Healthcare payers are changing their business approach. They are shifting focus toward managed health, increased regulatory compliance and greater investment in technology, while optimizing costs. Healthcare exchanges are not only driving growth for payers, but also empowering consumers to make their own choices. These trends have prompted the payer community including insurers, health plan providers, brokers and administrators to adopt a more customer-centric approach through collaborative partnerships.

WNS’ Business Process Management (BPM) provides the right mix of services and tech-enabled solutions to meet the challenges in the healthcare payer sector. We offer a multitude of services such as claims administration to payers, account maintenance, member / provider services, right through to mailroom operations and data conversion. With our diverse portfolio of end-to-end offerings, payers can expect to achieve process excellence, agility and flexibility in their business processes.

Case:
WNS enabled the client to raise productivity by 51% through proprietary automation and re-engineering solution..
Case:
WNS enabled the client to build more efficient claims processes and improve the claims auto-adjudication
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WNS built a robust performance management system and introduced Lean initiatives to eliminate redundant proces..

The WNS Advantage

WNS has rich experience in providing end-to-end services in managed care plans, indemnity and Medicare Advantage. Our expertise in North America and Europe healthcare claims underpinned with our agile technology solutions make us a capable player across the entire health payer value chain.

Domain Expertise

Our pool of certified and experienced employees process more than 420 Million transactions and manage 23 Million calls every year from multiple locations. We manage revenues of more than USD 5 Billion per year for our healthcare clients. Equipped with deep domain knowledge, our skilled employees handle a slew of tasks from mailroom operations to claims administration. 

Diverse Offerings

In the payer segment, our offerings include managed care plans (HMO, PPO and POS), indemnity, Medicare Advantage, Part D, supplement, Special Needs Plans and self-funded plans. Our services in billing and collections, overpayment recovery, and fraud detection and investigation are supported by our enabling technologies and transformation methodologies.

Technology and Shared Services

We have the capability to set up enterprise shared services across functions such as customer interaction services, legal, finance and accounting, and research and analytics. Our technology solutions include IT-enabled applications with Electronic Data Interchange (EDI) generation and Optical Character Recognition (OCR). They also meet the National Provider Identifier (NPI) standards.

Value Added Services

Our value added services in the payer segment include network services, research and analytics, and actuarial support. Under network services, we have expertise in provider updates and data verification, provider data research and contract and correction services. We also offer network analyst and actuarial analytics’ support.

"I was impressed with the amount of information WNS was able to gather in such a short period of time as well as the level of analysis that was conducted. I appreciate the consultative efforts and strategically planned deliverables that were focused on business stakeholders. The value derived from our relationship with WNS has had an influential impact on the business that goes well beyond the anticipated strategic and operational benefits."

Head – Information Management of a leading African and Middle East-based healthcare company

A ‘Major Contender’ in Everest Group’s Contact Center Outsourcing (CCO) Market for the Healthcare Industry – Service Provider Landscape with PEAK MatrixTM Assessment – 2014

Services

Mail Room Operations and Data Conversion

  • Mail Room (open-sort-prep)
  • Document Scanning
  • Document Management using search and retrieval functionalities
  • Data Capture
  • Forms Processing
  • Indexing and Categorization
  • Data Conversion
  • Fulfillment Support

Account Maintenance

  • Underwriting Support
  • Plan Loading, Setup and Maintenance
  • Data Entry Enrollment
  • New Account Setup
  • Member Records Maintenance
  • Customer Profile Creation
  • Billing and Account Reconciliation
  • Dependent Eligibility Verification Audit

Member / Provider Services

  • Claims / Bill Coverage
  • Billing Queries
  • Benefits
  • Cash Accumulation
  • Change in Address
  • Termination of Service
  • Claim Status Calls
  • Member / Eligibility and Benefit Calls
  • Provider Support
  • Premium Collection
  • Checking Provider Credentials and Enrollment

Claims Administration

  • Claim Receipt and Data Capture
  • EDI /ANSI X12 837 Generation and 835
  • Adjudication — Pre and Claim Adjudication
  • Claim Re-pricing
  • Co-ordination of Benefits
  • Rx Claim Adjudication
  • Claims Re-work and Post-payment Audit
  • Error Correction
  • Dispute Resolution
  • Grievances and Appeals

Value Added Services

Network Services

  • Provider Updates and Data Verification
  • Provider Data Research, Contract and Correction Services
  • Network Analyst Support

Research and Analytics

  • Claims Fraud Detection and Investigation Services
  • Overpayment Reduction
  • Payment Accuracy
  • Compliance Audit Support

Actuarial Support

  • Pricing, Reserving and Reporting
  • Actuarial Analytics

Shared Services

  • Finance and Accounting
  • Customer Interaction Services
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