Best Claims Processing Software - Page 4
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Compare the Top Claims Processing Software as of November 2025 - Page 4
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1
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). -
2
QuickCap
MedVision
MedVision Solutions' QuickCap is an administrative and clinical data process management solution that lets users focus on business and not the paperwork. With QuickCap, users have scalable control over their workflow and information to work smarter. QuickCap features a customizable dashboard for ease and gives them automation of their process for speed. QuickCap also streamlines claims work that makes users' work easier. QuickCap also allows users to easily determine profitability for individual providers with analytics. -
3
Evolent Health
Evolent Health
Driving breakthrough clinical and administrative results. Evolent Care Partners, Midwest health system ranked third in the nation for both total shared savings and percentage of savings off of benchmark. Evolent Care Partners enables independent primary care physicians with the capital and resources needed to participate and succeed within two-sided payer contracts, while limiting their financial risk. New Century Health delivers cost and quality improvements in oncology and cardiology by using clinical evidence to guide care decisions that are supported by both payers and providers. Evolent Health Services simplifies health plan operations through comprehensive services that are powered by a modern and integrated platform, and a true strategic partnership model. Explore insights and news on value-based care, population health, health plan administration and other health care transformation topics. -
4
Infrrd
Infrrd
We empower what you do by transforming how you do it. In a world where today is already late, your customers care about how fast your organization is compared to others in the market. This need for speed means that your teams cannot waste any more time with manual processing, rummaging through an ocean of data. That's where we come in. We empower your people with faster, more flexible solutions to increase speed and achieve the highest accuracy in the industry. We take an innovation-first approach to everything we work on. If there's a new and better way to do something, that's where we are headed. Ask our dedicated AI research lab. Ours is not a 'one-size-fits-all' kind of solution. A little customization to address your ground-level problems could take your team's efficiency from good to mind-blowing. -
5
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. -
6
LEAP
Flovate
Optimize and automate your processes without writing a line of code by harnessing the power of low-code. You can utilize the array of functional building blocks within LEAP to create custom and flexible applications that will enable you to automate your processes. Apply your processes to one of our pre-configured industry solutions. With the majority of the configuration already in place, your LEAP solution can be created in days by our analysts – and even demonstrated so that you can see it in action. By joining together functional building blocks your solution is built in weeks, not months – leaving you with a high-quality solution, at a lower risk and cost. An impressive array of functions and features can deliver the outcomes you need, providing you with a solution that is right for your organization. Pay for usage, not users. Activity-based, rather than user-based licensing means you only pay for what you use. Plus setup costs are kept to a minimum. -
7
Origami Risk
Origami Risk
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 is a 5-time Business Insurance Innovation Award Winner, and we've kept that title because we collaborate closely with our clients to develop solutions that address real-world challenges they're facing. Since our founding, Origami Risk has aimed to deliver industry-leading, real-world solutions for risk professionals around the globe. Our acceptance of the 2021 European Risk Management Award for Technology Innovation of the Year underlines this continuous effort. Fully-integrated, comprehensive solutions for reducing incidents & hazards. -
8
Teamworks IRO
IRO Solutions
We offer upfront pricing with several options; monthly flat rate, per case, or a combination of both. Included at no additional charge is our Information at a Glance Dashboard, Customizable Task List, and Scheduler. This means all Case Information is available in one place without needing any additional software. Some of Teamworks IRO unique features. Simplified method to collect and maintain data for IRO, URA, Peer Review, Insurance Companies and Attorneys. At a glance, you will know what cases are due, what tasks are due, what documents are due, what payments are due, faxes and emails - System generated and easily managed. Task List - Automatically created for each new case. Reports - Case and financial reports generated by easy point and click. Case closing Report - Automatically generated and sent to the appropriate state agency. -
9
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. -
10
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. -
11
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. -
12
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. -
13
CLAIMExpert
Acrometis
The Acrometis flagship claims processing solution offers unparalleled workflow management, with documents automatically routed by a configurable rules engine. Based around claim assessment scoring, body part to claim compensability matching, jurisdictional directives, relatedness scoring and a host of other claim elements the Acrometis business rules are designed to reduce claim duration and costs. CLAIMExpert automatically processes 65 percent of incoming medical bills and non-medical documents with no user intervention. Documents requiring adjuster intervention are flagged and sorted for easy review and straightforward decision making. Automatically processes incoming documents with NO adjuster intervention. Clients typically see between 11 and 23 points medical loss improvement in the first year. CLAIMExpert contains rules for over 190 different document types, quickly handling whitemail and any other documents that come across your adjuster’s desk. -
14
LMS Suite
Street Solutions
LMS enables efficient trading and management of residential whole loans. You can monitor the entire loan pipeline, handle third-party reviews, and fund/settle loans on a streamlined, automated basis. Sellers can lock and price loans on a flow or bulk basis that fit your product’s eligibility guidelines through our portal. They can upload credit documents and satisfy conditions raised during reviews. Securely upload and store credit documents at a trade, pool, and loan level. Exchange documents with third-party vendors through secure integrations. Direct orders to appropriate diligence vendors based on product & volume. View & resolve third-party reviewer’s results using automated vendor data feeds. Generate funding schedules with amortized balances, calculated interest and fees. -
15
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. -
16
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. -
17
Fermion Merimen
Fermion
We are a market leader in providing a collaborative and information exchange platform for the insurance industry. As the pioneer in offering Software as a Service (SaaS) for the motor insurance industry, we have successfully deployed this model throughout the insurance ecosystem communities. We have enabled our clients to grow without disproportionate overheads and provided rapid transformation capabilities with lower risks and predictable cost using our infrastructure. -
18
MergeWare-TIFA
J&J Technology Consulting
This software for Insurance Brokers automates the Truck / Commercial Insurance Form processing by transferring data from your source Quick Quote to any other Carrier Application, Broker Agreement/Legal Docs, Permits, or any other form. Best part is that we utilize your existing MS Office licensing and therefore there is no need to pay additional licensing fees. Additionally, TIFA is configured to be plug and play with our CRM application.Starting Price: $1700.00/one-time -
19
V3locity
Vitech Systems Group
V3locity®, Vitech’s cloud-native administration, engagement, and analytics platform, is a transformative suite of complementary applications that offers full life cycle business functionality and robust enterprise capabilities. It marries core administration with a revolutionary digital experience. Its modular design enables flexible, agile deployment strategies. V3locity employs an advanced, cloud-native architecture that leverages the unique capabilities of AWS to deliver a solution with unparalleled security, scalability, and resiliency. -
20
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 -
21
PCRS
PCMI
Allows users to provide real-time rates and contracts to dealer menus via eRating and eContracting. Users are able to issue policies with electronic signatures and present products to consumers through their own point of sales channels and/or their partners. Having 140+ partners in our network gives dealers the ability to connect to the eMenu or DMS system of their choice. Our policy administration software supports billing, commissions, cancellations, and different statuses of the policy throughout its lifetime, allowing for seamless coverage rating, contracting, and contract remittance. Being fully integrated with your accounting system lets you create, manage, and modify your agents, dealers, coverages, and contracts. This also grants your agents direct access via our Agent Portal. Our F&I software gives the Dealer Principal and Field Representatives access to integrated reports for F&I sales, forecasting, and overall dealership performance in real-time with powerful analytics. -
22
SSG Digital
iPipeline
Innovator, connector and leader for the insurance industry. We have the most extensive straight-through processing platform within the UK. Explore how our digital platform addresses your business needs. Business transformation powered by increased agility and a digital end-to-end experience. Improved productivity fueled by adviser and consumer self-service capabilities. Higher customer lifetime value through proactive ongoing engagement with customers. Customer and Adviser Portals – users access policy documentation and update personal and policy details and features digitally, in real time. Components cover every facet of the user experience including full reinsurance reporting, external portal integration, and automated and clerical underwriting. Flexible deployment – from full end-to-end SSG Digital platform deployment, to discrete integrated individual components (e.g. underwriting only, New Business only). -
23
InsuraSphere
IDP
InsuraSphere is a full suite of products and solutions that grows with your business. InsuraSphere is the complete suite of products designed by insurance people, for insurance people. Keep track of essential information across your business, like policies, quotes, claims, agents, and more — all in one place. Streamline your processes by using InsuraSphere’s integrated policy form management system. Give your stakeholders access to the information and workflows they need with agent and insured portals. Grant agents the ability to rate, quote, and issue their own policies based on your company’s business rules and role-based permissions. Customize your company workflows by added third-party integrations. InsuraSphere is designed for the evolving needs of carriers and agents. Whether you’re just starting, moving from a legacy system or want to bring your policy admin into one single product, InsuraSphere is designed to grow with your business. -
24
ClaimSuite
Whitespace Software
The Whitespace Platform is the truly digital platform for the global (re)insurance marketplace. Contracts created and processed using Whitespace are made entirely of data. When digital data is used as the vehicle for risk transfer (not Word or PDF documents), the potential benefits of digital transformation of your business become realizable. And the possibilities are endless. Increases in speed, accuracy, availability, and quantity of in-depth data for risk analysis, all provide significant benefits to Brokers and Carriers. Above all, insurers act in the interests their customers, for whom a digital connection can mean real-time access to the risk placement, quicker payments and faster responses on claims. The complete end-to-end process is supported; with Whitespace, brokers and underwriters create risk submissions, collaborate on contracts, communicate via real-time instant messaging, request and provide quotes, bind, sign and endorse (re)insurance contracts digitally. -
25
Polygonal
City Computers
Polygonal builds upon the strength and rich functionality of earlier versions and combines it with the latest Microsoft VB.Net and Business Intelligence technology to provide a comprehensive solution able to respond efficiently and quickly in the dynamic market of today. Polygonal, a modular, multi-currency, underwriting, policy/claims administration software solution integrated with transactions, reinsurance, accounting, messaging, data warehouse reporting, document management, and workflow modules to provide a full end-to-end business process with tangible results. Polygonal, designed from a business prospective using City Computers specialist team. We have many years' experience working in the insurance market as practitioners as well as solution providers. -
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
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. -
28
POWEReob
Unicomp Corp. of America
Insurance payment posting, like so many other tasks, falls under the proverbial 80/20 rule. The 20% of your payments that are still posted from paper EOBs take 80% of the overall payment posting work, if not more. Not so with POWEReob. POWEReob is a combination of free software and a pay-per-transaction service that will convert the paper EOBs you still receive from some payers into electronic remittances files in the ANSI 835 or NSF format. These files can then be used for automated payment posting to your practice management software, electronic secondary claims billing and denials management. POWEReob can work with any practice management that accepts remittance files from 3rd party sources (not just from their designated clearinghouse). For those that don't, we'll work with your practice management or clearinghouse so you, too, can benefit from the labor savings resulting from 100% electronic remittances. -
29
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. -
30
Risk Manager
ERIC Systems
Risk Manager utilizes Microsoft SQL Server allowing the creation of custom views and queries for reporting purposes. ODBC compliant applications may also be utilized without dependency on ERIC Systems. Risk Manager is under constant development and updates are regularly published. Our policy for providing updates is simple. We offer newer versions at no additional cost to the standard technical support agreement. Dollar limits for individual check and reserve transactions are assigned to user logins. Not to exceed without acknowledgment controls are also provided for total paid to date and total incurred thresholds configured at the enterprise level. Our policy for development of new program features and standard reports is based on client suggestions.Starting Price: $19995.00/one-time
