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  • 28+Clients

  • 6,000+Clinical and Non-clinical Staff

  • $100 Mn+Incremental Savings

  • 4:1Average ROI Delivered

  • Accredited by URAC, HITRUST, NCQA

48% of healthcare professionals say that over three-fourths of their organization's revenue is still tied to fee-for-service reimbursement.

Yes, for health plans, achieving value-based healthcare has long been a challenge, prompting healthcare reform and a focus on balancing risk and reward, enhancing patient care quality and optimizing healthcare services.

What will outpace profit-driven healthcare? A data-driven approach prioritizing digital technologies, and this is the focus of WNS.

WNS has over 20 years of experience in Specialty Management Programs, Clinical, Care Management, and Knowledge Process Management across Commercial, Medicare, and Medicaid segments. We prioritize delivering value to health plans through our unique product offerings, pay-for-performance methodology, and a globally sourced talent pool.

Paving the Way for
Better Healthcare

Tackling the Challenges Head-on

As the health industry moves toward value-based care, health plans and providers must be ready to address key challenges that hinder progress. These include:

  • Being underprepared to meet the surge in healthcare delivery

  • Need for a digital shift to provide hyper-personalized care at optimized operating cost

  • Low awareness and adoption of remote care delivery

  • Inability to meet the growing demand for real time analytics and data-driven support

  • Lack of innovative and sustainable solutions to mitigate pressure on medical loss ratio

How is WNS Making a Difference?

Our clinical operations management solutions are already re-defining the healthcare landscape by providing a unified experience for providers and health plans, while ensuring the interactions are seamless.

You have a vision to scale your business and WNS has the expertise to bring that vision to life. We know what your business needs are, helping you succeed in the ever-changing competitive landscape.

Comprehensive Clinical Operations Services and Solutions

Onboarding

Benefits
Management

Provider Network
Management

Utilization
Management

Provider
Education

Administration
(Clinical and
Non-Clinical)

PBM
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Member
Services

Patient visit

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or call

Provider
Services

Submit / approve

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Communication

Prior Auth.
Management

Pharmacy
Operations

Pharmacy

Claims
Adjudication

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Pharmacy
and Medical
Invoicing

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Medical
Claim Recon

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Claims submission with NDC

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Deliver to patient home or provider

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(Voice and Back Office)

Receive medical claims with JCodes to reconcile, analyze and monitor utilization trends

Care
Continuum

Care
Management

Quality and
Compliance

Reporting and
Analytics / BI

Value Added
Support

Talent Management

Quality Management

Compliance

Training

Medical Economics

PMO

Risk Management

IT / Infrastructure

Clinical Care Management Operations

End-to-end clinical and care management BPM expertise

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Clinical Intake

Key Functions

  • Clinical Case Setup
  • Pre-certification Support
  • Provider and Member Support
  • Provider Outreach
  • Member Notifications
  • Prospective / Retrospective

Resource Profile

Non-clinical Staff

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Clinical Review Management

Key Functions

  • Clinical Case Prep
  • Utilization Review
  • Coverage Determination
  • Denial Management
  • Case Management Referral

Resource Profile

PHRN, USRN, Pharmacists

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Physician Review

Key Functions

  • Peer-to-Peer Review
  • Clinical Guidelines and Rules Enhancements
  • Research and New Program Development
  • Provider Education

Resource Profile

MDs across Multiple Specialities

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Clinical Data Management

Key Functions

  • Case Summarization
  • Claim Reconciliation
  • Reconsideration, Appeals and Grievances Support
  • Provider Benchmarking / Network Management

Resource Profile

U.S. RN, Data Scientists, DW / BI Analysts

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Compliance

Key Functions

  • CMS Audits
  • URAC and NCQA Accreditation
  • Utilization Review and Care Management Laws
  • State Reporting

Resource Profile

U.S. RN, Attorneys

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Quality Management

Key Functions

  • Transactional Quality
  • Inter-Rater Reliability (IRR)
  • Trend Reporting
  • Total Quality Management

Resource Profile

U.S. RN

 
 

Enabling Clinical Business Support Functions

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Clinical Product Team

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Medical Economics
and Informatics

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IT Application Team

Create Better Experiences with Key Accelerators

WNS EXPIRIUS™

Our unique CX model is designed to strike the right balance between technology and human-assisted support across the patient journey. Underpinned by AI, analytics and industry expertise, it drives digitally enabled, on-demand, seamless and personalized patient interactions. EXPIRIUS powers hassle-free experiences across provider awareness, scheduling, triaging, prior authorization, registrations, care, billing and retention.

Explore more

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Win with WNS Clinical Center of Excellence and Clinical Knowledge Process Management

-

%

improved patient experience

%

turn adherence for all member and provider notifications

-

%

reduced cost of ownership through digital customer experience

%

efficiencies leveraging AI / NLP based chatbot and reduction in human errors

%

increase in TAT compliance

Real-world Outcomes with Our Clinical Operations
Management Offerings

A Regional Provider Network-led Health Plan in the U.S. was struggling with disparate systems and processes, change management, and inconsistent performance and risk management

We leveraged business process re-engineering, automation and robotics, and workforce optimization to unlock outcomes such as:

  • 20% efficiencies in just two years
  • 37% reduction in manual steps in the first year
  • 99.50% TAT adherence for all member and provider notifications
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For one of the Top 5 national payers in the U.S., addressing increased regulatory oversight, poor NPS and provider experience and high member turnover was top priority

Through operating model re-design, intelligent automation and analytics, we helped drive:

  • 10% incremental savings delivered consistently year-on-year
  • 7% year-on-year consistent member growth, and
  • >98.50% provider satisfaction scores

By harnessing digitization and automation, we have helped multiple U.S. payer clients tackle imperatives of operational cost reduction, and improvement of physician performance and Turnaround Times (TAT)

Some of the tangible outcomes include:

  • 40% cost reduction in two years
  • 30% reduction in manual errors
  • 25% better physician performance, and
  • 180% TAT compliance
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Optimize your clinical operations outcomes with WNS.

Reach out to us now