Alternatives to Complete Claims
Compare Complete Claims alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to Complete Claims in 2026. Compare features, ratings, user reviews, pricing, and more from Complete Claims competitors and alternatives in order to make an informed decision for your business.
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1
Cloud Claims
APP Tech
Improve claim outcomes with streamlined First Notice of Loss (FNOL), claim processing and flexible reporting. INCIDENT BASED CLAIMS MANAGEMENT Effective claims management is about more than simply managing claims outcomes. It is about having an automated process that ensures efficiency and accuracy across the organization, getting timely notice of losses, and taking swift action are keys to success. The incident-based approach of Cloud Claims covers all accidents and losses, delivering a complete picture of loss to executives and claims managers. Cloud Claims by APP Tech is an integrated solution that is highly configurable, with actionable reports to guide decision-making and a friendly UI so you can get work done faster and more confidently. Cloud Claims runs in the cloud, so there’s minimal IT burden and no installation required — just simple configuration, effortless system upgrades, best-in-class security, and the ability to scale quickly.Starting Price: $2,500 per month -
2
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. -
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
ClaimAdept
Isoft
This product is an end to end claims system. The primary functions are claims adjudication, claim workflow and payment disbursement. The flexible design allows the addition of adjudication modules on a line of business basis. Each new line of business added reuses the core functionality of the system. This system takes advantage of the user friendly windows screen design and makes use of a relational database to store information within the system. The software platform is Powerbuilder with an SQL database such as Oracle or Sybase. This combination of software supports a client server based environment that is capable of processing large volumes of claims. Installation and training are available and source code is included as part of the licence fee. Expert staff is available for customizations and tailoring of the system to meet any special requirements identified by the client. All modifications are available with detail design and support for acceptance testing. -
5
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. -
6
ppoONE Connect
ppoONE
This application automates the repricing of claims in a Web environment. WebCR verifies provider participation and patient coverage, validates dates of service, and identifies possible duplicate claims. It is supported by a data management team and system, WebDM, that works to ensure accuracy and currency of data. This application automates the repricing of claims in a client/server environment. WebCRX verifies provider participation and patient coverage, validates dates of service, and identifies possible duplicate claims.Starting Price: $1000.00/month -
7
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 -
8
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). -
9
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 -
10
Curacel
Curacel
Curacel’s AI powered platform enables insurers track fraud and automate claims seamlessly. Collect your claims from your Providers in real-time and easily auto-vet the claims. Curacel Detection helps you detect and curb fraud, waste and abuse in the Claims Process. Collect claims from their providers and prevent fraud, waste and abuse in the claims process. We studied the Health Insurance industry to understand where the most value is lost by Insurers. This was identified to be the Claims Process. The Process is mostly manual and is fraught with a lot of fraud, waste and abuse. Our solution, driven by AI, helps to curb wastage and make the Insurer more efficient, thereby making them unlock hidden value. ravel insurance is peculiar in that it is built on on-demand policies that cover relatively short periods of time. Should a policy holder want to make a Claim, both the insurer and the insured want claim settlement to be as efficient and accurate as possible. -
11
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. -
12
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. -
13
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. -
14
FBCS Enterprise
DSS
FBCS Enterprise is a centralized system for guiding decisions about non-VA Purchased care to improve fee basis claims management and adjudication through efficient claims processing. A web-based solution, CTM Plus streamlines workflows and provides oversight to resolve consult and Return to Clinic (RTC) tracking pain points, and ensure patients are called and scheduled on time. Purchasing analytics help to reduce cost and waste, for greater overall accountability. Expired and recalled items are also monitored automatically to keep patients safer. Delayed or misplaced orders can have significant consequences for your bottom line and quality of care. Time spent sorting through paper records and scrolling through screens is time you won’t have for patients. Checking every patient for opioid prescriptions can be an exhausting, multi-step process. DSS PDMP streamlines everything into one simple step. -
15
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 -
16
PBM Express
Laker Software
The core of PBM Express is the adjudication program. Claims undergo hundreds of edits to achieve accurate processing results, regardless of the difficulty of the plan design. The parameter drive program provides for an extremely flexible architecture that allows for client customization as needed. Laker's advanced software solution provides clients with superior performance and industry-leading uptime. As a technology leader, Laker continually updates and enhances our systems to meet the growing needs of our customers. Laker customers have the marketplace advantage of the fastest, most flexible and most durable system available. What’s more, Laker works closely with our customers to develop, test, and implement new products which allow them to better compete and win new business. Laker grows as our customer's claim volume grows. It is in the best interest of both Laker and our customer’s to provide changes to the software in a timely and efficient manner to allow for that growth. -
17
PLEXIS Payer Platforms
PLEXIS Healthcare Systems
PLEXIS’ suite of best-in-class apps has a proven record of giving payers the extended functionality necessary for modern core administrative ecosystems. From real-time benefit administration and adjudication to automatic EDI transmission and self-service customer portals, PLEXIS Business Apps have you covered. Passport provides essential connectivity from the core admin and claims management engines to PLEXIS business apps, your own apps, and existing in-house systems. With its flexible API layer, Passport delivers real-time integration with portals, automated workflow toolsets, and business apps. Connectivity is limitless. Streamline workflows with a centralized, modern core administration & claims management platform. Process claims in a timely and accurate manner, and automate the complexities of benefit administration to capture a quick ROI and deliver superior customer service. -
18
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 -
19
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. -
20
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. -
21
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. -
22
Claim Agent
EMCsoft
EMCsoft’s Claims Management Ecosystem assures that healthcare providers and billing companies deliver clean claims to insurance payers for proper claim adjudication. It is the integration of our versatile claims processing software Claim Agent and comprehensive fitting process called the Four Step Methodology into your claim adjudication process. This approach enables, supports, and automates your work process to maximize claim reimbursement. Request our free online demo for a great introduction into the functionality/features of Claim Agent and how it fits into your claim adjudication process. Claim Agent scrubs and processes your claims from the provider system to the insurance payers in a efficient, cost effective, and timely manner. The software is compatible with any system making implementation process quick and simple. We provide custom edits, bridge routines, payer lists, and work flow settings that are unique to each user. -
23
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. -
24
FINEOS
FINEOS
The FINEOS Platform provides clients the only complete end-to-end SaaS core product suite that includes FINEOS AdminSuite enabling quote to claim administration as well as add-on products, FINEOS Engage to support digital engagement and FINEOS Insight for analytics and reporting. The foundation of your digital insurance strategy. The FINEOS Platform seamlessly blends FINEOS AdminSuite + FINEOS Engage + FINEOS Insight + Platform Capabilities to create the most modern single core insurance platform for Life, Accident and Health. Legacy core systems utilized a ‘one size fits all’ business technology approach that no longer fits the needs of an agile business. Today, consumers, employers and brokers have access to powerful SaaS computing platforms and software tools that set a much higher bar for an insurer’s digital strategy. Monolithic insurance software models of the past focused solely on details of the insurance contract. -
25
IMPACT
Managed Care Systems
IMPACT is the core to our suite of Healthcare administration software that supports all facets of health care related data transactions. Our customers use Impact to manage enrollment, provider contracts and re-pricing, benefit plans, authorizations/referrals, claims payment and the various complications that surround these functions. IMPACT has tremendous flexibility and provides a wide offering of industry-specific features. Nothing makes us happier than gratitude and accolades from our customers. We enjoy our client interactions and the delivery of software that makes their work lives easier. Technology is meant to serve the customer. MCSI focuses on the development of solutions that fit well within a client's enterprise allowing them to grow and change with their market. We have experience in all aspects of healthcare data management and solutions deployment. We pride ourselves in creating software that focuses on automation, accuracy and reliability. -
26
Smart Data Solutions
Smart Data Solutions
Streamline Your Complete Healthcare Data Workflow. Smart Data Solutions has the tools and experience needed to streamline both your paper and electronic workflows. Our integrated validation, matching, and normalization tools ensure the highest quality data possible, increasing auto-adjudication and reducing manual processing. Whether you’re new to Smart Data Solutions or a long time partner, our development process helps guide you through projects to ensure the best possible position for overall success. Whether your needs are basic or complex, our staff will work with you to understand your needs and the impacts of your workflows. We believe in focusing on your goals, what you want to accomplish, and from that, identifying the best way to get there. Smart Data Solutions provides complete front-end pre-adjudication solutions for hundreds of Payers nationwide. Whether you need basic services or a completely custom workflow, Smart Data Solutions offers a variety of solutions. -
27
Reimbursify
Reimbursify
Reimbursify is the first and only mobile-enabled, software platform delivering a truly innovative solution empowering patients, serving practitioners, and enabling digital partners to easily file out-of-network reimbursement claims for medical and mental health services. Reimbursify is the fast, easy way to file out-of-network (OON) reimbursement claims from your health insurance company! Our intelligent app takes the pain and trouble out of claim filing to make sure you get all the money coming to you. Fast, streamlined registration for primary insured, spouse & dependents. Smart dashboard manages all your claims and keeps track of money you’re on track to collect. Proprietary Rejection Resolution Pathway to help resolve rejected claims fast. Provider search function that auto-populates provider information.Starting Price: Free -
28
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. -
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Tyler's Workers’ Compensation Software
Tyler Technologies
Tyler Technologies' Workers' Compensation software automates processes while adhering to the complex rules and regulations that drive workers' compensation programs. It enables agencies to efficiently receive, track, and process a wide variety of workers' compensation claims, including work-related injuries and occupational diseases, ensuring timely and accurate benefits delivery. It supports the entire claims lifecycle, from initial intake through adjudication and resolution, providing tools for document management, workflow automation, and reporting. It is designed to enhance operational efficiency, reduce administrative burdens, and improve compliance with regulatory requirements. Streamlining case management processes helps agencies focus on delivering quality services to claimants while maintaining program integrity. -
30
eOxegen
eOxegen
eOxegen is an AI-powered claims management system designed to streamline and enhance the efficiency of health insurance operations. Automating claims processing through a Straight Through Process (STP), reduces manual intervention, leading to faster claim settlements and improved accuracy. It incorporates advanced fraud detection capabilities, utilizing AI algorithms to identify and flag potentially fraudulent activities early in the process. Additionally, eOxegen offers features such as provider contracting and empanelment, pre-authorization management and adjudication, and robust reporting with business intelligence analytics dashboards. Its AI-driven workflow automation ensures consistent task completion, minimizes repetitive activities, and enhances overall productivity. By integrating these functionalities, eOxegen empowers insurance companies and third-party administrators to optimize their claims management processes, and reduce operational costs. -
31
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 -
32
I-CAPS
W.O. Comstock & Associates
I-CAPS is an Intelligent Claims Administration System that addresses all functional areas of the health claims payment environment with a single common architecture that spans the needs of payers including membership, billing, enrollment, mailroom, claims, network management, contracting, pricing, utilization review and customer service. Our Intelligent Claims Administration System (I-CAPS) and our coding compliance software (Advanced Value Scale-AVS) , support knowledge-based decision-making to help our clients contain costs. Guaranteeing the integrity of Provider information has never been easier with (Advanced Network Administrator-ANA) while our (RB-UCR) is the industry's first Resource-Based, Usual Customary, and RESPONSIBLE fee schedule based on RBRVS and NCCI. Need a check-up for your plan or provider, use Cost Containment Audit and Recovery Services (CCARS) for a completely noninvasive audit retrospective look at claims effectiveness. -
33
Nirvana
Nirvana
We work with private insurance clients to get your therapy sessions covered, every time. Navigating mental health billing and your health insurance plan shouldn’t feel like wandering in the dark. From eligibility to reimbursement, Nirvana makes the insurance process seamless for you and your therapist, so you can save time, headaches, and get paid faster. Instead of spending hours on the phone with insurance trying to figure out what you’re covered for, get a clear understanding of your coverage as soon as you sign up. From eligibility to reimbursement, Nirvana makes the insurance process seamless for you and your client. Seamlessly monitor the lifecycle of your claims with the ability to track submission, processing, and adjudication. Filter between sessions and date ranges to get an in-depth understanding of reimbursement amounts for your sessions.Starting Price: $129 per therapist per month -
34
TrackAbility
Recordables
Liability claims management software solutions from Recordables. Software solutions to improve claims management including General Liability, Auto, Property, Incidents, and more. Recordables Liability insurance tracking software organizes incidents and claims that include auto, property, and general liability policies. Tracking all liability and risk incidents and claims, TrackAbility provides comprehensive liability claims tracking software solutions Benefits of TrackAbility liability claims management include start to finish injury liability claims management from incident through completion. Create customizable liability claim types with user-selectable criteria. Safety professionals and field users can collaborate on claims and reports, continuing to add pictures and videos for incidents or claims. Receive a holistic view of financial data necessary for claims management, such as payments and losses based upon individuals, locations, policy specifications, and other data. -
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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. -
36
Majesco ClaimVantage
Majesco
Digital technologies are having a significant impact on insurance, and those keeping pace with this evolution are on track to maintain a competitive advantage. Traditional claim management tools, involving multiple systems, paper files and manual processes, are being replaced with cloud-native enterprise claim management platforms. The Majesco ClaimVantage Claims Management Software for L&H platform streamlines the claims process through the full life cycle of a claim, from intake through payment calculation, integrating multiple systems to improve the flow of information across your business. Improve the customer experience and drive operational effectiveness with accurate and timely claim decisions. Built on the Salesforce Lightning Platform, Majesco ClaimVantage Claims Management Software for L&H enables insurance companies and TPAs to modernize and optimize their claims operations today and into the future. -
37
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. -
38
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. -
39
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. -
40
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 -
41
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. -
42
ClaimLogik
Claim Central Consolidated
Connect everyone in your property claim. ClaimLogik connects everyone in a property claim from first notice of loss through to completion. Property assess & repair ecosystem. We connect everyone in your property claim from start to finish. Stakeholder Management. ClaimLogik connects EVERY stakeholder in a claim with real time access, to complete tasks and manage activities at the right time, in the right order and with complete transparency. All stakeholders have access to workflow modules that have been customized to enable them to track, manage and complete tasks throughout the claim. Stay connected. All stakeholders connected on one claim. Complete transparency on claim status for all stakeholders. Line of sight for all activities across the entire claim. Digital contracts between Insurer and supply chain. Service level agreements with all suppliers and trades KPI management to measure and compare supplier performance. Automated exception management when tasks fall outside SLAs -
43
ClaimsXPress
Insurity
In insurance, no interaction has a greater long-term business impact than a claim. It’s the moment of truth for insurers and policyholders. ClaimsXPress maximizes insurers’ opportunities to deliver distinctive experiences that drive positive results. Claims service is a major differentiator for insurers, no matter the market. ClaimsXPress helps insurers enhance the claims experience, earn customers’ loyalty and drive more business from distribution channel partners. Nimble companies know they can grow faster with efficient processes and systems that are able to scale. ClaimsXPress is designed with insurers’ growth in mind. Speed is valuable, in claims response and access to data. ClaimsXPress is a top performer in both areas, enabling users to accelerate their objectives. -
44
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 -
45
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. -
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CoreLogic Claims Connect
CoreLogic Australia
CoreLogic’s Claims Connect is a powerful solution designed for the insurance industry to streamline and manage claims processes efficiently. The platform allows insurance companies to quickly assess property damage, automate claims handling, and access real-time property data, helping to accelerate claims resolution. By integrating advanced property data analytics, Claims Connect helps insurers improve decision-making, reduce processing times, and enhance customer satisfaction. With features such as automated workflows, reporting tools, and access to accurate property information, this platform optimizes the claims lifecycle from start to finish. -
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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. -
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SSI Claims Director
SSI Group
Elevate your claims management process and decrease denials through unmatched edits and an industry-leading clean claim rate. Health systems require access to technology that facilitates accurate claim submission and rapid reimbursement. Claims Director, SSI’s claims management solution, streamlines billing practices and provides visibility by guiding users through the electronic claim submission and reconciliation process from beginning to end. As payers change or modify reimbursement criteria for services, the system actively monitors and incorporates these changes and requirements. And with a comprehensive mix of edits at the industry, payer and provider levels, the solution aids organizations in making the most of reimbursement efforts. -
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Quadient Correspondence
Quadient
Quadient® Correspondence, manage claims correspondence, in the cloud. Quadient® Correspondence is a subscription-based SaaS solution that enables insurers to create, approve and deliver regulatory compliant, accurate and personalized claims correspondence to customers across print and digital channels, with no reliance upon IT. Quadient Correspondence was designed and priced for insurers who want to further their transformation to digital, but don’t have the resources to invest in an end-to-end customer communications management (CCM) solution. Business analysts create and update templates. Claims managers and compliance experts edit & approve templates for use. Business users write correspondence using a controlled editing experience. Designated personnel review and approve correspondence for delivery. Instant delivery via email, PDF and SMS. Business users start by selecting the appropriate claims correspondence template and customizing the content within pre-defined editable fields. -
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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.
