WNS Healthcare Claims

Powering Payer Success: Streamlined Claims Processing

Claims processing in today’s competitive and complex marketplace needs to go beyond point solutions and embrace digitalization across the entire value chain. Payers have an opportunity to optimize costs and improve turnaround times, accuracy and customer experience by leveraging automation and analytics.

WNS offers a selection of bolt-on automation solutions to enhance a payer’s capabilities for auto adjudication, smart audits and intelligent workflows, and analytics for better decisions based on insights into operations data. We combine technology, domain expertise and advanced analytics capabilities to help our clients improve:
  • Operational efficiency by 25-30 percent
  • First-pass rate by 2-5 percent
  • Provider and member satisfaction
  • Claims processing accuracy
  • Turnaround time SLA compliance

Faster, Smarter Solutions for End-to-End Process Transformation

Easy integration into existing operational systems to achieve business goals with quick gains


Mailroom and scanning

  • PO Box (US)
  • Sorting of invoices
  • Prepare for scanning

Audit and adjustments

  • Medical records audit
  • Code review
  • Clinical audit
  • Relevant adjustments based on Preferred Provider Organization (PPO) pricing
  • Out-of-Network (OON) bill repricing
  • Refund and payment adjustment
  • Retrospective adjustments

Payment integrity review

  • Pre-payment reviews
  • Post-payment reviews
  • Retro audits
  • Co-ordination of Benefits (COB) processing
  • Recoupment and recovery

Data extraction

  • Data extraction
  • Document identification
  • State form identification and triage

Claims intake and pre-adjudication edits

  • Claims data entry
  • Timely filing validation
  • Member validationy
  • Eligibility check
  • Provider validation
  • Date of Service (DOS) validation
  • Pre-adjudication edits

Adjudication – first pass and rework

  • Claim pends and edits
  • Process duplicate edits
  • Process member edits
  • Process provider edits
  • Prior authorization edits
  • Pricing and payment verification
  • High-dollar claims verification
  • Finalize payment for services

Intelligent Automation Underpinned by AI / ML Capabilities

Identify new opportunities to elevate process efficiency and accuracy with a power blend of automation and advanced analytics
  • Robotic Processing Automation (RPA) to automate 20-30 percent of manual pend codes and improve first pass rate by 2-5 percent
  • Pre-adjudication intervention for claims repair to address 10-15 percent of claims volume upfront using enhanced business rules and algorithms
  • Smart Audit tool to help you accomplish >99.5 percent financial accuracy and procedural accuracy scores besides improving audit coverage
  • Claims analytics to generate business and operation insights and thereby enhance optimization
  • WNS’ quality rigor to reduce delayed claims and interest payments

Incomparable Experience in Claims Management

Our strong experience and domain expertise combined with powerful technology and tools makes us the partner of choice


Health plans

>99.5 %

Financial accuracy

>99.5 %

Procedural accuracy

30 million

Claims processed annually

>99 %

Claims turnaround
time of two days

Impact Delivered


Leading workers’ compensation service provider


Online reporting system, digital OCR solution and a flexible staffing model to cater to business volume variations


High operating costs, workflow issues and manual processes


32 percent improved operational efficiency via automation interventions; 50 percent volatile volumes handled and claims TAT reduced form 3 days to 1 day


Leading platform provider for medical liability claims for auto casualty


Digital workflow solution, unique transition methodology (EnABLE) for seamless transition of multiple end clients, focused audit approach to improve financial accuracy, and AI / ML tools for nurse reviews


Complexities due to unique processing guidelines, manual-intensive processes


35 percent operational efficiencies achieved by leveraging AI / ML interventions; 99.75 percent financial accuracy achieved


Major leading claims management software company


Process re-engineering, operating model re-design, and digitization


Fragmented processes, compliance and workflow issues


15 percent improved quality improvement in casualty claims, 100+ error scenarios caught and fixed in the data capture – for a highly compliant operations; ~25 percent improvement on critical service levels; quality improvement of 15 percent on DPU metric via clinical decision tree tool kit

Why WNS?
  • 20 years of experience working with the Chief Claims Officer’s organization, Head of Clinical Operations and all segments, Medicare, Medicaid and Commercial
  • An average of 7+ years long relationship with existing healthcare clients
  • More than 3000 associates servicing 20+ payers including 5 of top 10 payers in North America
  • VOC score consistently above 9.0 for the last 5 years