Revolutionizing Appeals and Grievance Management: Digitization with PEGA AI

Abstract

In the realm of healthcare administration, the management of appeals and grievances represents a critical yet complex process prone to inefficiencies, delays, and errors. Leveraging the transformative capabilities of artificial intelligence (AI) and the robust functionality of the PEGA platform, this thesis explores the digitization of appeals and grievance management. Through an in-depth analysis of industry challenges, AI methodologies, PEGA implementation strategies, and real-world case studies, this research elucidates the potential of AI-powered PEGA solutions in revolutionizing appeals and grievance management. By synthesizing academic literature, industry insights, and practical experiences, this thesis provides a comprehensive framework for organizations seeking to optimize appeals and grievance processes through digitization with PEGA AI.