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description: Page 4 - Discover the best Claims Processing Software for your organisation. Compare top Claims Processing Software tools with customer reviews, pricing and free demos.
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title: Page 4 - Best Claims Processing Software - 2026 Reviews, Pricing & Demos
---

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# Claims Processing Software

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## Products

1. [SAIBA Global](https://www.softwareadvice.com.au/software/429289/saiba-global) — 1.0/5 (1 reviews) — SAIBA is an insurance broking software tailored for direct insurance brokers. It aids in the effective management of ...
2. [AdInsure](https://www.softwareadvice.com.au/software/98153/adinsure) (0 reviews) — AdInsure is a line-of-business agnostic insurance platform that helps insurers adapt to industry changes. It enables ...
3. [maxRTE](https://www.softwareadvice.com.au/software/234703/maxrte) (0 reviews) — maxRTE provides healthcare facilities, medical clinics, and revenue cycle management / billing services companies wit...
4. [Origami Risk for P\&C Insurance](https://www.softwareadvice.com.au/software/144301/origami-risk) (0 reviews) — Origami Risk provides a highly configurable, integrated SaaS platform that enables insurance organizations—insurers, ...
5. [CaseGlide](https://www.softwareadvice.com.au/software/288043/caseglide) (0 reviews) — CaseGlide helps claims teams at insurance companies, corporations and TPAs align their defense attorneys around case ...
6. [Encoda BackOffice](https://www.softwareadvice.com.au/software/359413/encoda-backoffice) (0 reviews) — Encoda is a leader in healthcare reimbursement automation and technology-enabled revenue cycle management services, t...
7. [Automated Ship and Debit](https://www.softwareadvice.com.au/software/364135/automated-ship-and-debit) (0 reviews) — All too often, vendors frequently fail to produce a sufficient ROI on their channel incentive programs. Automated Shi...
8. [Acuity ELM](https://www.softwareadvice.com.au/software/334269/acuity-elm) (0 reviews) — Acuity is a central software hub for legal operations and legal claims management for small to mid-sized organization...
9. [P\&C Claims Intake Decisions](https://www.softwareadvice.com.au/software/229540/shift-claims-automation) (0 reviews) — P\&C Claims Intake Decisions is an insurance software designed to help businesses manage property and casualty cla...
10. [Service Hub CRM](https://www.softwareadvice.com.au/software/209536/servicehubcrm) (0 reviews) — Service Hub CRM is a customer relationship management solution that helps businesses streamline appointment schedulin...
11. [HEALTHsuite Advantage](https://www.softwareadvice.com.au/software/326023/healthsuite-advantage) (0 reviews) — HEALTHsuite Advantage is a benefits administration solution that helps organizations streamline processes related to ...
12. [Smart Integrity Platform](https://www.softwareadvice.com.au/software/371622/smart-integrity-platform) (0 reviews) — The Smart Integrity Platform by DISS-CO is a blockchain-based, secure and easy-to-implement software that meets the r...
13. [Smart Data Solutions](https://www.softwareadvice.com.au/software/247713/smart-data-solutions) (0 reviews) — Smart Data Solutions provide healthcare process automation technology to help reduce costs, streamline workflows, and...
14. [Aclaimant](https://www.softwareadvice.com.au/software/221356/aclaimant) (0 reviews) — Aclaimant is a web-based solution that helps organizations manage safety and risk in the workplace. It is suitable fo...
15. [StreamlineMD](https://www.softwareadvice.com.au/software/1032/streamlinemd) (0 reviews) — StreamlineMD has served Radiology \& Interventional Radiology practices for 45+ years with cloud-based ONC-certifi...
16. [Verity](https://www.softwareadvice.com.au/software/322696/verity) (0 reviews) — Discover Verity, the web-based policy administration solution tailored to meet the specific needs of MGAs and carrier...
17. [QuickCap](https://www.softwareadvice.com.au/software/420205/quickcap) (0 reviews) — QuickCap is an administration software designed specifically for payers and providers in the healthcare industry. It ...
18. [CaseworksPro](https://www.softwareadvice.com.au/software/420847/caseworkspro) (0 reviews) — CaseworksPro is a claims management software designed for insurance companies, third-party administrators, and self-i...
19. [V3locity](https://www.softwareadvice.com.au/software/296264/v3) (0 reviews) — V3locity is a suite of complementary applications that brings about transformation in businesses, offering complete l...
20. [Snapsheet Claims](https://www.softwareadvice.com.au/software/425454/snapsheet-claims) (0 reviews) — Snapsheet makes claims simple. We do this through a suite of innovative insurance software solutions which transform ...
21. [PLEXIS Payer Platforms](https://www.softwareadvice.com.au/software/84300/plexis-payer-platforms) (0 reviews) — PLEXIS Payer Platforms is on-premise and cloud-based solution designed to help small to large businesses manage all p...
22. [TOSHFA](https://www.softwareadvice.com.au/software/526681/TOSHFA) (0 reviews) — TOSHFA – Intelligent Health Insurance Administration and Claims Processing Platform TOSHFA is Acess Meditech Group’s ...
23. [ClaimBuild](https://www.softwareadvice.com.au/software/528004/ClaimBuild) (0 reviews) — ClaimBuild is a construction project management solution that streamlines the claims processing and project collabora...
24. [AdInsure Claims](https://www.softwareadvice.com.au/software/529510/AdInsure-Claims) (0 reviews) — AdInsure Claims is an insurance claims management software designed to help support the entire claims lifecycle, from...
25. [Arnie](https://www.softwareadvice.com.au/software/501070/Arnie) (0 reviews) — Arnie is a cloud-based motor insurance claims management system designed to streamline the claims process from lodgme...

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## Related Categories

- [Complaint Management Software](https://www.softwareadvice.com.au/directory/499/complaint-management/software)
- [Practice Management Software](https://www.softwareadvice.com.au/directory/4527/medical/software)
- [Electronic Medical Records Software](https://www.softwareadvice.com.au/directory/8/electronic-medical-record-software/software)
- [Legal Billing Software](https://www.softwareadvice.com.au/directory/980/billing/software)
- [Medical Billing Software](https://www.softwareadvice.com.au/directory/11/medical-billing-software/software)

## Links

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This technology consistently finds unknown billable commercial and government coverage for up to 25% of all self-pay patient accounts, extending beyond primary coverage to secondary and tertiary payers. It reduces costs associated with sending accounts to collection or taking legal action, contributing to patient retention. The monthly subscription rate provides unlimited transactions without payer caps and costly contingency fees, translating to a savings of 70%+. And maxRTE processes self-pay files on day one to save staff time, limit denials, improve cash flow, reduce patient contact, and lower fees paid to other vendors.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/fc70e42b-f019-4821-a905-8e9a299a40db.jpeg","url":"https://www.softwareadvice.com.au/software/234703/maxrte","@type":"ListItem"},{"name":"Origami Risk for P&C Insurance","position":4,"description":"Origami Risk provides a highly configurable, integrated SaaS platform that enables insurance organizations—insurers, MGAs, program administrators, risk pools, and third party claims administrators (TPAs)—to transform their approach to managing critical workflows, leveraging analytics, and engaging with stakeholders. Origami’s P&C insurance solution includes policy administration, rating, and billing; claims administration; analytics, dashboards, and reporting. \n\nPolicy Administration:\nStreamline policy administration from quote to renewal. Deliver new property and casualty insurance products to market quickly and efficiently, while offering a modern buying experience to agents and insureds. Origami gives you the ability to manage the entire policy life cycle from a single system that includes fully integrated digital underwriting, billing, and analytics solutions. \n\n  Rating - Our flexible solution provides you with the ability \n  to update your own underwriting calculations, \n  eliminating the need for expensive, time-consuming \n  custom programming – without compromising accuracy. \n  Access to update rate tables, rating formulas, and \n  associated communications & policy documents via a \n  user-friendly interface that allows you to configure \n  options for limits and deductibles in proposals and \n  policies. \n\n  Billing – Billing is tightly integrated with the policy \n  lifecycle in order to automatically create accurate \n  invoices, track payments, and generate cross-policy \n  financial analytics. \n\nClaims Administration:\nDigitize your claims administration by leveraging analytics, automating best practices, and enabling collaboration between adjusters, agents, and policyholders. Origami manages the entire claim life cycle from first notice of loss to settlement, including triage and assignment, reserving, payments, and audit. \n\n  Automated Workflows - Free staff from repetitive, time- \n  consuming activities associated with claims \n  administration. Automate processes, standardize \n  procedures and increase efficiency. Any event—initial \n  claim entry, changes made to claim details, or payments \n  and reserves that exceed defined thresholds—can trigger \n  the generation of alerts, diaries, tasks, claimant \n  communications, and the routing of financial approvals. \n\n  Document Management - Make it easier to find critical \n  files and move toward a paperless environment by \n  centralizing storage and production of claims-related \n  documentation. Generate mail merge letters and industry \n  standard forms using automated tools. Attach scanned \n  versions of paper documents to any record in the system. \n  Email file attachments directly to claim records. View \n  documents by selecting from a list of recently opened \n  files, or search across all files in the system by specific \n  words or phrases. \n\nDigitally Engage:\nAccessible via web and mobile, our cloud platform is designed for all key stakeholders in the policy and claims life cycle: underwriters, CSRs, adjusters, vendors, agents, and insureds. Customize online portals without requiring IT resources or product development requests. \n\nSeamless Integration of Data: \nOrigami was built to enable you to integrate your insurance technology platform with any third party application without the need for custom development or cumbersome, back-end processes to be solely managed by our data processes. Our solution provides you options as it relates to the transfer of data between platforms with interfaces developed using APIs for web-services integration or via batch processes through our integrated tools. We also provide on-screen tools for easily importing data from spreadsheets, as well as for encrypting and exporting via FTP.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/9f3a12ac-264c-4c94-bbfa-5de288115cf9.png","url":"https://www.softwareadvice.com.au/software/144301/origami-risk","@type":"ListItem"},{"name":"CaseGlide","position":5,"description":"CaseGlide helps claims teams at insurance companies, corporations and TPAs align their defense attorneys around case strategies, expectations and desired case outcomes. Through a highly configurable litigation management solution, claims leaders utilize CaseGlide to better predict and manage case outcomes, reduce case cycle times through greater visibility into each file, assign the right attorneys to the right cases, and work litigated files more strategically.\n\nCaseGlide captures critical case data, activities, documents and more directly from defense counsel working the cases. By structuring this data and making it immediately available to claims professionals, CaseGlide enables better case prediction, oversight and outcomes.\n\nIn turn, CaseGlide can seamlessly feed this structured information to and from existing claims systems, document management and imaging systems, and to data warehouse environments. Alternatively, CaseGlide can serve in a stand-alone and self-contained capacity.\n\nAs a SOC II Type 2 compliant solution, CaseGlide allows an unlimited number of users, such as outside counsel, staff counsel, internal legal operations teams, analytics teams, and internal claims professionals, to operate in a highly secure, permissions-based, environment that is much more secure than the traditional use of email with attachments.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/fac97bdd-24fc-492e-80a9-03cc2a9def0a.jpeg","url":"https://www.softwareadvice.com.au/software/288043/caseglide","@type":"ListItem"},{"name":"Encoda BackOffice","position":6,"description":"Encoda is a leader in healthcare reimbursement automation and technology-enabled revenue cycle management services, that empower medical business offices to cost-effectively collect the most revenue in the shortest time possible. \n\nEncoda BackOffice is a rules-based software platform that identifies and places problematic claims and remittances in an intuitive work queue, enabling billing teams to work rejections faster and more profitably. Fix a claim in Encoda BackOffice and it's automatically fixed in the practice management system. \n\nClaims scrubbing includes NCCI, LCD, NCD, and MUE rules, ICD-10/CPT mismatches, overlooked CPT codes, payer-specific bundling and frequency rules, a specialty-specific edit library, and custom demographic scrubbing.\n\nEncoda’s Maestro Analytics platform is a robust, dashboard reporting tool that combines data from the practice management system and payers, creating easy-to-use dashboard reports that are automatically updated daily and available on a PC or mobile device.\n\nEncoda works with medical practices, MSO and PE firms that own physician practice that use Greenway Prime Suite, Centricity Practice Solutions, Athena Practice, Nextech, or NextGen practice management systems and perform medical billing in house. \n\nEncoda also performs RCM services for clients on these same practice management systems, giving clients access to Encoda BackOffice and Maestro Analytics so clients can see what our billing team is doing and what is taking place in the revenue cycle on a daily basis. \n\nAt this time we do not support FQHCs.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/eb032471-e436-4e18-a77b-a8636ebf43a6.png","url":"https://www.softwareadvice.com.au/software/359413/encoda-backoffice","@type":"ListItem"},{"name":"Automated Ship and Debit","position":7,"description":"All too often, vendors frequently fail to produce a sufficient ROI on their channel incentive programs. Automated Ship and Debit module removes this burden by establishing a centralized safe haven for all your channel partners and direct sales data.\n\nThrough robust automation, our ship and debit solution cleanses channel POS and inventory data, and normalizes this data into a scalable format, providing you with actionable business intelligence. By implementing an Automated Ship and Debit into your financial workflow, you have the capacity to identify revenue leakage, without doing the dirty work of evaluating each claim manually.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/4738df5a-753a-4af0-9b31-febab082ef2c.png","url":"https://www.softwareadvice.com.au/software/364135/automated-ship-and-debit","@type":"ListItem"},{"name":"Acuity ELM","position":8,"description":"Acuity is a central software hub for legal operations and legal claims management for small to mid-sized organizations seeking an easy-to-use, quick-to-implement e-billing system solution – one that’s been validated by two decades of proven performance. Better yet? Acuity is designed to scale with you as you grow. Replace your spreadsheets with a single source of truth for your matter management, legal claims management, complete with unique, “as you go” dashboards, analytics, and insights.\n\nAcuity tracks legal cases and claims through automated best practices and provides reports and dashboards for tracking processes and the performance of teams. Users can also build workflows to track billing, time sheets and other legal operations and automate processes to ensure compliance with regulatory guidelines.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/ccf2a5c4-3f8c-4655-aeda-43d85a62919a.png","url":"https://www.softwareadvice.com.au/software/334269/acuity-elm","@type":"ListItem"},{"name":"P&C Claims Intake Decisions","position":9,"description":"P&C Claims Intake Decisions is an insurance software designed to help businesses manage property and casualty claims. The platform offers tools such as the claim intake decision tool and claim notification wizard that enable teams to streamline the claim management process.\n\nAdministrators can utilize the optical character recognition (OCR) functionality to capture incident data from various claim forms and policy documents. Additionally, it lets supervisors identify the next best actions regarding liability determination and loss mitigation services.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/d5dd6c7e-0e86-452e-93fb-b723ec249e34.png","url":"https://www.softwareadvice.com.au/software/229540/shift-claims-automation","@type":"ListItem"},{"name":"Service Hub CRM","position":10,"description":"Service Hub CRM is a customer relationship management solution that helps businesses streamline appointment scheduling, claims processing and field service management operations. The application allows organizations to process payments, manage orders and handle billing processes via a unified portal.\n\nIt provides a host of features such as invoicing, communication management, automated reminders, case management, an activity dashboard, geofencing, route optimization and more. Service Hub CRM enables managers to view historical reports, track employees’ activities and store customer data in a centralized repository. Additionally, field service executives can utilize mobile applications on Android and iOS devices to capture and record data about clients and deliveries, even from remote locations.\n\nService Hub CRM comes with an application programming interface (API), which facilitates integration with several third-party platforms. Pricing is available on request and support is extended via phone, email and other online measures.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/e29d5b14-f110-4ccf-9a49-484d8d030412.png","url":"https://www.softwareadvice.com.au/software/209536/servicehubcrm","@type":"ListItem"},{"name":"HEALTHsuite Advantage","position":11,"description":"HEALTHsuite Advantage is a benefits administration solution that helps organizations streamline processes related to provider data management, claims administration, reimbursement, and more from within a unified platform. It also offers a built-in white-labelled provider portal, which lets users verify member eligibility, monitor claim status, manage demographic data, and track authorization status.\n\nHEALTHsuite Advantage enables organizations to ensure compliance with common standards and regulations, such as HIPAA, PCI DSS, SOC 2, and SSAE 18 Type II. It also lets staff members edit claim details, handle credentialing, recover overpayments, manage service requests, and more.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/cb0f1ba2-6993-49c1-ab53-2d4a0d0ea4e8.png","url":"https://www.softwareadvice.com.au/software/326023/healthsuite-advantage","@type":"ListItem"},{"name":"Smart Integrity Platform","position":12,"description":"The Smart Integrity Platform by DISS-CO is a blockchain-based, secure and easy-to-implement software that meets the requirements of the EU Whistleblowing Directive and whistleblower protection laws in Europe. The platform is customizable and can be used as a complaint management system to meet supply chain act requirements or for patient complaints in healthcare. Visit us at: https://diss-co.tech\n\nOur blockchain-based whistleblowing software - Smart Integrity Platform by DISS-CO is available at the best value for money. \n\n- ISO 27001 certified\n- No US Providers\n- Whistleblowing law compliance\n- GDPR compliance\n- High data security & whistleblower protection\n- Seamless 3-way communication\n- Multiple reporting channels\n- Case management\n- eLearning\n- Live chat","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/96ca7936-e53f-4d4f-82d2-731f620850e6.jpeg","url":"https://www.softwareadvice.com.au/software/371622/smart-integrity-platform","@type":"ListItem"},{"name":"Smart Data Solutions","position":13,"description":"Smart Data Solutions provide healthcare process automation technology to help reduce costs, streamline workflows, and improve the customer experience for businesses in the healthcare industry. Available solutions cover mailroom management, medical claims management, OCR / data capture, and more. Smart Data Solutions are suitable for healthcare payers, providers, TPAs, HMOs, and others who process medical transactions, claims, or enrollments.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/35c02b66-0fb7-486e-9483-b2b91b3dadc4.png","url":"https://www.softwareadvice.com.au/software/247713/smart-data-solutions","@type":"ListItem"},{"name":"Aclaimant","position":14,"description":"Aclaimant is a web-based solution that helps organizations manage safety and risk in the workplace. It is suitable for organizations in various industries such as construction, real estate, staffing, hospitality, insurance, and others. Aclaimant offers intuitive workflows for incidents and claims reporting as well as structured data and actionable insights. This solution is accessible from mobile devices for on-the-go reporting and data access.\n\nWith Aclaimant, users can electronically submit incidents for rapid triage and escalation. The system securely organizes data and can restrict access to sensitive files. Aclaimant can also automatically complete OSHA forms and return-to-work schedules to help organizations meet compliance requirements. Using the system’s analytics tool, users can access custom dashboards that provide data-based insights related to all reported incidents and claims activity.\n\nPricing information is provided by Aclaimant. Support is available via an online help center, email, and other resources. Please reach out to sales@aclaimant.com for more information.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/695c80f0-c978-4e50-b6c6-39d74a7c5ef9.png","url":"https://www.softwareadvice.com.au/software/221356/aclaimant","@type":"ListItem"},{"name":"StreamlineMD","position":15,"description":"StreamlineMD has served Radiology & Interventional Radiology practices for 45+ years with cloud-based ONC-certified EHR & Practice Management Software, Medical Coding & Billing Services for Hospital-Based Radiologists, Outpatient Endovascular & Interventional Centers, Interventional Vein Centers, and Interventional Pain Management Centers","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/5aab3018-2110-43fd-b2f0-aff7589077d2.png","url":"https://www.softwareadvice.com.au/software/1032/streamlinemd","@type":"ListItem"},{"name":"Verity","position":16,"description":"Discover Verity, the web-based policy administration solution tailored to meet the specific needs of MGAs and carriers operating in the ever-evolving P&C insurance marketplace. Equipped with an array of essential features, Verity simplifies policy management across multiple office locations.\n\nEffortlessly handle policy issuance, thanks to Verity's user-friendly interface and comprehensive rating engine. Manage billing & accounting tasks with ease and reduce manual errors. Stay on top of renewals effortlessly with our automated system. Simplify task management by creating tasks and tracking critical assignments, ensuring timely follow-ups.\n\nVerity provides essential tools for MGAs, including insured, agent & carrier portals, electronic payments, carrier reporting, surplus line reporting, and seamless quoting and policy issuance. Insurers benefit from insured & agent portals, Bordereaux uploads for easy data management, streamlined reinsurance tracking, and agency & direct billing. Our platform also takes care of compliance requirements with 1099 reporting and fiduciary accounting. Plus, simplify claims administration and enhance overall efficiency.\n\nEnjoy a personalized experience with Verity's user-selectable color themes and role-specific visual dashboards. Say goodbye to cluttered screens with modernized input screens and dynamic screen sizing. Navigate through the platform effortlessly with enhanced intuitive navigation.\n\nExperience the power of Verity as it revolutionizes policy administration in the P&C insurance marketplace. Improve productivity, streamline operations, and boost your competitive edge. Discover Verity today and unlock the true potential of your business!","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/5f561422-e89c-4d48-8390-5242935ae901.png","url":"https://www.softwareadvice.com.au/software/322696/verity","@type":"ListItem"},{"name":"QuickCap","position":17,"description":"QuickCap is an administration software designed specifically for payers and providers in the healthcare industry. It helps manage claims processing, clinical data, financial transactions and more.\n\nQuickCap allows users to simplify healthcare claims processing workflow, ensuring seamless and efficient operations. It offers advanced features such as workflow automation, quality reports, and AI-assisted analysis, enabling payers and providers to streamline their processes and enhance overall productivity.\n\nThis web application software is specifically tailored to handle the complex workflows associated with healthcare-payer services. Its pricing details are available on request and support is provided via phone, email and other online measures.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/eec0e8b2-24ae-4eb0-91d9-4f60948fb351.png","url":"https://www.softwareadvice.com.au/software/420205/quickcap","@type":"ListItem"},{"name":"CaseworksPro","position":18,"description":"CaseworksPro is a claims management software designed for insurance companies, third-party administrators, and self-insured organizations. It offers various features including policy data capture, a dashboard, electronic reporting, and user permissions.\n\nThe tool includes an accounting system to track reserve, transaction, and payment processes. Managers can automatically handle claim records, generate invoices, and track various official documents. The solution comes with data visualization tools that provide insights into claim trends.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/6eebdfd1-8218-488e-b799-6d714912d2f9.png","url":"https://www.softwareadvice.com.au/software/420847/caseworkspro","@type":"ListItem"},{"name":"V3locity","position":19,"description":"V3locity is a suite of complementary applications that brings about transformation in businesses, offering complete life cycle functionality and robust enterprise capabilities. With its modular design, the platform enables flexible and agile deployment strategies, making it easy to access data seamlessly across the organization.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/488af9d5-b77f-4e24-9bed-967f7014fdc8.png","url":"https://www.softwareadvice.com.au/software/296264/v3","@type":"ListItem"},{"name":"Snapsheet Claims","position":20,"description":"Snapsheet makes claims simple. We do this through a suite of innovative insurance software solutions which transform insurance companies' ability to seamlessly manage claims, reduce cycle time, increase appraisal accuracy, and deliver payments effortlessly. We started it all with virtual appraisals, and followed that up with our leading claims management system. Today we are driving an industry-wide movement in claims by delivering solutions that enhance customer experiences while our customers create innovative, data-driven claims organizations.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/fc10369c-a78f-4399-a0c7-730e9d9ee4a5.png","url":"https://www.softwareadvice.com.au/software/425454/snapsheet-claims","@type":"ListItem"},{"name":"PLEXIS Payer Platforms","position":21,"description":"PLEXIS Payer Platforms is on-premise and cloud-based solution designed to help small to large businesses manage all processes related to benefits administration and claims management. It comes with a self-service health care portal, which allows enterprises to centralize information including claims history, providers' information, ID cards, employee eligibility and more.\n\n\nKey features of PLEXIS Payer Platforms include employee database, COBRA administration, disability insurance administration, FMLA administration and deduction management. The solution provides an auto-adjudication functionality, which enables users to automatically capture and update claims data in real-time, optimizing expenses and operational productivity. Additionally, businesses can use the application to regulate ICD-10 compliance, prevent claim frauds and improve payer-provider collaboration. \n\n\nPLEXIS Payer Platforms lets enterprises use application programming interface (API) to integrate the solution with several third-party website portals and business systems. Pricing is available on request.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/7bfd410b-f569-4625-9f3f-659d2437703c.png","url":"https://www.softwareadvice.com.au/software/84300/plexis-payer-platforms","@type":"ListItem"},{"name":"TOSHFA","position":22,"description":"TOSHFA – Intelligent Health Insurance Administration and Claims Processing Platform\n\nTOSHFA is Acess Meditech Group’s cloud-based health insurance administration platform, developed to meet the dynamic and complex needs of health insurers and third-party administrators (TPAs). Built with a modular architecture and scalable cloud infrastructure, TOSHFA offers insurers a fully digital ecosystem to manage everything from policy issuance to claims settlement — with real-time insights, process automation, and complete operational control.\n\nThe platform is engineered to solve the specific challenges that health insurance stakeholders face, including fragmented systems, manual claims processing, lack of data visibility, and difficulty complying with evolving health sector regulations. TOSHFA offers a powerful combination of efficiency, configurability, and intelligence — enabling insurers and TPAs to scale operations, reduce processing time, and enhance stakeholder satisfaction.\n\nEnd-to-End Functional Modules\n\nTOSHFA covers all the core components required to run a health insurance operation. Its integrated modules include:\n\t•\tQuotation Engine: TOSHFA supports dynamic, rules-driven quote generation based on customer profile, group size, and plan selection. The quote engine enables real-time pricing, benefit configuration, and quote approval workflows.\n\t•\tPolicy Administration: This module facilitates policy creation, premium management, endorsements, cancellations, renewals, and member lifecycle management. It supports hierarchical group structures, multiple plan tiers, and policy-level customizations, making it ideal for both retail and group health business models.\n\t•\tClaims Management: TOSHFA offers a complete claims processing module, covering pre-authorization, hospitalization, reimbursement, and settlement workflows. The platform supports multi-level approval hierarchies, medical coding (ICD/DRG), automated validations, and integration with provider billing systems to minimize fraud and improve processing speed.\n\t•\tHospital Network Management: This feature allows TPAs and insurers to manage provider onboarding, credentialing, rate negotiations, and service-level agreements. It also enables real-time claims routing, provider performance tracking, and contract-based pricing logic.\n\t•\tMaster-Level Data Management: TOSHFA includes robust tools for managing master data sets across the ecosystem — such as benefit definitions, diagnostic codes, treatment packages, provider details, and pricing matrices. This ensures standardization and clarity across operational units, enabling accurate decision-making and regulatory reporting.\n\t•\tReporting and Analytics: With 360-degree visibility into operations, TOSHFA provides dashboards and real-time reports for underwriting, claims performance, network utilization, and compliance. Customizable reports can be generated for management, clients, and regulators — supporting both strategic planning and day-to-day operations.\n\nAutomation and Efficiency\n\nWhat makes TOSHFA especially valuable is its emphasis on automation. Through process triggers, rule-based validations, and digital workflows, the platform significantly reduces manual intervention. Key automation features include:\n\t•\tAuto-adjudication of claims based on predefined rules\n\t•\tAutomated notifications for approvals, rejections, and renewals\n\t•\tIntegrated document verification and OCR compatibility\n\t•\tSmart flagging for anomalies or potential fraud cases\n\nThis results in faster processing times, lower administrative overhead, and improved service turnaround for both members and providers.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/3d33fea6-9dc4-4760-bfd3-15dfdc5e8b0d.jpeg","url":"https://www.softwareadvice.com.au/software/526681/TOSHFA","@type":"ListItem"},{"name":"ClaimBuild","position":23,"description":"ClaimBuild is a construction project management solution that streamlines the claims processing and project collaboration for construction businesses. The platform is designed to cater to the unique needs of the insurance building space. \n\nClaimBuild enables users to handle claim submissions and resolutions, reducing paperwork and administrative burdens for faster project progress. It provides users with clear insights into project costs and claims status, leading to streamlined budget management and financial control. Additionally, the platform facilitates communication between stakeholders.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/a665fb54-102a-487a-ab66-00ccba96cea0.png","url":"https://www.softwareadvice.com.au/software/528004/ClaimBuild","@type":"ListItem"},{"name":"AdInsure Claims","position":24,"description":"AdInsure Claims is an insurance claims management software designed to help support the entire claims lifecycle, from First Notice of Loss to settlement. It is customized for property and casualty insurers seeking to streamline claims processes and address operational challenges. The software helps manage claims while adhering to regulatory requirements.\n\nThe platform includes automation tools and configurable workflows that help reduce operational costs. Claims handlers can access a comprehensive view of claims, supported by SLA tracking and performance monitoring features. It offers fraud management capabilities, reinsurance integration, recoveries handling, and dispute management functionalities. Predictive analytics assist in evaluating claim complexity and routing cases.\n\nAdInsure Claims allows insurers to customize claims operations using its low-code configuration tool, AdInsure Studio. Users can modify workflows, automate decision-making, and enforce business rules to enhance accuracy. The software includes a document management system and portals for collaboration between handlers and managers.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/d0496cb1-3dc4-4227-acb4-188a3078c4ff.png","url":"https://www.softwareadvice.com.au/software/529510/AdInsure-Claims","@type":"ListItem"},{"name":"Arnie","position":25,"description":"Arnie is a cloud-based motor insurance claims management system designed to streamline the claims process from lodgment to settlement. It is used by insurance companies, claims assessors, repair shops, and other stakeholders in the automotive insurance industry to process claims efficiently while meeting regulatory requirements.\n\nThe system includes automated workflows that can be customized to reduce manual tasks and minimize errors. It centralizes claims-related information with AI-powered search capabilities and provides real-time tracking of claims. Features include document management tools, repair cost estimation functionality, and access to a network of registered repairers across Australia. Data analytics tools offer insights to support decision-making.\n\nArnie facilitates communication between all parties involved in the claims process through its centralized platform. Its cloud-based architecture reduces duplicate entries and administrative work while allowing access from any device. Security features such as controlled access and encryption protect sensitive claims data and support compliance with regulations.","image":"https://gdm-catalog-fmapi-prod.imgix.net/ProductLogo/a749c7d3-b13a-4d41-99b6-bd0901b94d80.jpeg","url":"https://www.softwareadvice.com.au/software/501070/Arnie","@type":"ListItem"}],"numberOfItems":25}
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