Best Claims Processing Software of 2024

Origami Risk provides integrated SaaS solutions designed to help organizations--insured corporate and public entities, brokers and risk consultants, insurers, third party claims administrators (TPAs), risk pools, and more, transform their approach to managing critical workflows, leveraging analytics, and engaging with stakeholders. Origami Risk has won five consecutive Business Insurance Innovation Awards. This is because we work closely with our clients to create solutions that address real-world problems. Origami Risk was founded in order to provide real-world solutions that are industry-leading for risk professionals all over the world. This continuous effort is reflected in Origami Risk's acceptance of the 2021 European Risk Management Award as Technology Innovation of the Year. Comprehensive, integrated solutions to reduce incidents and hazards.

We offer upfront pricing with multiple options: per-case flat rate, monthly, or a combination thereof. Our Information at a Glance Dashboard and Customizable Task list are included at no additional cost. All Case Information is accessible in one place, without the need for additional software. Teamworks IRO's unique features. A simplified way to collect and maintain data in IRO, URA and peer review, Insurance Companies, and Attorneys. You will quickly see what cases, tasks, documents, payments, faxes, and emails are due. Task List - Created automatically for each case. Reports - Easy point and click to generate financial and case reports. Case closing Report - Automatically generated, and sent to the appropriate state agency.

The most accurate and powerful solution on the market for claims processing. CyberSource Medical Claims Scanning Solution is a turn-key system for HMOs, PPOs, TPAs, or Self-Funded Organizations. It can be installed at your location to automate data entry for CMS-1500, ADA 2006 UB-04, and enrollment forms. CyberSource uses advanced "intelligent", combined with your business rules to recognize, validate, and format the data from medical claims forms. Fuzzy Matching uses intelligent search to identify the exact match between your provider and member database. The matched data can then be used to verify and correct the medical claim data before it is sent through to adjudication. Combining industry-leading OCR efficiency, business rules and "Fuzzy Matching", results in exceptional accuracy for the data from your medical claim forms.

The adjudication program is the core of PBM Express. Claims go through hundreds of edits to ensure accurate processing results, regardless how difficult the plan design is. The parameter drive program allows for a flexible architecture that allows clients to customize as required. Laker's innovative software solution delivers superior performance and industry-leading uptime to clients. Laker is a technology leader and continually improves its systems to meet our customers' growing needs. Customers of Laker have the advantage of the most efficient, flexible, and durable system on the market. Laker works closely alongside our customers to develop and test new products that allow them to compete and win new business. Both Laker and our customers have the best interests to make changes to the software quickly and efficiently to allow for this growth.

Claims adjudication for short- and long-term disability claims. Available as an on-site license (ASP) or as a hosted app (ASP). Microsoft technology: SQLServer database with Windows front end. Highly acclaimed Customer service, staffed by experts in health care claims with at least 12 years of experience in the field. Support calls are recorded and status is available online. Plans can be copied and modified quickly using the plan modification feature. Auto-adjudication with benefit codes built using business principles based on more than 25 variables from the claimant and claim records that were made available to the adjudication engines. Inbound claims can either be scanned images or EDI. HIPPA EDI-5010 transaction sets. The system can be loaded with UCR Schedules and re-pricing fees in advance of the effective date. The date-driven logic will reprice based on the date service was rendered.

I-CAPS, an Intelligent Claims Administration System, addresses all functional areas in the health claims payment environment. It uses a single architecture that covers the needs of payers, including billing, enrollment, claims, claims management, contracting and pricing. 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 reduce costs. With (Advanced Network Administrator -ANA), it is easier to ensure the integrity of Provider data. Our (RB-UCR), which is the first industry-first Resource-Based Usual Customary and Responsible fee schedule based upon RBRVS/NCCI, is also easier. Cost Containment Audit and Recovery Services, (CCARS), can be used to perform a non-invasive audit of claims effectiveness.

Analytics-driven claims and remittance management software for healthcare providers. It is designed to automate workflows, increase resource utilization, prevent denials and accelerate cash flow. Your first pass claim acceptance rate will increase. Our comprehensive edits package will help you keep up to date with changes in payer rules and regulations. Automated tasks and intuitive workflows that are exception-based will increase productivity. Our flexible, cloud-based technology is available to your staff from any computer. Automated generation of secondary claims and explanations of benefits (EOB), from the primary remittance advisor, will help you manage your secondary claims volume. Predictive artificial intelligence (PAI) helps you focus on the claims that are most urgent. Avoid denials and errors before submission. You can process claims faster. Print and deliver primary paper claims. Collated claims and EOBs can be added for secondary claims.

Acrometis' flagship claims processing solution provides unparalleled workflow management. Documents are automatically routed using a configurable rules engine. Acrometis business rules, which are based on claim assessment scoring, claim compensability matching, body part to claim compensationability matching, jurisdictional directives and relatedness scoring, are designed to reduce claim costs and length. CLAIMExpert automatically processes 65 per cent of all incoming medical bills. Documents that require adjuster intervention are flagged for easy review and quick decision making. All incoming documents are processed automatically with no adjuster intervention. In the first year, clients typically see an average of 11 to 23 points improvement in their medical loss. CLAIMExpert has rules for more than 190 document types. This allows you to quickly handle whitemail and other documents that may come across your adjuster's desk.

LMS allows for efficient trading and management residential whole loans. LMS allows you to monitor your entire loan pipeline, manage third-party reviews, fund/settle loans in a seamless, automated manner. Through our portal, sellers can lock and price loans on either a flow basis or in bulk that meet your product's eligibility criteria. They can upload credit documents and meet conditions during reviews. Securely upload credit documents to a trade, pool, or loan level. Secure integrations allow you to exchange documents with third-party vendors. Direct orders to the appropriate diligence vendors based upon product and volume. Utilizing automated vendor data feeds, view and resolve the results of third-party reviewers. Generate funding schedules using amortized balances, calculated interests and fees.

Startech Software's TotalEclipse™ product offers a fully-featured single-database Claims Management & Medical Bill Review Software Application. TotalEclipse™, the culmination over three years worth of development and testing, was created by real claims adjusters and bill reviewers as well as administration managers who use this critical software every day to do their job. Software is often designed with the user in view. TotalEclipse was developed with our users in mind. The application was built around real-world workflows and focuses on making it easy to access the most important information for the job. Eclipse provides the processing power, functionality, and reporting capabilities that you need to maximize productivity and reduce costs. The single-database backend can be scalable to work with either the Microsoft SQL Server™, or Oracle™.

Recordables offers software solutions for managing liability claims. Software solutions for improving claims management, including Auto, General Liability, Property, Incidents, etc. Software that tracks incidents and claims for insurance policies, Recordables Liability, organizes auto, property, general liability policies, and more. TrackAbility offers comprehensive liability claims management software solutions. This software tracks all claims and liabilities. You can create customizable liability claims types using user-selected criteria. Safety professionals and field workers can collaborate on claims and reports, continuing with the addition of photos and videos for incidents and claims. You will have a complete view of financial data that is necessary for claims management. This includes information about payments and losses, as well as data on individuals, locations, policy specifications, etc.

We are a market leader in providing an information exchange platform that allows for collaboration and information sharing within the insurance industry. We are the first to offer Software as a Service (SaaS), for the motor insurance sector. This model has been successfully implemented across the insurance ecosystem. Our infrastructure has allowed our clients to grow quickly without having to spend a lot of money. It also allows them to transform faster and at lower costs.

This software is for Insurance Brokers. It automates the Truck / Commercial Insurance Form processing by transferring data directly from your source Quick quote to any other Carrier Application or Broker Agreement/Legal Docs, Permits or any other form. The best part is that we use your existing MS Office licensing, so there is no need for additional licensing fees. TIFA can also be used with our CRM application.

Vitech's cloud-native management, engagement and analytics platform V3locity® is a transformative suite that provides full life cycle business functionality as well as robust enterprise capabilities. It combines core administration with a new digital experience. Its modular design enables flexible, agile deployment strategies. V3locity uses a cloud-native architecture to provide a solution that is unmatched in security, scalability and resilience.

This application automates repricing claims in a Web-based environment. WebCR verifies provider participation, validates dates and identifies duplicate claims. WebDM, a data management system that ensures accuracy and currency of data, supports it. This application automates the repricing and pricing of claims in a client/server setting. WebCRX verifies provider coverage and patient participation, validates dates and identifies duplicate claims.

Users can provide real-time rates, contracts and dealer menus via eRating or eContracting. Users can issue policies with electronic signatures, and present products to customers through their own sales channels or their partners. Our network has 140+ partners that allow dealers to connect to the eMenu and DMS systems of their choice. Our policy administration software allows for billing, commissions and cancellations. This allows for seamless coverage rating, contracting and contract remittance. Integrating with your accounting system allows you to create, manage, modify, and change your agents, dealers and coverages. Your agents also have direct access to our Agent Portal. The F&I software allows the Dealer Principal and Field Representatives to access integrated reports for F&I forecasting, sales, and overall dealership performance in real time with powerful analytics.

Innovator, connector, and leader in the insurance industry. We offer the UK's most comprehensive straight-through processing platform. Find out how our digital platform can help you meet your business needs. A digital experience that is seamless and agile will drive business transformation. Improved productivity is possible through the use of adviser and consumer self-service tools. Continual engagement with customers will result in a higher customer lifetime value. Customers and Adviser Portals allow customers to access policy documentation and make changes digitally in real-time. The components cover every aspect of the user experience, including full reinsurance reporting and integration with external portals and automated and clerical Underwriting. Flexible deployment - from complete deployment of the SSG Digital platform to individual components that can be integrated (e.g. Only underwriting, New Business only

InsuraSphere is a complete suite of products and solutions that grow with your business. InsuraSphere is the complete product suite designed by insurance professionals for insurance professionals. All the essential information you need to manage your business, including quotes, claims, agents and policies, can be found in one place. InsuraSphere's integrated policy management system will streamline your processes. With agent and insured portals, you can give your stakeholders access the information and workflows that they require. Agents can rate, quote, or issue their own policies using your company's role-based permissions and business rules. Add third-party integrations to customize your company's workflows. InsuraSphere was designed to meet the changing needs of agents and carriers. InsuraSphere can grow with your business, whether you're just starting or moving from a legacy system.

The Whitespace Platform is a digital platform that connects global (re)insurance markets. Whitespace is entirely data-driven. Digital data can be used to transfer risk (not Word or PDF documents) and transform your business. The possibilities are limitless. Brokers and Carriers can reap the benefits of increased speed, accuracy, availability, as well as the quantity of in-depth information for risk analysis. Insurers act in the best interests of their customers. A digital connection can provide instant access to the risk placement, faster payments, and quicker responses to claims. Whitespace supports the entire process from start to finish. Brokers and underwriters can create risk submissions, collaborate and sign contracts, communicate through real-time instant messaging and request and provide quotes.

Polygonal takes the strengths and rich functionality of previous versions and combines them with the most recent Microsoft VB.Net technology and Business Intelligence technology. This comprehensive solution is able to quickly and efficiently respond to the changing market. Polygonal is a modular, multi-currency software solution for underwriting, policy/claims management, transactions, and reinsurance. It integrates with accounting, messaging, document management, document management, and workflow modules to provide an end-to-end business process that delivers tangible results. Polygonal was designed using City Computers' specialist team. As both solution providers and practitioners, we have many years of experience in the insurance industry.

DataGenix was founded in 2000 and is committed to providing TPAs, adjusters, insurance companies and other entities with modern claims processing solutions. We know that claims processing and managing health benefits can be complicated. Our ClaimScape software automates the entire adjudication process so that your business doesn't suffer any losses. Our Claims software and business are designed to solve the problems that prevent you from providing a superior customer experience for your clientele. Our software products can help your business grow in the most modern ways, keeping in mind current trends and requirements. We have earned the trust of top TPAs across the country and are ready to serve you more.

Like many other tasks, insurance payment posting falls under the 80/20 rule. The 20% of your payments that are still deposited from paper EOBs make up at least 80% of the overall payment post work. POWEReob is a better option. POWEReob is a combination software and a pay per transaction service that converts paper EOBs from certain payers into electronic remittances file in the ANSI-835 or NSF formats. These files can be used to automate payment posting to your practice management software as well as electronic secondary claims billing. POWEReob will work with any practice management that accepts remittances files from third party sources (not only from their designated clearinghouse). We will work with any practice management that accepts electronic remittances.

FINEOS Platform offers clients the only comprehensive SaaS core product suite. It includes FINEOS AdminSuite, which allows for quote to claim administration, as well as FINEOS Engage which supports digital engagement, and FINEOS Intelsight for analytics. Your digital insurance strategy's foundation. FINEOS Platform seamlessly combines FINEOS AdminSuite, FINEOS Engage, FINEOS Insight, and Platform Capabilities to create a modern, single-core insurance platform for Life, Accident, and Health. Legacy core systems used a single-size-fits-all approach to business technology that does not fit the needs of agile businesses. Consumers, brokers, and employers have access to powerful SaaS computing platforms, software tools, and a higher standard for digital strategy for insurers. The monolithic models of insurance software that were used in the past focused only on the details of the insurance contract.

Advanced Insurance System (AIS), which is available to all sizes of organizations, is intended to be an out-of the box solution. Customers can also modify and deploy products quickly, while also taking advantage of the wide range of configuration capabilities of the software. This modular integrated system can be used to interface with other platforms or as a complete policy administration solution. It can be used for Personal, Commercial, and Specialty business lines. AIS makes it easy to create new lines. AIS gives agents and insurers the functionality they need to grow their business. AIS provides automation and self-service functionality in a highly competitive market to increase sales and save time. AIS gives you the competitive advantage that you've been searching for.

Risk Manager uses Microsoft SQL Server, which allows the creation of custom views or queries for reporting purposes. ODBC-compliant applications can also be used without dependence on ERIC Systems. Risk Manager is constantly under development. Updates are published regularly. Our policy regarding updating is simple. We provide newer versions without additional charges to the standard technical support agreement. User logins are given dollar limits for individual check or reserve transactions. You can not exceed the total paid to date or total incurred thresholds at the enterprise level without acknowledgment. Client suggestions are the basis of our policy for developing new program features and standard reporting.