Expanding the Digital Platform to Improve Business Operations, Customer-Centricity, and Growth

The Company

The insurance carrier is a Fortune 500 company, providing financial protection to more than 50 million people worldwide. It is a leading US based large supplemental insurance provider for individuals and groups. The company was founded in 1955 and is based in Columbus, Georgia, US.


A major US financial organization dealing in financial, retirement, insurance, and investment services, products, and solutions. Requirements included:

  • Comprehensive self-service across multiple channels with Omnichannel experience
  • Inbound and outbound with proactive communication
  • Digital/software driven, cloud based, and API driven
  • Predictive queues and intelligent workforce management
  • Customer journey, empathy-based metrics and outcomes
  • Leveraging Al to improve customer engagement technologies’

The Challenge

The insurance carrier is going through a major transformation and expects its partners to provide agility, quality and cost effectiveness through their services. They are aggressive in expanding their digital platform as this would tailwind their business growth. It will embark a new era where it would open a gateway for different groups of customers like Millennials.

Their current customer service operation is a manual agent based and heavily dependent on the intervention by agents. All the queries are passed to an email account where the agent responds to the queries by collating the data from different systems and manually drafting the response. This process takes a longer time to respond to customer query and involves higher operation costs.

Looking to reimagine customer experience through omnichannel capabilities and leveraging contact center as a service, the client wanted to provide customers the ability to do self-service transactions on digital channels seamlessly.

The Solution

  • Create the blueprint to provide a customer service framework application, to read emails in an inbox, create an inbound correspondence case, apply Pega AI capabilities like text analysis, sentiment analysis, and text extraction to send automated response and/or to route cases appropriately to the correct work queue.
  • Users can also integrate with Policy and Claims SORs to get Policy and Claim information required to successfully resolve the request by CSRs.
  • Provide the functionality for Policyholders and Account administrators to chat with Intelligent Virtual Assistant using web and social media to seek information or to fulfil their request.
  • Provide a customer focused 360 UI, with policy and claims data. The data will be displayed in the designated UI section in the Pega Customer service platform.
  • Facilitate a 3-Layer API approach having experience, process, and system APls.


  • Pega (AI capabilities, Email Listener, Customer Service layer, Pega Call, Pega Chat, Intelligent Virtual Assistant, Pega Diagnostic Cloud).
  • API gateway (MuleSoft) /EIB API interfaces
  • Document Management (FileNet)
  • BI/Analytics (Pega Analytics)
  • Single Sign-on
  • Avaya, Business Intelligent Exchange (BIX)
Save for Later Download Case Study