity & faster time to market
• Reduce Manual hand-offs & overheads with STPs
• Reduce Operational Cost (OpEx)
• Multi-lingual conversation and voice enabled assistants
• Eliminate mundane & monotonous tasks with OCR & RPA
• Personalized Customer Experience
• Providing a human-face to your brand
• Elevation of the Nature of Work
• Improve Speed & Scale
• Proactive detection of Fraudulent Claims with AI/ML techniques

• HCLTech ADvantageTM Azure Intelligent Assistant (Chatbot, Multilingual, OCR, Virtual Assistant - Alexa/Google Assistant)
• Robotic Process Automation (Automated email parsing & processing of claims - leveraging UiPath)
• AWS Machine Learning / Sagemaker Integration for Fraud Detection / Prediction
• Google Map APIs integration for Street View
• Pega 8.x for Case Management Implementation
• WhatsApp Integration for fetching claim status info (leveraging Twilio Integration)
• Workato for iPaaS layer and defining a loosely coupled architecture