Pega AI for Adaptive/Predictive Model Development in Claims Processing: A Comprehensive Review
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Description
This research paper examines the application of Pega Artificial Intelligence (AI) in the development of adaptive models for claims processing. Claims processing is a critical function in various industries, including insurance, healthcare, and finance, where efficiency, accuracy, and customer satisfaction are paramount. Pega AI offers advanced capabilities for building adaptive and predictive models that can dynamically adjust to changing data and business requirements, thereby improving the speed, accuracy, and cost-effectiveness of claims processing. Through a comprehensive review of existing literature, case studies, and practical examples, this paper explores the potential benefits, challenges, and best practices associated with using Pega AI for adaptive model development in claims processing. Additionally, it discusses future research directions and implications for practitioners seeking to implement AI-driven solutions in claims processing workflows.
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JSAER2024-11-1-270-275.pdf
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References
- [1]. App Tech, "Common Challenges In Claim Management," apptechllc.com, [Online]. Available: https://apptechllc.com/common-challenges-in-claimmanagement/. [Accessed April 2023].
- [2]. A. Veenendaal, "Claims Process Automation Explained," blueprism.com, [Online]. Available: https://www.blueprism.com/guides/claims-processautomation/#:~:text=Most%20automated%20claims %20processing%20software,claims%20faster%20and %20more%20accurately.. [Accessed June 2023].
- [3]. Virtusa, "Intelligent Claims Adjudication," pega.com, [Online]. Available: https://community.pega.com/marketplace/component/ intelligent-claims-adjudication.
- [4]. PegaSystems, "Predicting customer behavior using predictive models," pdn.pega.com, [Online]. Available: https://academy.pega.com/topic/predictingcustomer-behavior-using predictivemodels/v1/in/ 16766. [Accessed June 2023].