Kartheek Kalluri on AI, Pega, and the Future of Claims Processing

In today’s fast-moving business world, companies are constantly seeking ways to improve efficiency and streamline operations. One solution gaining momentum is Pega software, a user-friendly platform that automates business processes and enhances customer engagement. Kartheek Kalluri, a software engineer with over 13.5 years of experience, is at the forefront of integrating Pega and AI to revolutionize claims processing and fraud detection. In this exclusive interview, he shares insights into his journey, achievements, and the future of automation in the insurance sector.

What inspired you to explore AI and automation in claims processing?

I’ve always been passionate about process optimization and intelligent automation. My experience across organizations like CareFirst BlueCross BlueShield (BCBS), Asurion Insurance Services, and a leading financial institution has shown me how inefficiencies in claims processing impact both businesses and customers. AI and automation provide a way to accelerate decision-making, improve accuracy, and enhance customer experience.

Can you tell us about a major achievement in your career?

One of my most significant projects was at CareFirst BCBS, where I led the transformation of claims processing using Pega’s decision-making platforms. My team embedded dynamic rules into claims workflows, which reduced processing time by 35%. This not only improved operational efficiency but also allowed for faster claims settlements, greatly benefiting customers.

How did you enhance operations at Asurion Insurance Services?

At Asurion, I was involved in the implementation of Horizon, a mobile solutions platform. This system simplified the claims process, cutting processing time by 30%. It allowed customers to submit claims seamlessly while reducing operational bottlenecks.

Fraud detection is a major challenge in the financial sector. How did you tackle this issue?

At a leading financial institution, I spearheaded the integration of AI-driven decision models for fraud detection and compliance checks. These AI-powered models improved fraud detection accuracy to 90% while significantly reducing false positives. This innovation enhanced security measures, ensuring fraudulent claims were caught early without disrupting legitimate transactions.

How have your automation strategies impacted business operations?

Automation plays a crucial role in efficiency. At the financial institution, I designed intelligent automation workflows that resulted in annual savings equivalent to over 30 Full-Time Equivalents (FTEs) and reduced manual processing by 40%. Similarly, at Pega Systems India Pvt Ltd, I contributed to developing a Customer Process Management for Insurance (CPMI) system. This scalable platform increased customer interaction value by 40%, helping businesses handle high-volume claims efficiently.

What challenges did you face while implementing these solutions?

Each project had its own set of hurdles. At CareFirst BCBS, I had to navigate legacy system limitations. While deploying AI-powered fraud detection, overcoming integration complexities was a challenge. At Asurion, real-time data inconsistencies required innovative solutions. Lastly, at Pega Systems, ensuring scalability in the CPMI system was critical to maintain performance during high traffic.

How do you contribute to knowledge-sharing in your field?

I actively write blogs and whitepapers on AI integration with Pega for process optimization. I also contribute to internal knowledge-sharing platforms, focusing on workflow automation and decision models. Sharing insights helps others leverage Pega effectively.

What trends do you foresee in the insurance and claims processing industry?

The future lies in AI and machine learning-driven claims processing. These technologies will enable predictive analytics and real-time decision-making, improving efficiency and fraud detection. Automation tools like Pega RPA are becoming indispensable for optimizing claims workflows. Additionally, cloud integration will play a vital role in managing large-scale claims securely and efficiently.

How should organizations address data security in AI-driven claims processing?

Investing in AI-powered compliance tools is crucial to mitigate risks and ensure transparency. Organizations must also foster collaboration between IT and business teams to identify and implement high-impact automation solutions.

What is your advice for professionals entering the automation and AI space?

Stay curious and keep learning. The industry is evolving rapidly, and professionals should develop expertise in AI, automation tools, and business processes. Collaboration is key—work closely with business teams to create impactful solutions.

Any final thoughts on the role of technology in claims processing?

Technology is redefining the insurance sector. Efficient claims processing is essential, and AI-driven automation is the future. As the industry progresses, individuals like me will continue developing solutions that enhance efficiency, reduce costs, and improve customer experiences.

With experts like Kartheek Kalluri leading the charge, the future of claims automation and fraud detection looks promising. His work highlights the transformative impact of AI and Pega in modernizing business operations and enhancing customer satisfaction.