Alternatives to CLAIMExpert
Compare CLAIMExpert alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to CLAIMExpert in 2026. Compare features, ratings, user reviews, pricing, and more from CLAIMExpert competitors and alternatives in order to make an informed decision for your business.
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1
Virtual Examiner
PCG Software
Virtual Examiner®, PCG Software’s flagship product, monitors the internal claims process of an organization to trend provider data for fraudulent and abusive billing patterns, and maximizes financial recoveries. PCG Software’s Virtual Examiner® allows healthcare organizations to enhance their current claims adjudication system with more than 31 million edits per claim. The software solution monitors an organization’s internal claims process to identify unclean claims and reduce payment for improper or erroneous coding to conserve premium dollars. Virtual Examiner® is more than a claims review solution with a focus on code combinations. It is a cost containment solution that evaluates the claim not only for abusive billing patterns but also identifies those claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports. -
2
Duck Creek Claims
Duck Creek Technologies
Duck Creek Claims is a comprehensive claims management solution designed to streamline the entire claims lifecycle for insurers. From the initial report to final settlement, it automates workflows, simplifies data analysis through integrated analytics, and ensures seamless integration with existing systems. Key features include dynamic first notice of loss (FNOL) capabilities, automated assignment based on adjuster skills and workload, instant access to policy and coverage data, and efficient adjuster workflows. By enhancing operational efficiency and reducing manual workloads, Duck Creek Claims enables faster claims resolution, improved customer satisfaction, and compliance with the latest regulations. -
3
Guidewire ClaimCenter
Guidewire Software
Guidewire ClaimCenter is a leading claims management system designed to streamline the entire claims lifecycle for property and casualty (P&C) insurers. It offers comprehensive functionality from initial claim intake to resolution, enabling insurers to process claims efficiently and accurately. Key features include automated workflows, embedded analytics, integrated fraud detection, and real-time performance monitoring, all of which enhance operational efficiency and improve customer satisfaction. ClaimCenter supports various lines of insurance, including personal, commercial, and workers' compensation, and can be deployed as a standalone solution or as part of the Guidewire InsuranceSuite. By leveraging ClaimCenter, insurers can accelerate claims processing, make data-driven decisions, and adapt to evolving market demands. -
4
Newgen Claims Processing
Newgen Software
Newgen’s Insurance Claims Automation & Management software, built on AI-first low-code platform, streamlines the full claims lifecycle, from first notice of loss to final settlement, through automated workflows, smart routing, and integrated document management. Customers can register and track claims through a web or mobile self-service portal, while the system automatically retrieves policy details, prevents duplicate entries, and routes cases based on workload and expertise. Built-in rules classify claims as fast-track or non–fast track, with flexibility to add assessors, investigators, and other stakeholders. Adjusters gain a unified view for registration, adjudication, document review, and communication. AI-driven insights support fraud detection, highlight missing information, and improve decision accuracy. Real-time dashboards monitor KPIs, SLAs, and escalations for transparent and timely processing. -
5
ClaimBook
Attune Technologies
ClaimBook enables faster settlement of insurance claims, improved accountability and fewer rejections. It is well equipped with the features to address every part of the claims and evidence submission. ClaimBook supports international patient treatment with dedicated workflows, therefore enabling medical tourism. A built-in Rules Engine that disallows incomplete submissions, and knows what information and documents need to be submitted. This results in error-free submissions that are complete and guarantees that it is pre-authorized. ClaimBook's Smart Data Extraction can read documents uploaded to extract relevant data from the Hospital's Information System (if integrated with ClaimBook) to prevent the need for manual entries. ClaimBook also features Integrated Emailing by creating a virtual inbox in your dashboard. Withing the dashboard, emails can be composed, the design feature is similar to Microsoft Outlook. -
6
Claims Software
Claim Ruler
A new and smarter way to process and settle claims. Modern, end-to-end solutions to settle claims for all lines of property, liability, and workers’ compensation insurance. ClaimRuler™ is a cloud-based claims management system designed specifically for I/A firms and Third-Party Administrators, CAT Adjusters, Insurance Carriers, Self-Insureds, and Municipalities. The platform supports end-to-end claims processing with built-in guided workflows, robust reporting capabilities, and a fully automated diary system to streamline the settlement of claims. ClaimRuler™ was purposefully built to service the needs of real people in the industry. Its functional and intuitive approach to design makes working with forms, lists, documents, and photos a simpler and more natural experience. From I/A firms, TPAs, and insurance carriers to municipalities and self-insured corporations, ClaimRuler™ adapts and scales along with your organization. -
7
CyberSource Medical
ComCom Systems
The market's most powerful and accurate solution for claims processing. CyberSource Medical Claims Scanning Solution, a complete turn key system for HMO, PPO, TPA, or Self Funded Organization, is installed at your location for automated data entry of CMS-1500, ADA-2006 UB-04 and enrollment forms. Using advanced "intelligent" features combined with your business rules, CyberSource recognizes, validates and formats the data from medical claim forms. Fuzzy Matching performs an intelligent search of your member and provider database correctly identifying the exact match. The matched data is then utilized to verify and correct data on the medical claim before being passed through to adjudication. The combination of industry-leading OCR efficiency, your business rules and “Fuzzy Matching” results in exceptional accuracy of the data from your medical claims forms. -
8
KMR Medical Claims Manager
KMR Systems
KMR Claims Processing Manager is a state-of-the-art, fully integrated, customizable claims processing solution for TPAs, Self Insured and Claims Administrators. Our system includes a comprehensive Medical & Dental Reimbursement module, allows for electronic claims, integrates with Document Imaging systems, has the ability for debit card processing and is totally HIPAA compliant. -
9
MediClaims
WLT Software
WLT’s MediClaims system offers a cost-effective, straightforward, and efficient approach to benefit and claims administration. WLT’s rules-based architecture and integrated EDI processes allow claims to be processed quickly, easily, and accurately. MediClaims’ administration and processing capabilities encompass a range of benefit and claim types, from Medical, Dental, Vision, and Prescription Drugs, to Consumer-Driven Healthcare, Disability, and Capitation processing. With WLT’s MediClaims system, you have the flexibility to configure your groups for a single line of coverage or for complex benefit packages with multiple lines of coverage. No plan can work efficiently without support from reliable information systems. WLT makes a point of always working with the most advanced technologies, providing you with the most sophisticated and flexible systems available today.Starting Price: $1 one-time payment -
10
mobile claims
Symbility Solutions
Virtual diagramming, voice annotation, photo documentation and full pricing capabilities in the palm of your hand. Quickly and accurately capturing claim information onsite eliminates the need for followup visits and provides a great chance to engage policyholders in the settlement process. Adjusters can document, estimate, and close a claim in a few easy steps leading to a faster, efficient and more accurate claim settlement. Mobile Claims ensures that onsite estimates become onsite settlements. Utilizing logic-based questionnaires, our algorithms can be applied to generate custom loss specific estimates in a fraction of the time than the standard estimate construction today. Easy to integrate, train, and use. Virtually eliminating the cost of change, creating enormous benefits for carriers, adjusters, contractors, and policyholders alike. Fully equipped with aerial imagery/measurement, 3D virtual diagramming, geospatial visualization, video collaboration, contents, etc. -
11
Venue Claims Management
KLJ Computer Solutions
Venue ™ Claims Management for Independent Adjusters provides end-to-end management of the entire claims processing workflow. Whether you are an adjustment firm, third-party administrator, insurance carrier, or a self-insured organization, Venue ™ is for you. The user-configurable interface allows for extensive self-customization of the claim system by an end client. Built-in web service interface that allows for real-time or batch data import, update and export to virtually any third-party data sharing source of ALL claim-related information. Integration with policy and billing systems allows real-time synchronization on all policy-related details, which may include critical policy dates and flags such as active fraud investigation and assumed policy. Comprehensive capabilities for every aspect of claims processing, including claim payments and recovery, reserves tracking, contact management, excess and trust accounts, forms templates, reporting etc.Starting Price: $5 per month -
12
Claims Manager
JDi Data
Claims Manager is a comprehensive, integrated RIMS system built to streamline your process from FNOL to settlement. A unique, configurable business rules engine automates workflow, reduces manual and duplicate work, saves time, and improves outcomes for all stakeholders. Claims Manager’s integrated solutions streamline workflow by helping you administer, adjust, and report your property and casualty claims. Claims Manager is a versatile, and simple to use Risk Management Information System that offers tomorrow’s solutions, today. Its intuitive interface seamlessly integrates with an automated workflow that is accessible anytime, anywhere, from any device. Letting you easily capture, benchmark, administer, and report claims for all lines of property and casualty insurance. -
13
Five Sigma
Five Sigma
Five Sigma set out on a mission to allow claims organizations to innovate. With the set of claims management tools and unique platform, Five Sigma's suite is what Insurers need to bring their claims operation to the rapidly changing world. With our suite of Claims-First Cloud-Native and User-Centric products, we enable adjusters to handle claims better and faster. With Automating administrative tasks, Adjusters can focus on making the right decisions, while the system takes care of everything else. Clive™ by Five Sigma is the industry's first AI-powered claims adjuster, transforming how claims are processed by insurers, MGAs, and TPAs. Leveraging advanced AI and automation, Clive streamlines the entire claims lifecycle, from FNOL (First Notice of Loss) through to settlement. The AI agent enhances claims handling efficiency, accuracy, and cost reduction by automating tasks. -
14
Beagle Labs
Beagle Labs
Streamlining the claims process from end to end. Technology-driven, people-centric, and built on integrity. A robust claims service interaction platform for insurance carriers, MGAs, captives, and self-insured entities. Deployments, claims organization, and advanced file management at your fingertips. At Beagle, we understand the unique challenges faced by insurance service providers and independent adjusters when it comes to claims handling. Our core software functionality is designed to streamline the process, reduce costs, and provide rapid responses to your claims. Our technology brings efficiency and expertise to every step of the adjustment process. Express claims and inspection responses that reduce liability and drive efficiency. New policy inspections, policy renewals, and daily losses. Beagle was developed to handle the processes required on a daily basis. Streamlined claims handling by leveraging the latest technologies that enable a more efficient resolution. -
15
EvolutionIQ
EvolutionIQ
Our solutions drive lower loss costs, lower expenses, and higher customer satisfaction, and are proven at tier 1 carriers. EvolutionIQ enables the future of claim handling for complex lines of coverage, a deep partnership between skilled professional adjusters, and a highly specialized predictive guidance system. Equipped with clear prioritization, pro-active claim alerts, and rich context, empowered adjusters reduce losses and expenses while delivering an enhanced claimant experience. Reduce unwanted variability in the claims pipeline with a consistent, scalable claim guidance system. With the more efficient allocation of adjuster resources & fewer wasted claim reviews. With targeted claim investigations, litigation avoidance, and timely claim settlement. Our claims AI acquires and harnesses data to deliver the tactical guidance your team needs. EvolutionIQ combines structured and unstructured carrier data with our proprietary third-party data. -
16
ScanNStore
DocuStream
ScanNStore is a full-featured electronic document storage and retrieval system in a small package. It's the perfect solution for increasing productivity by electronically organizing and managing paper files. ScanNStore lets you and your staff quickly scan, index, store and retrieve your claims, attachments, remittance notices, and other documents. You can search by multiple indexes and display claims and all related information on-screen, as if you are looking at the original paper. Where instant access to the right claim information is critical, ScanNStore is the right solution. Contact us to download and try out a fully functional multi-user version of ScanNStore for 30 days. Volume seat licensing and vendor discounts available. Supports a wide variety of TWAIN scanners and production level scanners including HP, Fujitsu, Ricoh, Bell & Howell and Panasonic. Supports single page or multi-page batch scanning, automated document feeder, page size, contrast adjustment, etc. -
17
ClaimsControl
Claims Control
Our goal is to digitize the data exchange between all claims handling participants: insurers, brokers, their customers, loss adjusters, and all others. Use our platform to account and share your claims or connect your claims system to our API hub to get integrated with your partners. Connect your claims system to our API hub to start exchanging the data with your partners. Direct integration of all claims systems is impossible, therefore information is exchanged manually. This slows down the process, increases costs and complicates claims process automation. The purpose of ClaimsControl is to enable digital data exchange for all insurance claims handling process participants. If you develop any solutions related to claims management, let's talk and find the ways how we could help you to exchange the data with other systems or how we can provide your solution to our users.Starting Price: $400 per year -
18
FileTrac Evolve
Evolution Global
FileTrac has a long-standing legacy of being the #1 claims management system in the industry. Building on this reputation, it has now evolved into FileTrac Evolve. This enhanced version is a crucial component of the Evolve Suite, a comprehensive platform designed to revolutionize your claims management process. FileTrac Evolve is a leading web-based claims management system for independent adjusters, third-party administrators (TPAs), managing general agents (MGAs), and insurance companies of all sizes. Comes with a built-in diary system with reminders and provides integrations with Quickbooks, Outlook, Xactanalysis, Symbility, LEDES, NFIP/NFS, and Google Maps, FileTrac Evolve helps businesses manage their adjusters while ensuring accountability to their customers. Other key features include time and expense tracking, invoicing, adjuster timesheets, image and video uploads, accounting reports, quick notes, and more. -
19
TotalEclipse
Startech Software
Startech Software’s TotalEclipse™ product is a fully featured single-database Claims Management & Medical Bill Review Software application. Representing the culmination of over three years of development and testing, TotalEclipse™ is designed by real claims adjusters, bill reviewers, and administration managers who use this mission-critical software to do their jobs every day. Many companies develop their software with the user in mind. TotalEclipse is developed with our users involved. The result is an application designed around real-world workflow with a strong focus on making easily available the information most often needed on the job. Eclipse offers the specific processing power, functionality and reporting capabilities you need to maximize productivity while controlling costs. The single-database backend is scalable for use with either the Microsoft SQL Server™ or Oracle™ platform. -
20
Complete Claims
Complete Health Systems
Claims Adjudication for medical, dental, vision, prescription, short and long-term disability claims. Available for on-site license or as a hosted application (ASP). Microsoft technology: SQLServer database with a Windows front end. Acclaimed Customer service staffed by health care claims experts with a minimum of 12 years’ experience in the field. Support calls are logged with status available via the internet. Plan copy and modification feature enable quick setup of plans. Auto-adjudication using benefit codes built using business rules based on over 25 variables from both the claim and the claimant records made available to the adjudication engine. Inbound claims can be scanned images, EDI or paper. HIPAA EDI 5010 transaction sets. Re-pricing fee and UCR Schedules can be loaded on the system in advance of the effective date. The date-driven logic will re-price based on the date of service. -
21
Assurance Reimbursement Management
Change Healthcare
An analytics-driven claims and remittance management solution for healthcare providers who want to automate workflows, improve resource utilization, prevent denials, and accelerate cash flow. Increase your first pass claim acceptance rate. Our comprehensive edits package helps you stay current with changing payer rules and regulations. Heighten your staff’s productivity with intuitive, exception-based workflows and automated tasks. Your staff can access our flexible, cloud-based technology from any computer. Manage your secondary claims volume through automatic generation of secondary claims and explanation of benefits (EOB) from the primary remittance advice. Focus on claims that need your attention with predictive artificial intelligence into problem claims. Resolve errors faster, and avoid denials before submittal. Process claims more efficiently. Print and deliver primary paper claims, or add collated claims and EOBs for secondary claims. -
22
CLAIMSplus
Addiox Technologies
Expedited claims. Multiple interfaces sync with your corporate brand. Digitized data environment that can be accessed from anywhere, at any time. Health and Life processing via faster systems that aligns with your processing needs. Speeding up the claims life cycle to match the influx of your claims—while reconciling and resolving the more complicated claims at record velocity. It’s in. It’s out. No interruptions or claims processing delays. CLAIMSplus moves claims faster, working with employers, TPAs and insurers with robust in-the-cloud processing platforms. CLAIMSplusis in the business of optimizing processes and expediting medical claims through secure, reliable and efficient electronic claims management. More to the point, our technology—first and foremost—manages claims quickly and efficiently. We’ve asked our clients, and the timescale of the claim is the most important element for claims processing. -
23
Hi-Tech Series 3000
Hi-Tech Health
Series 3000 is a cloud-based claims administration solution for businesses within the healthcare industry. No matter what your adjudication, reporting, or plan needs are, this platform reduces time processing claims and increases productivity as it assists with: •Client management •Benefits input •Electronic claim submissions •Claims processing •Real-time status tracking Our built-in database efficiently manages clients and employee benefits. This platform allows users to make real-time updates including: •Claims statuses •Currency conversion •ACH deposits and disbursements •Document printing No matter what happens, our cloud-based software is reliable, and we pride ourselves on 99 percent up time. Series 3000 is HIPAA compliant and ensures secure data management and backup. We upgrade our communications and IBM hardware every two to three years and maintain System Critical Support with all our vendors, keeping our technology up to date.Starting Price: $3500 per month -
24
ClaimPilot
Quick Internet
A web-based claims management solution paired with unparalleled customer support. For claims management professionals who are looking to scale and manage their business, ClaimPilot offers its web-based claims management solution that provides the ease of use, features and functionality you need to gain visibility of claim and financial information with custom reporting. Address increasing demands of data inputs required with customizable features. Increase claims processing efficiency. Unlike unwieldy, feature-loaded risk management-focused claims software or lighter software packages that focus on document management only, ClaimPilot provides the features you need to manage your claims including Lloyd’s compliance, and workers comp functionality. Plus, you get our legendary customer support. Our team of experts partners with our clients to build custom reports and functionality to support your growing business. The way we see it, if you are successful, you’ll be successful. -
25
ClaimScape
DataGenix
Emerged in the year 2000, DataGenix is strongly resolved to provide TPAs, adjusters, and insurance companies with modern claims processing solutions. We understand that claims processing and health benefits management can include several complications. So that your business does not suffer any losses, our experts have created the advanced ClaimScape software that can automate the entire adjudication process. The goal of our business and the Claims software is to resolve the perplexities that hinder the reach of unmatched customer experience for your clientele network. Keeping in mind the modern trends and requirements, we can assure your business's optimum growth with our software products. We have won the trust of top TPAs of the nation and are willing to serve more. -
26
ALYCE Claims Management
Brightwork
ALYCE is specifically designed for self-insureds, municipalities and small TPAs handling Workers’ Compensation, Auto Liability, Auto Property, General Liability, and Property claims. ALYCE has an intuitive design with important data elements on the main claim page, including the claim’s financial summary, with all of the other important details available with a quick scroll or a single click. Multi-tiered infrastructure for employer reporting requirements, based on locations and departments. Recoveries, including salvage, subrogation, and excess carrier payments. Automated scheduled and repeating payments with diary alerts. Automatic diaries based on events, time lines, and financial transactions. Automatic generation of form letters to claimants, lawyers, and other claim parties. -
27
omni:us
omni:us
Seamless integration into existing claims systems. Automate processes and reduce costs. No longer is it a choice between saving costs and improving the customer experience. Better decisions with data-driven insights. Automate manual processes. Empower your claims personnel. Invest in your customers’ happiness. Seamlessly integrate incoming claims with your insurance core system. Tackle process inefficiencies with claim automation and watch your customer satisfaction skyrocket. Reduced manual claims incidence of low to moderate complexity by automating claims handling. Improved triaging and manual claims assignment increased case team effectiveness drastically. Decreased process time for remaining manual claims. Allowed a real-time claims settlement in significant amount of cases. Automated digital claims journey by applying FNOL-completeness check, coverage check, automated claims file creation. -
28
MyClaimStatus
Medical Payment Exchange
If your staff is wasting precious time and resources by manually statusing claims on web portals and sitting on the phone with payors you need myClaimStatus. Get real-time, actionable claim status information on all of your claims and eliminate the waste. myClaimStatus’s suite of data tools helps you reconcile claims faster. It doesn’t matter how big or small you are. Save more with every claim when you use myClaimStatus. Are you working efficiently? MedX medical claim services use robotic process automation to maximize your workflow efficiency. Easily reconcile reimbursement rates with your contracted amount ensuring you’re receiving what you should. Drill down with real-time data for every healthcare claim from every payor, no matter the dollar amount. This is not your standard healthcare claims processing software. Optimize AR follow-up activities to work by exception and get more done in less time. -
29
W5 Claims
Burkitt Computer
W5 Claims Management Software - Managing your claims, understanding and growing your business. How many things do you and your staff do every day over and over? Get this, do that, repeat. It’s not just about saving time on repetitive tasks. It’s about making sure they don’t get missed when you have a long list of to do’s that need doing now. - Automation Documents, thousands and thousands of documents and photos. Getting them, organizing them, securing them, distributing them. It’s a big job and critical to your success. - Document Management Time constraints and customer SLA’s. It’s not enough that you need to meet those challenges but you have to measure and report your successes and failures. So how well do your adjusters perform? Where and what are the potholes that trip up your staff? Can you show your customers that their trust is well placed? - Workflow + Business Intelligence AnalyticsStarting Price: $7900 one-time payment -
30
Shift Subrogation
Shift Technology
Shift Subrogation is an AI-powered SaaS product that automatically identifies, scores, and surfaces subrogation recovery opportunities for insurance companies, especially in the Property & Casualty (P&C) domain. Using a combination of structured data (policy, claim, exposures) and unstructured text (loss descriptions, adjuster notes), generative AI and other models assess liability, apply relevant state/negligence law, compare exposures, take into account statute of limitations and jurisdiction rules, and reference external data sources (e.g., product recalls). It generates alerts with a score and rationale for each recovery opportunity, so handlers know not just which cases to pursue but why. The system supports continuous monitoring of claims as they evolve (for example, recognizing new information added later) and updates alerts if the recoverability changes. -
31
HEALTHsuite
RAM Technologies
HEALTHsuite is a comprehensive benefit administration system and claims processing software solution designed for health plans administering Medicaid and / or Medicare Advantage benefits. HEALTHsuite is a rules-based auto adjudication software solution designed to automate all aspects of enrollment / eligibility, benefit administration, provider contracting / reimbursement, premium billing, medical management, care management, claims adjudication, customer service, reporting and more. RAM’s Medicare Advantage-in-a-Box offering is unique in the industry; the product of RAM’s extensive experience in Medicare Advantage and an unwavering commitment to changing our industry. HEALTHsuite Advantage™ and eHealthsuite™ are the cornerstones of our pre-configured Medicare Advantage-in-a-Box offering. HEALTHsuite Advantage is a fully integrated suite of modules providing our clients with an unmatched solution to administer their Medicare Advantage and Special Needs Plans (SNP’s). -
32
Artsyl ClaimAction
Artsyl Technologies
Processing high volumes of medical claims through intelligent automation helps businesses deliver higher levels of efficiency that does more than reduce costs. For organizations that rely on manual processes, managing medical claims documents and data is labor-intensive and error-prone, injecting unnecessary risk into the process. With ClaimAction medical claims processing software from Artsyl, your organization can improve margins, minimize touch points and eliminate processing bottlenecks. Capture medical claims data without the need for custom software coding. Route claims data and documents automatically to the right claim examiner, based on your business rules. Configure complex benefits and reimbursement rules to streamline processing and reduce payment delays. Respond quickly to changing government regulations and support data, document and process compliance. -
33
Simsol Software
Simultaneous Solutions
Discover why thousands of insurance adjusters and contractors chose our affordable, easiest-to-use Estimating Software for Property Repair and Claims Processing Solutions. Generate estimates, sketches, digital images, reports, and insurance forms with minimal training. Never pay for a technical support call again. Our friendly and knowledgeable support reps are ready to assist you. Simsol provides the most competitive rates in the industry, especially when you sign up for a year. ClaimsWire is a web-based solution for the electronic assignment, tracking, and exchange of property claim data designed for insurance companies. It integrates seamlessly with Simsol, and supports all property estimating platforms. It offers powerful management and review tools, built-in accounting, and much more. -
34
ResolvMD
ResolvMD
ResolvMD is an experienced full-service medical billing company that processes all health service claims (AHCIP etc.) on behalf of physicians. Our goal is to make physicians as confident and competent in their billing as they are in their practice through surfacing data-derived insights and democratized knowledge. We have the most modern, cost-effective, and secure platform on the market for processing claims. Our target audience are physicians (mainly specialists such as emergency physicians, urgent care, plastic surgeons, anesthesiologists, paediatricians, general surgeons etc.). They need a billing agent to process their health service claims. They value time, trust, cost, efficiency and knowledge. We are targeting physicians in Alberta today (mainly in Calgary, Edmonton, Red Deer, Medicine Hat, Lethbridge, Okotoks and any other centre with a population in excess of 25,000. -
35
PlanXpand
Acero Health Technologies
PlanXpand™ is Acero’s proprietary transaction processing engine, one that powers each of our products for health benefits administrators. Leveraging this engine, clients may choose to implement Acero’s products concurrently or incrementally. In addition to selecting one of our standard products, administrators also may choose to utilize PlanXpand™ to develop a custom solution to extend existing system capabilities. Acero’s unique, integrated solutions feature Service-Oriented Architecture, allowing health benefits administrators and insurers to add features and functions to existing adjudication platforms. At the same time, our sophisticated design and engineering enables real-time adjudication of every type of claim, all in direct interaction with the core claims system, resulting in more accurate processing, more satisfied customers and less need for claims adjustments. -
36
Claimable
Claimable
Claimable is claims management software for businesses that removes the headache of managing insurance claims. Increase your claims handling capacity by spending less time on admin. Stop searching shared folders and inboxes. Your claims data is just a few clicks away! Your data is securely stored in the cloud and is accessible from anywhere. No more paper! Be ready for an audit with a complete history of each claim at your fingertips. Keep track of your documents and access them whenever and wherever you need! Filter and report on your claims data, to drive productivity and stay informed. Label your claims to categorize and organize them to suit your workflow. Keep detailed notes on each claim and collaborate and share with your team. Assign tasks to your team and see at a glance which are due or completed. Build and manage your claims contact database, and find contacts in an instant.Starting Price: $79 per month -
37
ENTER
ENTER Health
Enter gets Providers (doctors, practices & hospitals) paid faster than anyone in history. Enter processes health insurance claims and pays in 24 hours while automatically communicating and collecting patient responsibility with a white label collection engine, complete with payment plans. Enter is 30x faster at getting claims paid and 45x faster at getting patients billed at the same cost as existing medical billers. - $150mm+ of claims processed in just 1 year of operations. - $100mm credit facility actively being deployed for providers. - Revenue Cycle Management Partner for United Healthcare Nevada. - Enter supports a wide variety of specialties including ASC, Orthopedics, Neurology, Dermatology, Emergency Rooms, Behavioral Health, Pain Management and more. - Enter works with all commercial and government health insurance carriers. - Enter integrates with all EMR / practice management systems. - No monthly fees. No integration fees. - Enter is venture backed -
38
PayorLink
PayorLink
PayorLink solutions offer more than just medical claims management on behalf of employers to take on a comprehensive platform approach in providing better employee benefits to reduce healthcare costs, promote healthy lifestyle, lifetime health and improve workforce productivity in the process. Rising employee health costs is a worldwide phenomenon and a growing concern for both payor companies and provider entities alike. PayorLink™ is designed to reduce payor health cost, motivate staff productivity and optimize provider claims quality resulting from in part, information exchange efficiencies directly between payor companies and affiliate provider clinic, medical centre or hospital. Enhanced with Employee Health Profile and Assessment tools for staff wellness and productivity realization. -
39
Inaza
Inaza
Dramatically reduce your manual processes with intelligent document and image processing for instant underwriting and risk calculation. Automate your claims process from start to finish, with immediate document and image validation, rules engine, alerts and outreach. With our platform, you can release end-to-end data pipelines for claims processing, underwriting, data enrichment, and telematics at the click of a button. We revolutionize data-driven operations by offering seamless access, analysis, and action on real-time data. Our advanced AI capabilities enable straight-through processing, eliminating manual intervention and ensuring faster, more accurate outcomes while reducing fraud and bad data. Our platform enables straight-through underwriting by leveraging AI to process documents, streamlining the process and accelerating time-to-market. -
40
VCA Software
VCA Software
Dreaming of happy, efficient claim handlers; fast, accurate claims resolution; and 5-star policyholder ratings? Our agile, future-ready platform enables your people to perform like rockstars, and equips your company with scalable, intuitive processes to fuel profitable growth. By simplifying and automating the workflow, our clients reduce the cost of the claims journey by as much as 30%. VCA Software is one of the most scalable and integration-friendly platforms in the market. Our robust features, at a mid-range price point, make us a favorite among TPAs and adjusting firms. Yes, VCA is lightning fast, but the system is also whip-smart – equipped with a cutting-edge analytics suite so you can make fact-based decisions. You can count on VCA for industry-leading uptime, privacy, and data security. Our Tier 1 data centers are located in the USA, UK, Canada, and Australia. Our solutions can be easily customized to meet your team’s unique requirements.Starting Price: $65 per month -
41
Shift Payment Integrity
Shift Technology
Shift’s Payment Integrity is an AI-powered solution for health plans designed to improve accuracy and reduce costs in the claims payment process. It works both pre-payment (before claims are paid) and post-payment, helping plan administrators catch issues early and recover overpayments. Key features include claims editing (with updated, dynamic rules), generative AI-assisted medical record review, anomaly & fraud/waste/abuse detection, and external data enrichment for deeper context. The system supports evolving policy and guideline changes, allowing automated policy analysis and edit logic workbench features so health plans can test concepts before deployment. It provides explainable flags/alerts (so reviewers understand why claims are flagged), tools to accelerate document review, highlighting relevant parts of records, data mining for emerging trends, and a unified case management UI for investigative workflows. -
42
ALFRED Claims Automation
Artivatic.ai
Filing claims are complex and critical processes. More than 60% of people do not file complex due to its complex processes and time taking nature. Artivatic’s dedicated claims platform for each insurance vertical helps insurance businesses to enable digital claims journeys, self-claims processing, automated assessment, risk & fraud intelligence and claims payout. ONE PLATFORM FOR ALL YOUR CLAIMS NEEDS. End to End Claims Automation and Assessment Platform AUTO CLAIMS – HEALTH CLAIMS – TRAVEL CLAIMS – ACCIDENTAL CLAIMS – DEATH CLAIMS – FIRE CLAIMS – SME CLAIMS – BUSINESS CLAIMS – COMMERCIAL CLAIMSStarting Price: $10/claims/month -
43
PwC SMART
PwC
PwC SMART (Systematic Monitoring and Review Technology) increases the efficiency and effectiveness of your inpatient and outpatient coding quality evaluation process, and enables a mechanism for quality and compliance review. Coupled with the support provided by PwC Health Information Advisory, SMART bolsters your efforts to monitor coding and data quality. SMART Inpatient includes 1,000+ pre-defined business rules that identify potential coding inaccuracies and documentation improvement opportunities. You can also customize business rules for your specific areas of focus. Reporting and data analysis help you evaluate your staff’s performance and pinpoint education opportunities for Coding, Clinical Documentation Improvement (CDI), Quality and Providers. SMART Outpatient improves the accuracy of claims and identifies charge capture issues and areas for workflow improvements. It also improves regulatory compliance by decreasing the risks caused by inaccurate coding. -
44
Dragonfile
Dragonfile
Dragonfile – The Smarter Way to Manage Claims. Dragonfile is a powerful, intuitive claims management solution designed specifically for adjusters and adjustment companies. Built by industry experts, Dragonfile streamlines workflows, automates updates, and organizes files—helping adjusters save time, reduce stress, and focus on resolving claims efficiently. ✅ Centralized File Management – Keep all claim documents in one secure place. ✅ Automated Notifications & Reminders – Never miss a deadline again. ✅ Seamless Accessibility – Work from desktop, tablet, or mobile—anytime, anywhere. ✅ Zero to Minimal Training Required – Simple, user-friendly interface built for adjusters. ✅ Customizable Workflows – Adapt to your process and work smarter, not harder. Whether you’re managing P&C or Flood claims, Dragonfile simplifies the process, eliminates manual work, and enhances productivity. -
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HealthRules Payer
HealthEdge Software
HealthRules® Payer is a next-generation core administrative processing system that provides transformational capabilities to health plans of all types and sizes. For more than ten years, health plans implementing HealthRules Payer have been able to quickly address market opportunities and stay in front of their competition. HealthRules Payer is unlike any other core administrative solution because of its use of the patented HealthRules Language™, an English-like vernacular that delivers a revolutionary new approach to configuration, claims processing and transparency of information. HealthRules Payer helps transform health plans looking to grow, innovate and compete beyond any other core system today. -
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Total Loss Pro
Vemark
The frequency of total loss claims continues to rise, now accounting for some 20 percent of collision and liability losses across the auto insurance industry. Yet, far too often, carriers’ total loss operations lack cohesive integrated digital workflows, leading to excessive costs, customer dissatisfaction, and poor visibility and oversight. Enter Total Loss ProTM from Vemark. It’s the one solution you need to transform total loss claims processing from a frustrating black hole to a well-oiled machine while allowing you to keep up with the rapid pace of change. Faster settlement for Improved policyholder experience and satisfaction. Higher employee morale from reduced frustration, and fewer tedious processes. Increased visibility and transparency for data-driven decision-making. Auto claims that result in a total loss are more complex than vehicle repair claims. Total Loss Pro is a cloud-based solution that improves all stages of this complex salvage vehicle workflow. -
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EMSmart
EMS Management & Consultants
EMSmart™ claims processing technology raises the bar and your bottom line. At EMS IMC our priorities are clear, to employ a compliant, accurate, and efficient system to manage an increasingly complex billing process while quickly maximizing your revenue. For clients across the country, EMS IMC has done just that with a new solution called EMSmart™ which frees you to focus on the important work of patient care, while having confidence that the maximum amount of revenue is being collected in a compliant manner. EMSmart™ is our new, proprietary claims processing platform that delivers the industry’s best rulesbased process automation while retaining human judgment at the appropriate points in the revenue cycle process. EMSmart™ is our internal processing engine, but we’re excited to share this information with you so you can have confidence that your claims are in the industry’s best hands, both human and automated. -
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SimpleInspire
SimpleSolve
Smart Automation enhances user efficiency in servicing your customers. Minimizing manual intervention provides both your customers and users a superior experience. There is no reason to base annual system costs on your business success. We rationalize annual costs based on the services we provide you. Manage full policy lifecycle of transactions, rate, validate, quote, bind, issue & policy changes. A full-fledged double-entry accounting system to manage all policy and claims-related financial transactions. Auto-Verify Policy coverage in real-time. Manage reserves, loss payments & expenses at a claims feature level. Policyholders can verify coverage, print policy docs, review claim status, review accounts & make payments. Application has several pre-built interfaces; Payment Gateway, Repl Cost Valuation, Ins Credit Scores, MVR, eSign, etc. A mobile app that brings easy mobility to field adjusters. Instantly get assessments & photos into the claims system. -
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A1 Tracker
A1 Enterprise
A1 Tracker is presented by the vendor as a robust & configurable risk management software offering either stand-alone or fully-integrated risk management software covering many business segments across an organization. Claims & Incident Management Claims & incident reporting for claims of any type: injuries, medical, commercial, customer, insurance, work comp, asset, auto, liability. Risk Management & Threat Assessment: Risk register for tracking risks at any level in an organization, including by entity, project, asset, contract, vendor, division, business, unit, region, and more. Real-time risk reports & heat maps, dashboard metrics, alerts, & notifications. Contract Management: Contract module for tracking contracts of any type with vendors, employees, customers, and any other parties. Insurance Policies & Certificates: Policies & certificates of insurance tracking with reminders & renewals. For agencies & carriers policy management includes tracking clients.Starting Price: $800/month -
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CaseGlide
CaseGlide
CaseGlide is driving the revolution in claims litigation management. Gone are the days of disconnected and siloed claims systems, manual and inefficient workflows, and hundreds of emails passing between defense counsel and claims teams containing unstructured case data. With CaseGlide you can focus on strategy, data, and driving efficiency to improve your litigation management program. Our clients better predict and manage their case outcomes, assign the right attorneys to the right cases, work cases more strategically, and significantly reduce their litigation costs. As your defense attorney partners work your cases in the platform, integrations allow you to push important case data to your claims system, data warehouse, document management, or accounts payable system. It’s simple: the longer a case is open, the higher your costs.
