Pega

Customer submits claim via mobile app

Pega AI extracts data from photos of damage

Business rules validate policy coverage

Process AI identifies potential fraud

Claim is auto-approved or routed to an adjuster.

CDH identifies a customer at high risk of churn based on usage patterns

System calculates the Next-Best-Action (e.g., a personalized discount)

Discount offer is sent via SMS

Customer accepts, and Pega automatically updates the billing system.

System collects ID documentation via secure portal

Automated API calls check global sanctions lists

Discrepancies are flagged for manual review

Case is tracked through audit trails until final approval.

Customer flags a transaction

Pega Case Management initiates a dispute sub-process

System automatically sends required letters to the merchant

Refund is provisionally issued based on predictive trust scoring.

IoT sensors trigger a delay alert for a shipment

Pega identifies all impacted orders

AI recommends re-routing or alternative sourcing

Notifications are automatically sent to affected customers.

Provider submits auth request via HL7 FHIR integration

Pega Clinical Engine reviews against medical necessity guidelines

System auto-approves 60% of routine requests

Complex cases are routed to specialized medical reviewers.

Citizen initiates a permit request via a chatbot

Pega creates a case and routes it to the correct department based on geolocation

Status updates are pushed to the citizen automatically

Final permit is generated and digitally signed.