Analytics & Automation Drive ~30% Cost Reduction in Casualty Claims & Medical Case Management

This is our story of co-creating a solution with a leading technology provider in auto casualty and workers’ compensation

The challenge for a technology provider was ...

It had expensive, inaccurate and delayed claim settlements due to complex, large-scale global operations for casualty claims and medical case management. Due to the scale of its operations, the company possessed large repositories of residual data that required enhanced systems and processes to glean improved insights. The company was also looking to achieve economies of scale, meet stringent compliance requirements, and stay ahead of the competition in the auto casualty and workers’ compensation space.

Here’s what we co-created as a solution…

WNS leveraged its domain knowledge and automated key aspects of the technology provider’s processes while deploying advanced analytics. The solution included:

• Clinical Decision Tree Toolkit for Medical Case Management: Automated learning algorithms improved the clinical decisions required for complex treatment scenarios in the utilization review stage

• Nurse Assignment Tool: Capacity modeling helped in better work allocation of nurses

• Regulatory Compliance: WNS’ proprietary tool for medical case management helped maintain regulatory compliance. The automation feature of this tool enabled accurate and seamless communication between the technology provider and its clients

• True Task Manager Workflow Solution: Real-time workflow capability helped in controlling both under- and over-allocation of staff, as well as ensuring the claims were verified and error-free

• Analytics-enabled Quality Management System: Sampling tool enabled picking the right audit samples across the technology provider’s clients, service levels and diverse U.S. state guidelines. Analytics engine helped deliver actionable insights on process behavior and patterns

The outcomes from the process of co-creation are…

WNS’ transformative solution enabled the technology provider to enhance its client experience significantly. Automation and analytics reduced process complexity, increased the efficiency of the claims handling operations and reduced data leakage.

Other key benefits include:

• ~30 percent reduction in overall costs (covering both casualty claims and medical case management)

• ~15 percent quality improvement on Defect Per Unit (DPU)

• ~10-15 percent improvement in quality (casualty claims and medical case management) spread across various sub-functions

• ~10-25 percent improvement in turnaround time in medical case management

• Over 98 percent accuracy in the claims process

• 100 percent compliance with regulations (internal and external)

• ~60 percent reduction in error scenarios impacting external communication

• ~10-15 percent improvement in accuracy rates in auto casualty claims

To view the infographic, click here.