This is our story of leveraging a customizable and scalable platform to co-create an automated claims management solution for a leading technology firm that serves healthcare insurers.

As we know…

In healthcare and insurance, claims processing is a manual and fragmented activity with high operating costs. Managing information can be challenging as it comes from various unstructured sources, and the resulting ‘paper trails’ can be difficult to track and reconcile. Furthermore, this process involves numerous regulations, which often change and vary from region to region.

Cost-effective platform-led solutions that can automate end-to-end claims processing while being customizable and scalable are the need of the hour.

The challenge for a leading tech firm serving insurers was…

Its claims processing landscape was highly fragmented and manual. Claims were being received via e-mail, scan, fax and post in multiple formats, including bills and supporting documents. Spikes in daily volumes were leading to backlogs and high labor costs.

Manual processing was causing untimely and incorrect claim payouts, triggering penalties and interest paid to the providers. Incorrect denials were also breeding customer dissatisfaction.

Furthermore, there was no single, comprehensive tracking and audit mechanism across the claims lifecycle. Without a holistic view, the client was finding it challenging to increase efficiency, identify / plug the revenue leakage and ensure policy compliance.

Stepping in as a co-creation partner…

WNS leveraged its deep domain expertise, capabilities in digital automation and process excellence to deliver an end-to-end medical claims processing solution. We deployed a proprietary document processing workflow platform to co-create a customizable and scalable solution for the client.

This modular Business Process-as-a-Service (BPaaS) solution entailed:

Automated document ingestion, routing and allocation

Rule-based Optical Character Recognition (OCR) engine to automate data extraction from many structured and unstructured sources, including forms used by the Health Care Financing Administration (HCFA), Universal Billing (UB) and the Centers for Medicare & Medicaid Services (CMS)

Automated data indexing and validation

Streamlined exception handling

Real-time Data Analysis and Reporting Tool (DART) with complete audit trails

Advanced analytics for data management and claimant / provider validations

WNS’ proprietary document processing workflow platform helped the client process large volumes of data – from data extraction to the final XML outputs. It became the client’s sole platform for end-to-end claims processing while offering portal access to agents, supervisors and customers for ease of use.

The outcomes delivered from the process of co-creation are…

Built on an open and flexible platform, our proprietary document processing workflow solution helped the client swiftly adapt to changing regulatory guidelines and business rules. Rapid customization and continuous improvements brought several positive outcomes to the technology firm. Tangible benefits included:



improvement in data entry quality



improvement in critical service levels of meeting the TAT for claims processing



improvement in operational efficiency



of claim volumes processing within 24 hours



data accuracy achieved at the first-party bill level

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