Best Automated Claims Processing Software [2025]

The technology's real value emerges in how it handles ambiguity. Traditional automation works well for claims that fit neatly into predefined categories—a fender bender with clear liability, a residential roof replacement with standard damage patterns. But commercial claims often involve ambiguous language, complex causation chains, and coverage grey areas. Modern AI underwriting systems can identify these nuances and flag them for adjuster review, not by following rigid rules, but by understanding context and implications.

Consider how this changes the adjuster's workflow. Instead of spending hours reading through documents to piece together a timeline, they start with an AI-generated narrative that highlights key events, potential coverage issues, and areas needing closer examination. This doesn't replace their judgment, but it gives them a head start on exercising it.

But there's an important caveat: implementing these systems effectively requires a deep understanding of claims operations. Insurance companies that treat AI as a simple technology overlay often find themselves with expensive solutions that don't address their real operational bottlenecks. Success comes from understanding where adjusters actually spend their time and what information they need to make decisions.

Key Benefits for Insurance Companies

Implementing AI in insurance claims processing has led to significant improvements in efficiency and cost savings. For instance, Compensa Poland (part of the Vienna Insurance Group), achieved a 73% increase in claims process cost efficiency by adopting an AI-based system.

However, looking ahead, the most interesting developments aren't in processing standard claims faster—they're in handling complexity better. As commercial risks become more intricate and coverage requirements more nuanced, the ability to quickly understand and evaluate complex claims becomes increasingly valuable. The future of automated claims processing isn't about replacing human judgment with artificial intelligence.

• Learn more: AI in the Insurance Industry: Trends and Predictions

10 Best Claims Processing & Management Tools

Choosing the right claims processing software is a critical decision for insurers looking to optimize efficiency while maintaining compliance and accuracy. The best tools go beyond simple automation, leveraging AI to manage complex workflows, detect fraud, and assist adjusters in handling nuanced cases. Below, we examine the leading solutions available in 2025, highlighting their unique capabilities and ideal use cases.

• V7 Go: Uses advanced generative AI, optical character recognition (OCR), and large language model (LLM) orchestration to automate document processing, fraud detection, and complex claims handling. It can analyze unstructured data, such as scanned documents and images, reducing manual intervention while improving accuracy and speed.

• Guidewire ClaimCenter: An end-to-end claims management system designed for personal, commercial, and workers' compensation insurance. It offers automation features to eliminate low-level tasks, enhancing efficiency.

• Duck Creek Claims: Integrates advanced AI and data analytics to optimize claims processes. Its flexible platform supports insurers of all sizes, offering an open API architecture for enhanced customization.

• Sapiens ClaimsPro: Offers modular claims management solutions that simplify complex workflows, enabling insurers to adapt to changing market needs. Focuses on digital transformation and operational efficiency.

• Riskonnect Claims: A claims administration software designed to handle claims with speed and precision, enhancing operational efficiency.

• Claimable: A web-based claims management platform that facilitates communication with claimants, efficient processing, and reduced paperwork.

• Cloud Claims: A cloud-based solution ideal for property and casualty, workers' compensation, auto, and general liability claims management. It offers a clean, mobile-optimized interface for efficient claims handling. 

• A1 Tracker: An enterprise risk management system featuring claims, incidents, contracts, insurance, compliance, and assets management with analytics and workflow capabilities. 

• SimplePractice: A HIPAA-compliant practice management solution that helps businesses manage scheduling, clients, payments, calendars, and more, ensuring a seamless experience for both providers and clients.

• ClaimVantage Suite: Provides tools for managing the entire claims lifecycle, from initial reporting to final settlement, ensuring efficiency and accuracy in processing claims.

Now, let’s take a closer look at each of these automated claims processing platforms.

V7 Go: AI for Insurance Underwriting & Claims Processing

This AI platform is specifically designed to streamline insurance claims processing. Tailored for property, health, and auto insurance sectors, V7 Go addresses the challenges of handling extensive documentation by automating data extraction and analysis.

V7 Go employs frontier AI models to interpret complex documents, including medical reports, legal files, and adjuster notes. It also allows you to search and review documents using a conversational interface and get complete references and document highlights for quick verification. This capability reduces manual validation bottlenecks, accelerates claim assessments, and enhances accuracy.

Key Features:

• Long Document Support: Capable of analyzing lengthy claims files, the AI processes both detailed page-level information and generates comprehensive claim summaries, ensuring no critical data is overlooked.

• AI Citations: Every extracted data point is linked to its original source within the document, providing transparency and facilitating easy verification during the claims review process.

• Table & Graph Analysis: The platform can extract and maintain the relationships between data points in complex tables and graphs found in loss runs and medical billing statements, preserving the integrity of structured data.

V7 Go is ideal for insurance companies processing over 1,000 claims per month, particularly those dealing with intricate documentation. Its advanced AI capabilities make it suitable for insurers aiming to enhance efficiency, reduce processing times, and maintain high accuracy in data extraction.

Pros:

• Robust analysis of unstructured and structured data, with numeric calculations and Python support for complex operations.

• Transparent data points with direct citations to original document sources.

Cons:

• May require initial setup and training to customize AI models for specific organizational needs.

• Primarily benefits larger insurers with substantial claims volumes; smaller companies might not fully utilize its advanced features.

For more information, visit the V7 Go homepage.

Guidewire ClaimCenter: Comprehensive Claims Management Solution

Guidewire Software, established in 2001, is a prominent provider of software solutions for property and casualty (P&C) insurance carriers. Their flagship product, ClaimCenter, is a comprehensive claims management system designed to support all lines of personal, commercial, and workers' compensation insurance. Over the years, Guidewire has solidified its position in the industry by offering integrated platforms that enhance operational efficiency and customer satisfaction.

ClaimCenter distinguishes itself through its configurable workflows, allowing insurers to tailor the claims process to their specific business requirements. This flexibility ensures that the system can adapt to diverse operational needs, facilitating efficient claims handling and improved customer service. Additionally, the platform's real-time claim tracking capabilities provide users with immediate updates on claim statuses, which is crucial for timely resolutions.

Key Features:

• Allows customization of the claims process to align with specific business needs, enhancing operational flexibility.

• Provides immediate updates on claim statuses, enabling timely and informed decision-making.

• Seamlessly integrates with other systems within the insurance ecosystem, promoting data consistency and streamlined operations.

Guidewire ClaimCenter is particularly beneficial for mid to large-sized insurance companies that manage a high volume of claims across various lines of business. Its scalability and configurability make it suitable for insurers seeking to enhance efficiency, improve customer satisfaction, and maintain robust control over their claims processes.

Pros:

• User-friendly interface that simplifies claims tracking and management.

• Highly configurable to meet diverse business requirements.

• Strong integration capabilities with other insurance systems.

Cons:

• Implementation can be complex and may require substantial time and resources.

• Some users have reported a learning curve associated with the system's extensive features.

Duck Creek Claims: Management with Advanced Automation

Duck Creek Technologies has established itself as a leading provider of software solutions for the property and casualty (P&C) insurance industry. Their comprehensive suite includes policy administration, billing, and claims management systems, all designed to enhance operational efficiency and customer satisfaction.

Duck Creek Claims sets itself apart with its cloud-native architecture, which allows for rapid deployment and scalability. The platform's low-code configuration enables insurers to adapt quickly to market changes without extensive coding efforts. Additionally, Duck Creek Claims offers pre-configured templates that streamline compliance with regulatory requirements, reducing the time and effort needed to meet industry standards.

Key Features:

• The system provides a flexible First Notice of Loss (FNOL) process, allowing for efficient intake and routing of new claims.

• Claims are automatically assigned to adjusters based on their expertise and current workload.

• The platform includes built-in analytics that offer insights into claims trends, performance metrics, and potential areas of improvement, supporting data-driven decision-making.

Duck Creek Claims is particularly beneficial for mid-sized insurers seeking a cloud-based solution that offers flexibility and rapid deployment. Its modular design allows companies to implement the system in phases, aligning with their specific operational needs and resources. Insurers aiming to enhance regulatory compliance and quickly adapt to market changes will find this platform advantageous.

Pros:

• Cloud-native architecture facilitates scalability and reduces infrastructure costs.

• Low-code configuration enables quick adaptations to changing business requirements.

• Pre-configured templates assist in meeting regulatory compliance efficiently.

Cons:

• The user interface has been described as outdated by some users.

Sapiens ClaimsPro: AI-Driven Claims

Sapiens International Corporation, founded in 1982, is a leading provider of insurance technology solutions, serving Property & Casualty (P&C) insurers worldwide. With decades of industry experience, the company has built highly configurable core systems that help insurers manage claims more efficiently. Sapiens ClaimsPro is its specialized claims processing platform, designed to support multi-line claims automation with AI-powered decision-making and customizable workflows.

This solution offers built-in medical and disability claims management capabilities, making it one of the few solutions optimized for injury and workers' compensation claims. Additionally, Sapiens integrates directly with Hi Marley, an AI-driven messaging tool that enables real-time communication with claimants via SMS—a feature not commonly found in other claims platforms.

Key Features:

• Uses machine learning to detect fraud, prioritize claims, and automate approvals, reducing manual intervention.

• Provides specialized tools for injury tracking, treatment approvals, and medical reimbursements.

• Allows insurers to create dynamic, custom AI workflows for different claim types.

Sapiens ClaimsPro is best suited for mid-to-large P&C insurers dealing with multiple lines of business, particularly those managing complex claims requiring extensive customization. Insurers handling workers' compensation, disability claims, and specialized commercial policies will benefit from its robust rule engine and AI-driven automation.

Pros:

• Works well with third-party analytics, policy management systems, and customer communication tools.

• Speeds up fraud detection, claim approvals, and decision-making.

Cons:

• The look and feel of the platform is not as modern as competitors.

• Some users feel pricing doesn’t justify all features.

Riskonnect Claims Management: Data-Driven Administration

Riskonnect is a recognized leader in risk and claims solutions, with a strong reputation for delivering integrated software that meets the real-world needs of insurers. Their Claims Management Software is designed to streamline the claims process from intake to final settlement, consolidating people, systems, and data in a single, unified platform. This focus on end-to-end integration has positioned Riskonnect as a trusted partner for mid-sized to large insurers seeking both efficiency and compliance.

Riskonnect’s solution distinguishes itself by emphasizing deep integration and practical workflow automation. Rather than relying solely on surface-level digitization, the software consolidates all claim-related data—including documents, images, and notes—into one accessible system. This enables teams to track every claim detail accurately while automating routine tasks such as intake, adjuster assignment, and data validation. Advanced reporting and real-time collaboration tools further support informed decision-making, helping insurers identify potential issues—such as “sleeper claims”—early in the process.

Key Features

• Offers customizable checklists, standards, workflows, and scoring methodologies to align with regulatory requirements and internal best practices.

• Centralizes claim details, attachments, and communications to eliminate duplicate work and improve data accuracy.

• Provides configurable dashboards and risk analytics (e.g., monitoring lag time, litigation rates, and claim duration) that support proactive resource allocation and early intervention.

This software is best suited for mid-sized to large insurers managing complex or multi-line claims environments—such as workers’ compensation, general liability, or other specialized portfolios. The platform’s ability to integrate diverse data sources and automate detailed workflows makes it especially valuable for organizations looking to reduce costs, streamline operations, and resolve claims swiftly while ensuring full regulatory compliance.

Pros:

• Consolidates data from multiple sources, offering a unified view of every claim.

• Highly customizable workflows that can be tailored to specific operational and regulatory needs.

• Robust analytics and reporting tools that support proactive claims management and early intervention.

Cons:

• Implementation may require significant configuration and dedicated training, particularly for organizations with legacy systems.

• The extensive customization options might be challenging for smaller teams or those with limited IT resources.

Claimable: Customer-Focused Claims Management

Claimable is a cloud-based claims management solution developed by Claimable Ltd. in the United Kingdom. Designed with a clear focus on reducing administrative burdens, the platform aims to help businesses settle claims efficiently while delivering a superior customer experience. Its straightforward approach has made it a popular choice for companies that manage a high volume of claims across diverse industries.

What truly sets Claimable apart is its commitment to simplicity and customer-centric design. The system minimizes the complexity often associated with claims management software by providing an intuitive interface that centralizes all claim-related activities. Rather than overwhelming users with unnecessary features, Claimable prioritizes ease of navigation, seamless document storage, and real-time collaboration. This focus not only speeds up the claims process but also ensures that every step—from initial intake to final settlement—is transparent and fully auditable.

Key Features

• All documents and claim details are securely stored in the cloud, ensuring that data is accessible from anywhere without the clutter of physical paperwork.

• Users can tailor the claims process to their specific needs, reducing repetitive administrative tasks and ensuring consistency across claim evaluations.

• Built-in messaging and notifications facilitate proactive, real-time communication between team members and claimants, helping to streamline collaboration and expedite resolutions.

Claimable is ideally suited for businesses that manage a variety of claim types, including loss adjusters, construction and property repair firms, brokers, and in-house claims teams. Its user-friendly design and robust feature set make it a particularly good fit for organizations looking to modernize their claims processing without extensive IT overhead. Companies that value transparent communication and need a system that supports both operational efficiency and regulatory compliance will find Claimable a compelling option.

Pros:

• Intuitive, easy-to-navigate interface that reduces the learning curve.

• Secure, cloud-based storage that eliminates the hassles of paper-based systems.

• Ongoing updates and improvements based on direct user feedback.

• Flexible, customisable workflows that adapt to various business needs.

Cons:

• Photo upload functionality is limited to single uploads, which may slow down processing when multiple images are needed.

• New users may experience an initial adjustment period while adapting to the platform’s workflow.

Cloud Claims: Incident-Based Risk Management

Cloud Claims is APP Tech’s flagship product—a purpose-built, cloud-based incident and claims management solution designed for self-insured companies, third-party administrators (TPAs), and insurance providers. With decades of experience in risk and claims management since 2003, APP Tech has refined its approach to incident-based systems. Cloud Claims stands out in the market by offering a highly specialized Risk Management Information System (RMIS) that supports organizations in consolidating and managing every aspect of the claims lifecycle.

Cloud Claims is built around an incident-based architecture. This design enables users to manage multiple claim lines under a single incident—ideal for events that generate varied types of losses (such as a construction accident affecting workers’ compensation, property damage, and business interruption). The platform emphasizes robust document management, real-time automated notifications, and tag-based organization, which collectively streamline workflows while ensuring full audit trails. Its deep integrations with HR, accounting, and external insurance carrier systems make it a holistic solution that aligns risk and claims data into one unified source of truth.

Key Features

• Consolidates all claim lines under a single incident, enabling seamless management and accurate total loss cost calculations.

• Enhances collaboration by keeping all stakeholders updated and organizing documents efficiently for quick retrieval.

• Tailored analytics and filter-driven dashboards, allowing for detailed tracking, exportable reports, and proactive insights into claim trends.

Cloud Claims is best suited for self-insured entities, third party administrators, and insurance providers that require a comprehensive view of risk and claims data across multiple lines of business. Its incident-based approach is particularly beneficial when a single event triggers several types of claims. Companies managing complex, multi-faceted loss events—such as construction or industrial operations—will appreciate the platform’s ability to integrate financials, claim notes, and supporting documentation. Additionally, organizations that value proactive support benefit from APP Tech’s unlimited technical assistance and in-depth training.

Pros:

• The incident-based system simplifies handling claims that span several business areas, reducing administrative overhead.

• Seamlessly connects with HR, accounting, and external systems while offering extensive customization of workflows and reporting.

• APP Tech backs Cloud Claims with extensive training and unlimited technical support, ensuring users can maximize the platform’s value.

Cons:

• The licensing structure can be on the higher side compared to some competitors, especially when scaling across multiple incidents.

A1 Tracker: Integrated Risk and Claims Management

A1 Tracker by A1 Enterprise is an enterprise risk management (ERM) system that includes robust claims, incidents, contracts, insurance, compliance, and asset management capabilities. A1 Tracker is designed to provide a single platform for managing various aspects of risk and claims, incorporating analytics and workflow automation to enhance efficiency. A1 Tracker offers a comprehensive approach, serving as a central hub for incident reporting, claims handling, and risk mitigation activities.

Key Features:

• The platform automates claims routing, task assignments, and notifications.

• Detailed analytics and reporting capabilities, including dashboards and customizable reports.

• Regulatory compliance by tracking requirements and providing audit trails.

Unlike cloud-native solutions such as Duck Creek Claims, A1 Tracker offers on-premise and cloud deployment options, catering to businesses with specific data security or compliance requirements. Although its user interface may not be as modern as Guidewire ClaimCenter or Sapiens ClaimsPro, its strength lies in its ability to correlate claims data with broader risk factors, providing a comprehensive view for risk mitigation.

Pros:

• Integrates claims management with broader risk and compliance functions for a holistic view.

• Offers both on-premise and cloud deployment options.

• Provides robust reporting capabilities for in-depth claims and risk analysis.

• Custom workflows can be tailored to meet unique requirements.

Cons:

• The user interface is less modern than some cloud-based solutions.

• Setting up and configuring the system requires significant effort and expertise.

SimplePractice: Bridging the Gap Between Provider and Payer

While many claims automation solutions cater to large insurance organizations, SimplePractice operates on the "hospital side," streamlining the front-end processes that feed into the larger insurance ecosystem. What differentiates SimplePractice isn't its ability to replace core claims processing systems, but its role in facilitating smoother data exchange and communication between providers and insurance companies.This alignment aims to reduce claims denials and increase efficiency across both sides.

Key features:

• It provides built-in integration with clearinghouses, enabling providers to submit claims electronically and track their status

• Streamlines the collection of patient demographics, diagnoses, and service codes, which can improve the accuracy and completeness of submitted claims

SimplePractice is best suited for practitioners who may not require the robust sophistication, customization or cost usually afforded within a traditional insurance setting, or the capacity for in-depth review, tracking and analysis.

Pros:

• Streamlined administrative tasks.

• Better data collection practices for subsequent, clean submissions.

Cons:

• Limited complex resolution.

ClaimVantage Suite: End-to-End Claims Platform

ClaimVantage, a FINEOS company, offers a comprehensive suite of claims management tools designed to handle the entire claims lifecycle While many vendors offer specialized solutions, ClaimVantage sets itself apart by providing a unified platform capable of managing life, accident, and health claims from initial reporting to final settlement. This all-in-one approach is particularly appealing to organizations seeking to consolidate their claims processes onto a single, manageable system.

Key features:

• ClaimVantage allows for the creation of client-configurable business rules to manage workflows for claims.

• The platform offers a view of all metrics across claims, types of product or incidents, and an insight-driven way of managing all claims and reducing manual intervention.

• Integrates claims data with policy information, allowing for a more holistic view of the customer relationship.

As a comprehensive solution with robust workflows, client configurable business rules and insight-driven, automated intervention, ClaimVantage makes claim processing simple. The software is suited for companies that manage a wide range of different incidents.

Pros:

• End-to-end solution: handles entire claims lifecycle with speed.

• Configurable workflows: The UI offers all the most important features needed by a claims analyst.

Cons:

• UI/UX limitations: The UI requires analysts to hunt for the right features

Navigating the Automated Claims Processing Landscape

As we've explored in this article, the claims processing software market in 2025 offers a diverse range of solutions, each with its unique strengths and ideal use cases. From AI-powered data extraction tools like V7 Go to comprehensive, end-to-end platforms like Guidewire ClaimCenter and ClaimVantage Suite, insurers have access to an unprecedented array of technologies designed to streamline operations, reduce costs, and improve customer satisfaction.

Automated Claims Processing Software: Overview

However, as with any rapidly evolving technology landscape, choosing the right solution requires careful consideration and a deep understanding of your organization's specific needs. It's tempting to get caught up in the hype surrounding AI and automation, but the most successful implementations are those that align technology with clearly defined business goals. A "rip and replace" approach rarely delivers the promised results.

Key Takeaways:

• The ideal claims processing software depends on factors such as the size of your organization, the complexity of your claims, your existing IT infrastructure, and your budget.

• Seamless integration with existing systems (policy administration, CRM, etc.) is crucial for maximizing efficiency and avoiding data silos.

• While automation can streamline routine tasks, human adjusters remain essential for handling complex claims and making nuanced judgments. The best solutions empower adjusters with better data and insights, rather than replacing them entirely.

• As illustrated by the inclusion of SimplePractice, it's important to consider the entire ecosystem of stakeholders involved in the claims process, including healthcare providers and claimants.

If you want to learn about AI-based solutions, book a demo with our team and tell us more about your specific needs and the processes you'd like to improve.