Best Insurance Claims Management Software of 2024

AdvantageGo delivers innovative commercial insurance and reinsurance management solutions that offer insurers the IT agility they need to create an intelligent digital strategy in partnership with a leading IT provider. With over 25 years’ experience, we harness the power of proven, functionally-rich core solutions and augments it with the energy and culture of being an InsurTech leader. AdvantageGo enables insurers and reinsurers worldwide to fuse the traditional with digital, helping them rapidly adapt, drive change, and succeed with agile software and Microservices. Enhance your digital landscape and open up the possibility of true risk mitigation with our pioneering technologies.

Claims Signal™, the next-generation open-claims quality platform from Aon & Athenium Analytics, allows insurers to quickly identify high-risk claims. You can improve the policyholder experience and achieve a 4-6% increase in claims indemnity or expenses. Today's claims departments are under increasing pressure to improve customer service, reduce leakage, and operate more efficiently. Routine quality audits can be very effective in identifying root causes and deviations to best practices. However, audit results may not be available until weeks or even months after claims have closed. Imagine if you could monitor claim files and address quality issues before they impact outcomes. The Claims Signal platform by Aon & Athenium Analytics uses AI to analyze open claims, spot possible issues, and push immediate alerts so your front line managers can intervene before a case is closed. Predictive analytics and proactive alerts can reduce claims leakage up to 4%

The ultimate insurance claims automation solution powered by patented Blockchain Technology. Claims are a critical moment for insurance. Our solutions have been designed to automate claims for insurers and insureds with unbeatable accuracy. MediConCen, a leading insurance software, automates claims and makes insurance available to insurance companies, medical networks and clinics. It uses Hyperledger Fabric blockchain technology. We equip claim assessors using powerful AI models, expert knowledge decision rule engine and expert knowledge to detect fraud and abuse instantly. Clean cases can then be approved immediately for consistently perfect cost management. With powerful analytics for claim management, you can be in the loop.

Insurance Systems Inc. (ISI), was founded by Terry Neilson in 1997. He recognized the need for modern IT solutions that would change how insurers interact with their insureds. ISI was founded on this premise to develop and implement custom software solutions. As the insurance industry changed, so did our technology requirements. In order to be competitive, insurers needed advanced graphical user interfaces (GUI), which allow them to create new products and make business changes via configuration, not through software development. We introduced ISI Enterprise in 2010, a complete end-to-end solution that is flexible and configurable for all P&C insurance companies. Our team of architects, business analysts, and quality assurance analysts has continued to develop and implement new features to the advanced architecture to keep up with the changing marketplace.

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.

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.

AgencyPro™, our Flagship product for Windows, provides all the tools you need in order to run an almost "paperless" insurance agency. You can download client and policy information automatically from your Carriers or rating vendor in ACORD®, Level 3 format. AgencyPro is the best agency bill insurance accounting system available. It can handle all aspects of agency accounting, including client A/R, rep, and company payables, direct reconciliation, invoicing, and receipts. It can be used on a cash or accrual basis. It produces all financial statements, including a Balance Sheet and Income and Expense Report as well as a Trial Balance. It also contains all the features of EZAgent. Our agency accounting experts are the best in the business.

WaterStreet's P&C platform and policy administration services can help your company do more. WaterStreet's services suite provides outsourcing for insurance business processes and extends a high-quality customer service with advanced technology and processes. Agents who have better visibility and engagement with policyholders are better equipped to identify cross-selling opportunities, and proactively assist customers when they most need it. Process automation and real time document and data access allow for quick and accurate data delivery to ensure accountability and visibility. WaterStreet P&C Insurance Suite combines all your data and processes, eliminating the need for multiple software systems. Excellent example of customer service between client, agent, and insurance company.

A risk management solution for property and casualty. All-in-one benchmarking and claims management system that simplifies claims-related processes and makes adjusters' lives more simple. TerraClaim provides two tools to simplify claims-related operations. These tools are powerful enough on their own, but even more so when combined. An innovative cross-industry data analytics and claims benchmarking solution that compares your claims performance to industry peers. This helps you set better goals, manage risk reserves, and improve claim outcomes. The world's best property and casualty claims management software that streamlines your internal processes, improves productivity, drives desired results, and prevents fraud.

COI Pro is a leader in certificate of insurance tracking software. It streamlines the process for collecting, verifying, managing and storing COIs. COI Pro is a leader in COI tracking software. It streamlines the process for collecting, verifying, managing and distributing certificates of insurance. COI Pro is used by organizations to reduce risk in their supply chains and reduce the administrative burden associated with document management. COI Pro works with small and medium-sized businesses as well as large corporations that rely on vendors, contractors, or suppliers to run their business. Software solutions that simplify insurance certificate tracking can streamline your life. COI Pro will transfer all documents within 72 hours of an agreement being signed. We offer easy-to-use templates and upload capabilities for new certs. Unique COI requirements can easily be set up at the business unit or division level.

Automate with confidence and increase efficiency by embedding timely and reliable insights directly into your claims-management system. Claims Compass is a multi-solution platform that integrates data from multiple systems into one system. It's scalable and easy to use. A platform that delivers solid data and analytics can help you improve your claims handling process, reduce cycle time, and lower costs. Streamline workflows, and use powerful analytics to get insightful intelligence that helps you make better decisions at every stage of the claims handling process. Reduce fraud by utilizing predictive analytics, advanced investigation, and management tools for medical providers to help you. A claims management system that taps into unmatched processing power can make customers whole again quicker.

All-in-one mobile and AI solution that reduces insurance claim costs and claims cycle time from days down to hours. MotionsCloud's estimation engine allows you to estimate the value of damages in real time. The evidence is of the highest quality, and comes in a variety of media formats, including text, audio and photo. All evidence is stored in a high-security standard to eliminate the possibility of fraud. Claims specialist working remotely with customer via voice and video communication to complete claim settlement. Ensure customer satisfaction through a smooth and efficient process. A great claims experience can help retain clients and convert claimants.

Reduce costs by administering claims in a way that is unparalleled in efficiency and accuracy. Ventiv is a global leader in risk management, insurance claims, and advanced analytics. Ventiv is helping some of the world's biggest brands with products such as our industry-leading risk analytics solution.

Five Sigma was founded with the mission of enabling claims organizations to innovate. Five Sigma's suite of tools and platform for claims management is what Insurers require to adapt to the rapidly changing world. Our suite of Claims First Cloud-Native products and User-Centric products allows adjusters to better manage claims and do so much faster. Automating administrative tasks allows adjusters to focus on making the right decision, while the system takes care everything else. The complete suite of claims management tools, including an in-system omnichannel communication platform, automated documentation and workflows, reporting, and open APIs. The state-of-the-art claims management platform allows you to go live in just weeks. Five Sigma's unique SaaS offerings, agile methodology, and weekly upgrades make it possible for carriers to improve their claims operations.

Our data predictor uses a dynamic artificial intelligence core that incorporates proprietary algorithms and machine-learning applications to identify and predict potential high loss and excessive litigation. Machine learning and statistical modeling are applied to client data. Then, the AI integrates it with external data sources to accurately identify and assess risk. Our products can be used in conjunction with your existing BI systems like MS BI, Tableau, and Board. We have a solution for you, whether you are self-insured or an insurance company. Reduce your risk by having complete and accurate defense files, lower settlement costs, faster resolution and proactive risk reduction. We can accurately set premiums and provide cost prediction for general liability or worker's compensation claims.

We work with private insurance clients to ensure that your therapy sessions are covered. Navigating your mental health bill and your insurance plan shouldn't be difficult. Nirvana streamlines the insurance process for you and your therapist. It covers everything from eligibility to reimbursement. This will allow you to save time, avoid headaches, and get paid quicker. Instead of spending hours calling insurance to find out what you are covered for, sign up now to get a clear understanding about your coverage. Nirvana simplifies the insurance process for both you and your client, from eligibility to reimbursement. You can track the submission, processing, adjudication, and lifecycle of your claims to easily monitor them. Filter by session and date ranges to gain a detailed understanding of the reimbursement amounts for your sessions.

Now, claims representatives can collaborate with policyholders. A deeper involvement of the policyholder in the claims process can improve customer satisfaction and lower claims-handling expenses. Today's policyholders expect high-quality service that is flexible to their needs and not yours. The experience of policyholders who are involved from the beginning to the end in the claims process is more satisfying. Gain the advantage of "eyes-on-site"--right from the desk. ClaimXperience video collaboration allows you to effectively triage the claim, and assess the extent of damage. You can settle more claims with greater accuracy, reducing the need for an on-site visit. You can also send the right person to the right person when you need an on-site visit.

RiskVille helps you automate core routine tasks in policy, claims, and risk management. All your day-today operations, including customer relationships, claims and policies, can be managed in one system. RiskVille, a cloud-based software solution for all types of insurance businesses, is designed to help you manage your day-to-day operations. We are familiar with your business and understand how important it is to have a complete picture of your business. We also know how important it can be to accurately and carefully execute daily operations. RiskVille automates your employees' routines, freeing them from the burden of doing repetitive tasks. Audits are something we all face. We want to smile and feel secure, compliant, and comfortable with them. Making audit processes simpler will improve compliance. RiskVille conforms to GDPR and is hosted on the secure Microsoft Azure platform. This ensures safety and security for your data as well as your processes. Clients can expect more from you by allowing them to access their policies and claims online. You can also remind them about renewals.

Integrate insurance into your digital experiences within days with a simple API and a commercial agreement. Our modular tech layer complements new and existing insurance programmes. We provide flexible technology that works with any insurer, regardless of whether you choose to work with our trusted network or your own. Add insurance to any business line, no matter where you are located. Qover has been licensed to distribute digital products for insurance in 32 countries throughout Europe. We can work with your existing insurance offering or create a new product tailored to you and your users. We treat your users as if they were our own. It's not your UX but our quick digital claims handling, fast payouts, and multilingual support. (With reported 90% satisfaction). We provide you with a transparent dashboard that helps you make data-driven program decisions. Our experts are available to advise and collaborate to help your business generate more revenue.

With one comprehensive software suite, you can improve clinical quality metrics, accuracy of risk scores, patient and provider involvement, patient outcomes, transparency in operations, and economic performance. Inovalon Payer Cloud transforms workflows into data driven processes that support the key objectives of your health plan. Our converged SaaS solution, backed by industry-leading analytics, delivers the member-centric insight, speed, accuracy and flexibility that you need to keep up in this ever-changing, diverse marketplace. Inovalon’s SaaS healthcare payer solutions deliver member-centric insights to help health plans improve healthcare outcomes, economics and quality. Payer solutions that improve member outcomes and care while improving operational performance and efficiency through sophisticated analytics and dynamic data intelligence.

Our AI-powered technology allows you to make fast and accurate decisions on claims, which will allow you to better serve customers. By adapting certain features, and data sources, our solution is configurable for all insurance lines, from motor and property to health and life. Sprout.ai delivers fast and accurate decisions on claims, no matter the industry. Our technology can extract all relevant information from any claim document, including handwritten notes, call transcripts, and prescriptions. The claim is validated using external data such as provider network policies, medication information, treatment codes and other data. It is then compared to policy documents. Deep learning AI algorithms determine the best next steps for a claim, and pair them with a clear explanation.

Wisedocs document processing platform features allow insurance companies, independent medical assessment firms, and legal entities process claims with greater speed, accuracy, efficiency, and precision. Automatically organized medical records according to date, service provider title, and category. Automatic page duplication saves up to 30% in time and money. Medical record sorting and reviewing can be a difficult administrative task. Wisedocs makes it easy for insurance, legal and medical firms to automate medical record reviews. Wisedocs creates a medical record index that is organized based on your needs. From the intelligent summary and medical record review, you can get important insights as well as easily searchable and indexed records.

ClaimScore, the only independent software dedicated to solving the ever-growing claim fraud problem within Class Action Settlements. Each claim is evaluated individually in real-time using our AI, ML & Cloud Architecture. The results are reported instantly in an interactive dashboard. Each claim starts with a ClaimScore (1000) and is reduced by one each time it fails to meet a criterion. Each criterion is assigned a fixed or sliding weight based on the correlation between the criterion and fraudulent claims, as well as the correlation between the criterions and valid claims. To maximize transparency, every claim is tagged by deduction codes that are associated with the criteria they fail. This ensures that the parties, administrator and court know definitively why each claim has been rejected.

Unified solution that provides a 360o view of all aspects of the P&C insurance lifecycle. A powerful, rules-based, multistate underwriting module automates the collection and creation of quotes, endorsements and cancellations. It also saves time and allows you to generate premium. A modern, streamlined and collaborative approach to claims adjudication reduces combined ratios. Facilitating information exchange with brokers can help increase business. From streamlining and standardizing information intake to giving brokers access to the information they require at any time, You can control which submissions your underwriters are looking at. Your policy holders will be able to access their policy information, claim intake and review, and online bill payment. This will increase customer satisfaction and retention. You choose the features you offer your customers to ensure the best user experience.

LexisNexis®, MarketView™, provides medical claims-based information to healthcare payers and providers, life science companies, and health IT organizations throughout the United States. MarketView provides actionable insights that help businesses remain competitive. It allows them to see valuable insights and visualize ways to transform their business. MarketView is available to all life sciences companies, health plans, health systems, and vendors. It can transform key business work streams such as marketing, sales and strategic planning, physician outreach, physician relations, network optimization, market research, pricing, contracting and recruitment. To remain competitive, your business needs the most actionable insight. It can be difficult to pinpoint the right areas of focus if the picture isn't clear. MarketView provides insights into areas such as physician alignment strategies, referral patterns, physician referral patterns, quality of clinically integrated network, patient volumes, and more.