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Pega Infinity platform

Pega Infinity and Pega Smart Claims Engine

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The Pega Infinity™ platform is the bedrock of the technology stack that supports the Smart Claims Engine. Pega Platform provides the industry-leading business process management, rules resolution, and workflow technologies that Smart Claims Engine leverages.

The Pega Infinity platform also supplies a high volume, high-performance processing engine and supplies the rules that enable context-driven claims processing in Smart Claims Engine. The urgency algorithms in the Pega Infinity platform ensure that claims examiners get the highest priority work item by using the Get next button.

Pega Platform provides extensible capabilities to support the following key Smart Claims Engine functions:

  • Claims operations reporting and dashboards allowing managers and supervisors to track work, service-level agreements (SLAs), and processing metrics
  • Searching and matching algorithms that enable Smart Claims Engine to select and validate the correct members, providers, and authorizations based on submitted claim data
  • System configurations that support horizontal and vertical scaling for performance
  • Data integration for claims processing; data can be sourced from external sources, reside locally, or both
  • A UX infrastructure that facilitates end-user interaction with the claims and the system

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