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PEGA Project Scenarios: Scenario: 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, Prerequisistes Case Management Urgency, Service Levels (Agents) Work Party, Work Status Creating subcases, Locking Integration Connectors Services Database table mapping Advanced Concepts SMA Agent Tracing Product Rule
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