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The Next-Gen Platform for Healthcare Claims Pre-Processing

A scalable, secure, multi-tenant workflow solution with integrated AI OCR, business rules, compliance checks, and analytics to optimize every stage of claims intake.

WNS ClaimsTRAC is a Next Gen Workflow Platform for HealthCare Claims Pre-Processing, hosted on Cloud (Azure/AWS), and designed to transform the way Healthcare and Insurance enterprises handle claims. Customers expect speed and precision in claims processing. But constrained by legacy systems, the process is often delayed, error-filled and frustrating. Added to this are regulatory complexities, rising instances of fraud and high operational costs. WNS ClaimsTRAC changes all that. By streamlining workflows with automation and AI-powered intelligence, our solution delivers cleaner claims, faster resolutions, lower manual efforts & costs with AI-driven data capture, validations, business rules, and real-time analytics.

The result is faster settlements, optimized costs and stronger customer trust. Made possible with WNS ClaimsTRAC.

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Delivering Real Outcomes

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Key Challenges We Solve

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Evolving Customer Expectations

Customers demand quick resolutions and transparent processes, and any delay or error in handling claims can significantly impact customer satisfaction and loyalty

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Stringent Regulations

Regulatory requirements are intensifying, necessitating more robust and audit-ready claims processing systems

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Outdated Systems

Traditional claims processing platforms have limited automation capabilities, higher susceptibility to errors and an inability to scale with increasing claim volumes

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Escalating Fraud Risk

As the complexity of claims grows, businesses need advanced analytics and machine learning to detect and combat fraud

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How WNS ClaimsTRAC Delivers

We offer a flexible and a scalable claims pre-processing workflow platform, leveraging AI enabled data extraction, automation and analytics with an enhanced security layer to ensure a frictionless customer experience at every touchpoint.

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HealthCare Claims Pre-Processing Workflow Platform:

  • Purpose-built for Healthcare Claims Processing (Payer & Provider) with configurable models for eligibility docs, claim packets, clinical notes, referrals, and pre-auth submissions
  • Delivered as cost effective BPaaS Offering for processing various types of documents across HealthCare & Insurance domains with enhanced accuracy and productivity benefits.
  • Built on latest technology with open source, flexible core platform capabilities.
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Automated Intelligent Data Capture

  • Supports payer & provider claim forms including CMS, HCFA-1500, UB-04, dental claims, prior auth requests, encounter forms, medical records, EOB/ERA attachments
  • ICD-10, CPT, HCPCS code extraction & validation for cleaner pre-adjudication accuracy
  • Advanced AI Algorithms ensure higher accuracy in data extraction and classification
  • Rubber Band OCR enabled additional accuracy for unstructured documents
  • Also support Structured / Un-structured documents and EDI-837, etc.
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Multi-Tenant Architecture

  • All client instances managed in one platform
  • Reduced infra and set up costs
  • Centralized Updates: platform-based updates reducing system downtime
  • Reduces latency
  • Supports multi-LOB healthcare operations (Commercial, Medicare, Medicaid, ACA) under separate tenant configurations
  • Tenant-level claim validation packs with configurable business rules
  • HIPAA-compliant data segregation with independent scaling for high-volume claim seasons
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Next-Gen Scalable Platform

  • Integrated with claims ingestion process —mailroom → scanning → OCR → validation → core claims system.
  • Pre-adjudication data checks for duplicate claims, missing data, eligibility flags, and routing based on claim type (professional, institutional, pharmacy)
  • Latest technology with flexible core platform and seamless integration
  • Configurable workflow, business rules and validations
  • Improved customer experience with rich UI and streamlined workflows
  • Scalable & Flexible architecture
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Complete Transactional Transparency

  • Single platform with multiple portal views
  • Advanced business rules and validations
  • Exception handling, email functionality and quality reviews
  • Systematic documentation handling
  • Multi-thread quality sampler
  • Robust, enhanced downloadable dashboard with drill down and multi-view functionality
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Business Intelligence

  • Workflow Platform designed for processes with:
  • Claim-level analytics: clean claim rate, denial trends, provider error patterns, specialty-level throughput
  • Data Management
  • Claimant / Provider validations
  • Custom Report Generator
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Adaptability & Scalability

  • Swiftly adapts to changing and new compliance requirements
  • Built-in compliance adherence as per industry regulatory standards
  • Complete audit trail
  • Advanced analytics to support scalability
  • Auto-routing to clinical review teams
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Security & Compliance

  • Advanced security measures with advanced data encryption and role-based access controls
  • Enabled with Single Sign On (SSO) for simplified user login using Security Assertion Markup Language (SAML) authentication
  • Multi-factor Authentication (MFA) via SMS, email or Microsoft/Google Authenticator app
  • Automated audit trails
  • Fully compliant with HIPAA, HITECH, CMS guidelines for healthcare document processing & compliant data segregation across Tenants
  • PHI – PII safe architecture with enhanced auditability for claims operations

Proven by Numbers

WNS partners with leading enterprises, enabling them to simplify and streamline fractured claims processes that are error-prone, time-consuming and costly. Our scalable solution manages volume fluctuations, tight regulations and tracking issues, offering control, efficiency and higher customer satisfaction.

Here is the impact delivered for two of our clients:

Leading US-based First-Party Claims Service Provider

  • 15% efficiency improvement in just three months of implementation
  • 5.4 million documents processed annually
  • 98% - 99% of the claim volumes processed within 24 hours
  • 100+ error scenarios caught and fixed
  • 75-90% quicker critical deliverables report preparation

Pension Risk Transfer Business of an American Insurance Company

  • 5.2 million documents processed annually
  • 60% reduction in time taken for indexing letters/forms
  • 1,000 (5,000 pages) documents are being targeted to be indexed within 24 hrs
  • 5,000 simpler and duplex letters/checks processed per month
  • 100% quality check conducted

Why Choose WNS ClaimsTRAC?

  • Next-gen platform, powered by AZURE
  • Configurable and scalable framework
  • Easy API integration
  • Cloud/ On-premise hosting
  • Advanced security with role-based access control
  • High-quality checks

Embrace the future of healthcare claims pre-processing with WNS ClaimsTRAC: Claims Automation - Compliance First, AI Next, Enterprise Ready.

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