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Claims and Benefit Administration, Claim Editing



  • Support Multiple Lines of Business
  • Fully Integrated System
  • Highly Configurable and Scalable
  • Industry Standard Protocols
  • Enterprise Data Interoperability with Internal/External Systems

Wipro's Claims360 solution with core administrative processing provides comprehensive support for members, providers, benefit plans, provider reimbursement and payment arrangements, claims, encounters, authorizations, and more for all lines of business and payers across the healthcare landscape.

Claims360 can automatically processes medical, dental and other ancillary claim types such a vision. The Medical claims include professional and institutional forms. Dental is also processed on its own claim form.


Streamline workflows with a centralized, modern, core administration & claims management platform

Fully Configurable

Accurate, Simplified Rules-based, Parameter driven Configuration

Multiple Lines of Business

Medicare, Medicaid, Duals, Commercial TPA, Group & Individual, Delegated, International Specialty Insurers

Real-Time Editing & Processing

Real-time Editing, Auditing FWA. Updated 20+ Medicare Payment methodologies.

High Auto Adjudication Rate

Very High 1st pass Rates.

Flexible Benefit/Plan Design

Medical, Dental, Vision-Value Based, Supplemental, Tele-Health, etc.

Automated Workflows

Workflow Orchestration between Internal/External System

Business Benefits

Simplifying Healthcare Business with Enterprise payer platform


Driving high auto-adjudication rates and minimizing the risk of paying claims incorrectly

Connect and

Connect Health Plans to members, providers, and all essential stakeholders.

Enhance Provider

Streamline workflow for Provider engagement and support multiple reimbursement arrangements

Utilization Rates

Data-driven utilization review, wellness services and monitoring/management of high-dollar claims.


Enterprise-wide efficiencies with end-to-end workflows for claims, Encounter data (RAPS/EDPS), and more

in Compliance

End-to-end transparency and centralized premium and claim data

Business process outsourcing

Extend your team with our domain staff

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AEP Support

Improve operational efficiency during annual enrollment period

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