Digitalization for Seamless Insurance Claims  Digitalization for Seamless Insurance Claims 

Digitalization for Seamless Insurance Claims 

Building a Transformative Platform for a Legacy Insurance Company


Established over a century ago, our client stands as a steadfast insurance company with a global footprint, having a workforce of over 4100+ employees and a presence in 25 offices worldwide. Specializing in providing comprehensive solutions that elevate wellbeing and ensure financial security, placing people at the heart of everything they do.  

The company’s insurance offerings are structured into four principal areas: Voluntary Benefits, Health Benefits, Small Business Benefits, and Health Fitness Benefits. Going beyond meeting the needs of their customers; they play a crucial role in helping working individuals cover unforeseen out-of-pocket expenses during unexpected crises. 

25 offices worldwide 


Business Challenges  

Our client grappled with a conventional and time-consuming benefits enrollment and claims process that was eating into their well-established reputation. The existing digital process required unnecessary manual steps for filing claims. Unaligned with evolving expectations of the market the process was projecting the company as outdated and less customer centric. 

Simplified enrollment and time-efficient claims procedures could be introduced with turnkey digitalization platforms. Addressing the need to transform their policy processes with a scalable platform, the client sought a solution that delivers immediate results. The problems were easily identifiable, but plenty: 

  • Time-consuming and tedious process 
  • Delayed claim filing and adjudication process 
  • No online submission capability 
  • Not being able to rollout benefits on time  
  • No online ‘self-serve’ ability to obtain the status of claim submission(s) 
  • Growing competition from recently born digital-savvy insurance companies 

Choosing a Roadmap to Digitalize  

The client’s final challenge lay in navigating the process of selecting an optimal solution for benefits enrollments and consequent services. Their benefits enrollment procedure required a solution that could seamlessly be adopted by their teams and provide a modern, efficient, and error-free experience.  

Hexaware emerged as the preferred choice by offering a bespoke, customized solution designed to cater to our client’s team as well as its policyholders, and ultimately to business success. Our consultants helped tailor a solution for immediate turnaround.  


The Hexaware solution 

Considering the drawbacks faced by the firm due to lack of modernization, Hexaware tailor-made a solution providing an online platform that helped policyholders navigate seamlessly through the online interface. Our solution: 

  • Digitalized their traditional approach of claim filing 
  • Ensured details entered in the portal were duplicated across other systems 
  • Designed a user-friendly portal 
  • Reduced errors in claims with auto-fetching of a policy owner’s details 

As part of the solution, Hexaware developed a claims online mash-up embedded on our client’s website. The combination and integration of features and functionalities from different online portals sourced customer data to verify the user and, upon verification, returns all active policies and coverages on the screen to proceed with filing a claim.  

This easy-to-use interface helps customers collect and input all the needed information for their claim, making the adjudication process smooth and efficient. By automating the form generation and submission procedures, the platform enhances the overall user experience and ensures that the essential information for passing the claim is collected systematically. 

Pega for Digitalized Insurance Claims  

We implemented a Pega-based solution that automatically pushed the claims along with additional documents uploaded to the customer’s workflow system for further claim processing. Pega’s solution was a holistic choice for all aspects including customer service, claims processing, underwriting, and overall workflow automation. Its benefits: 

  • Anyone flow vs. Smart flow: The solution displayed the active policies and coverages that could be claimed for a verified policy owner as a part of ‘Smart flow’ and also allowed a non-verified user to proceed with filing a claim under ‘Anyone flow’. 
  • Additional document upload: The solution allowed policyholders to upload additional documents on a submitted claim by using key policyholder identifier values like date of birth, first name, last name, and more. 
  • Claims dashboard: As part of the solution, users could access a dashboard for a summary and a detailed list of submitted and in-draft claims to review and continue finishing up a draft claim later. 
  • Claim maintenance: The solution also provided a platform for customer claim admin/manager to add/edit claim configuration in the data source as per future needs to maintain–claimable coverage group, claimable coverage, claim benefits, claim proofs/forms, smart search keyword list, claimable coverage benefit mapping, sub-product mapping, rider mapping, and form mapping. 

Hexaware helped the client to deliver superior experiences with easy claim submission and document upload features. Relevant details were made available to help the policyholder navigate easily for claim submission. 


Immediate Impact of Digitalization 

Streamlining claims and seamlessly accelerating insurance claims. 

Reduced Operation Costs  
30% cost savings by reduced manual interventions and reduced turnaround time. 

Reduction in Claim Errors 
Accessibility to applicable forms eliminating wrong claim submissions. 

Competitive Positioning 
Faster time-to-market for new products and services. 

Data-driven Business Acumen 

A holistic analytics dashboard for policy journey insights for business stakeholders. 


Hexaware’s solution tackled the client’s business challenges and laid the foundation for a digital insurance landscape characterized by heightened efficiency, user-friendly interactions, and enhanced competitiveness.  

As a result, the client is now poised to propel forward to the forefront of the insurance industry, embracing innovation and redefining industry standards.  

A future roadmap has been envisioned to elevate the claims experience for policyholders. The benefits would include auto adjudication and streamlined online claim payments, ensuring a more efficient and seamless process for policyholders. 

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Every outcome starts with a conversation