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:
percent
improvement in data entry quality
percent
improvement in critical service levels of meeting the TAT for claims processing
percent
improvement in operational efficiency
percent
of claim volumes processing within 24 hours
percent
data accuracy achieved at the first-party bill level
FAQs
1. Why is India emerging as a strategic market for orphan drugs and rare disease therapies?
India has one of the world's largest rare disease patient populations, yet significant unmet medical needs remain due to delayed diagnosis, limited treatment access and evolving reimbursement pathways. This creates substantial opportunities for pharmaceutical companies to introduce innovative orphan drugs while supporting patient access. WNS helps life sciences organizations evaluate market potential, navigate regulatory requirements and develop commercialization strategies that accelerate successful market entry.
2. How can pharmaceutical companies accelerate orphan drug commercialization in India?
Successful commercialization requires more than regulatory approval. Companies must develop evidence-based pricing, market access, stakeholder engagement and patient support strategies while addressing complex healthcare and reimbursement environments. WNS combines market intelligence, competitive benchmarking, analytics and commercialization expertise to help pharmaceutical companies launch orphan drugs with greater speed and confidence.
3. How can AI and advanced analytics improve rare disease research and market access strategies?
AI and advanced analytics enable pharmaceutical organizations to identify patient populations, analyze epidemiological trends, optimize clinical trial planning and uncover market opportunities using real-world and scientific data. These capabilities support better investment decisions and accelerate commercialization. WNS leverages AI-powered analytics and life sciences expertise to help organizations transform complex rare disease data into actionable commercial and clinical insights.
4. What are the biggest barriers to orphan drug adoption in India?
Pharmaceutical companies face challenges including limited disease awareness, underdiagnosis, evolving regulatory frameworks, high therapy costs, reimbursement complexities and fragmented healthcare infrastructure. Overcoming these barriers requires integrated regulatory planning, patient access programs, market education and evidence-based commercialization strategies. WNS helps organizations address these challenges through strategic consulting, competitive intelligence and end-to-end market access support.
5. Why should pharmaceutical companies partner with WNS for rare disease commercialization and market intelligence?
WNS combines deep healthcare payer expertise with proprietary automation platforms, AI, OCR, analytics and intelligent operations capabilities. From digital document ingestion and claims adjudication to workflow orchestration, audit management and performance analytics, WNS helps healthcare organizations build future-ready claims ecosystems that improve operational efficiency, compliance, scalability and customer satisfaction.