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StoneRiver: Claims Processing Made Simple

Top 10 Claims Processing and Management Solution Providers 2016

Claims processing, a core function in the insurance value chain, is witnessing new trends that are influencing claims management and enhancing the customer experience. Today, the market is replete with a number of end-to-end claims management solutions that help insurers achieve regulatory compliance, detect fraudulent and invalid claims, and optimize processes to support a streamlined claims experience. These solutions are capable of providing real-time analysis of claims processes, enabling insurers to gain actionable insights that support decision-making. With an approach built on Key Performance Indicators (KPIs), the claims management solutions are empowering insurance companies to enhance claims efficiency, monitor, and measure overall improvement.

Importantly, the companies are implementing advanced fraud detection technologies to recognize false claims. Today’s end-to-end solutions use a blend of technologies including predictive analysis, data mining, rules-based engines, and activity analysis to identify scams— giving insurers comprehensive visibility into claims processes. By transforming the existing processes, these solutions help reduce costs, enhance customer satisfaction, and boost fraud detection.

To help CIOs and CFOs find the right claims processing and management solution for their enterprise, a team of prominent CEOs, CIOs, and VCs along with Insurance CIO Outlook’s editorial board has evaluated the best players in the space. The companies featured here demonstrate an ability to develop innovative technologies combined with outstanding customer service.

In our selection, we looked at the vendor’s capability to fulfill the burning need for cost-effective and flexible claims processing solutions that will add value to the insurance landscape.

We present to you Top 10 Claims Processing and Management Solution Providers 2016.

Top Claims Processing and Management Companies

Designs cloud-based applications for claims administration

www.hi-techhealth.com

Delivers consistent claim outcomes and improves adjuster productivity by streamlining the end-to-end claims process

www.pega.com

Delivering the industry’s widest range of technology solutions and services to insurance carriers, agents, and broker-dealers

www.stoneriver.com

Provides applications to process unemployment claims at all levels of adjudication and track status through activity reports

www.us4u.us

VBA is a pro-active, leading edge software design company providing custom solutions to the insurance industry for nearly two decades

vbasoftware.com

Context4 Healthcare

Context<sup>4</sup> Healthcare

Provides an online real-time claim editing software containing millions of edit combinations identifying inaccurate billing practices, regulatory requirements, and other errors

FINEOS

FINEOS

Helps customers transform from outdated legacy administration systems to modern customer-centric processes for billing, claims, and policy administration

Mitchell

Mitchell

Simplifies, enhances, and accelerates claims handling processes through deep workflow solutions that include unparalleled access to data, advanced analytics, and decision support tools

PLEXIS Healthcare Systems

PLEXIS Healthcare Systems

A payer technology company that delivers trusted enterprise core administration and claims management solutions to healthcare payers and delivery systems

Sapiens

Sapiens

Provides a Claims Management Software that aligns claims processes with company policy