PEGA BPM CASE STUDY
PEGA Project Scenarios:
Claims (Healthcare) Analyst System:- Includes Case
Management/Claims Use Case UI Development/Email/Validations/Database tables/SLA
Handling
The Healthcare Claims Solution is a design model showcasing how
business edits can be configured, arranged, and maintained effectively to
process claim files. It is important to understand that one of the key goals of
the Claims Solution is to provide an alternative, efficient way to handle
claims processing edits; especially those that change frequently and/or require
a high level of custom programming effort on the main claims adjudication
system(s). Also it primarily focuses on the Customer get the insurance claims
redeemed based on the credibility and process with shortest turnaround as
possible.
Topics:
UI:
Properties, Harness
Sections and Layouts
Flow Action
Rule Resolution, Circumstancing, Rule Availability, Prerequisites
Sections and Layouts
Flow Action
Rule Resolution, Circumstancing, Rule Availability, Prerequisites
Case Management
Urgency, Service Levels (Agents)
Work Party, Work Status
Creating subcases, Locking
Integration
Connectors
Services
Database table mapping
Urgency, Service Levels (Agents)
Work Party, Work Status
Creating subcases, Locking
Integration
Connectors
Services
Database table mapping
Advanced Concepts
SMA
Agent Tracing
Product Rule
SMA
Agent Tracing
Product Rule
Specific
topics can be included in further based on the clarifications and request.
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