{{item.videoDuration}}
{{item.title}}
{{item.text}}
{{item.videoDuration}}
{{item.text}}
Claims administration
Simplifying, implementing, and executing holistic complex claims programs
Our extensive knowledge and longstanding history of helping administer complex claims programs allows us to leverage our tailored Claims Management System and to provide perspectives and lessons learned from program strategy, planning, and execution through wind down.
PwC has a longstanding history of helping support complex claims programs from strategy through execution
- Management & strategy: Governance, strategy and planning, process design and implementation, program management.
- Claim adjudication: Claim processing activities, including review, valuation and adjudication of claims leveraging enabling technologies (e.g., AI, data-driven approach), quality control, appeals functions.
- Technology and reporting: Integrated secure platform for claim filing and document submission, file review, reporting and analytics, data management, website design and deployment.
- Supporting functions: Payment and release review, claimant notification strategies and communications, management of claimant call centers, fraud prevention and mitigation.
| Settlements resulting from: |
|
| Extensive experience with various claim types including: |
|
- Governance
- Strategy and planning
- Process design and implementation
- Program management
- Claim processing activities, including review, valuation and adjudication of claims leveraging enabling technologies (e.g., AI, data-driven approach)
- Quality control
- Appeals functions
- Integrated secure platform for claim filing and document submission
- File review
- Reporting and analytics
- Data management
- Website design and deployment
- Payment and release review
- Claimant notification strategies and communications
- Management of claimant call centers
- Fraud prevention and mitigation
How PwC can help
- Unmatched claims administration excellence
- Specialized and scalable resourcing
- Accelerated AI data driven technology and reporting
- Backed by PwC global network
- Public trust and credibility
Unmatched claims administration excellence
With decades of experience in complex, high-profile claims, we are skilled with building and executing high-volume programs including key support functions (e.g., fraud, claimant communications, and appeals).
Specialized and scalable resourcing
Specialized, scalable resources to help adapt to evolving program needs, enabling rapid integration with experience in areas like technology, economics, statistics, and industry.
Accelerated AI data driven technology and reporting
We deploy an AI and data driven approach through our integrated Claims Management System facilitating claim reviews and featuring public website, claimant and attorney portals, and in-depth reporting and analytics.
Backed by PwC global network
Bolstered by PwC's vast global network, featuring over 50,000 U.S.-based staff and partners spread across all major U.S. cities, and a worldwide network of over 370,000 professionals.
Public trust and credibility
Commitment to a transparent, fair, and efficient claims program designed to provide timely compensation to claimants, backed by a long-standing tradition of stakeholder collaboration.
Claims life cycle and functions
We implement an agile and streamlined claim review process aligned with the claim type, risk, and requirements of each program. Below is an illustrative life cycle of a claim, which can be customizable based on the needs of each program.
- Supporting functions
- Program management and strategy
- Claimant support and communication
- Reporting and analysis
- Information technology
- Document administration
- Fraud, waste and abuse
- Claims life cycle
Enabling technology
Our technology and data driven approach to claims programs utilizes a variety of AI-enabled analytics and technology across the life cycle of each program to help achieve a more efficient, accurate, and transparent process.
| Claims management system | Reporting and analytics | Automation and controls |
|
|
|
GenAI solutions
We leverage GenAI to streamline claim review by summarizing complex data, automating the appropriate review pathway for claims via comprehensive characteristic analytics, and accelerating document analysis. With claimant equity, fairness, and ability to disburse funds quickly, GenAI promotes review consistency, increases speed of processing, and supports strategic decision-making across the program life cycle.
{{filterContent.facetedTitle}}
{{contentList.loadingText}}
{{contentList.loadingText}}
