Average Ratings 0 Ratings
Average Ratings 0 Ratings
Description
Riskonnect Claims Management Software is an advanced claims administration platform that helps organizations efficiently manage claims from the initial incident report to final closure. The system centralizes claims information, automates workflows, and connects data from multiple internal and external sources to improve visibility and streamline operations. Businesses can use the platform to simplify claims intake with mobile-friendly forms, automatic alerts, instant data validation, and real-time access to critical information. The software includes robust capabilities for assignment management, reserve tracking, adjudication workflows, settlement processing, subrogation management, and return-to-work coordination. Integrated AI and predictive analytics tools help claims teams identify litigation risks, detect potential problem claims early, estimate claim durations, and make faster, more informed decisions. Riskonnect also supports compliance management through electronic filing tools for workers’ compensation reporting and proactive monitoring of regulatory requirements. Collaboration features enable adjusters, claimants, insurers, and third-party partners to communicate and share information more effectively throughout the claims process. The platform integrates with more than 900 external systems used by carriers and third-party administrators, allowing organizations to unify and validate claims data across different environments. Custom dashboards, reporting tools, and analytics capabilities provide actionable insights that help businesses evaluate performance, reduce costs, and optimize resource allocation. Automated task management and configurable workflows reduce administrative burdens while helping organizations accelerate claim resolution times.
Description
Virtual Examiner®, PCG Software’s flagship product, monitors an organization's internal claims process to track provider data for fraudulent or abusive billing patterns and maximizes financial recovery. The Virtual Examiner®, a PCG Software product, allows healthcare organizations to improve their claims adjudication system by allowing for more than 31,000,000 edits per claim. The software monitors an organization's internal claim process to identify and reduce payments for incorrect or erroneous code to save premium dollars. Virtual Examiner®, is more than a claims management solution that focuses on code combinations. It is a cost containment solution that evaluates the claim not only for abusive billing patterns but also identifies those claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports.
API Access
Has API
No
API Access
Has API
No
Integrations
Rayven
No
Pricing Details
No price information available.
Free Trial
No
Free Version
No
Pricing Details
No price information available.
Free Trial
No
Free Version
No
Deployment
Web-Based
Yes
On-Premises
No
iPhone App
Yes
iPad App
Yes
Android App
Yes
Windows
No
Mac
No
Linux
No
Chromebook
No
Deployment
Web-Based
Yes
On-Premises
No
iPhone App
No
iPad App
No
Android App
No
Windows
No
Mac
No
Linux
No
Chromebook
No
Customer Support
Business Hours
Yes
Live Rep (24/7)
Yes
Online Support
Yes
Customer Support
Business Hours
Yes
Live Rep (24/7)
No
Online Support
Yes
Types of Training
Training Docs
Yes
Webinars
Yes
Live Training (Online)
Yes
In Person
Yes
Types of Training
Training Docs
Yes
Webinars
No
Live Training (Online)
No
In Person
No
Vendor Details
Company Name
Riskonnect
Founded
2007
Country
United States
Website
riskonnect.com/claims-management-software/
Vendor Details
Company Name
PCG Software
Founded
1984
Country
United States
Website
pcgsoftware.com/product-offerings/virtual-examiner/
Product Features
Claims Processing
Adjustor Management
No
Case Management
No
Claim Resolution Tracking
No
Co-Pay & Deductible Tracking
No
Compliance Management
No
Customer Management
No
Electronic Claims
No
Forms Management
No
Paper-Based Claims
No
Payor Management
No
Policy Administration
No
Insurance Claims Management
CRM
No
Claims tracking
No
Customer portal
No
Document management
No
EDI data exchange integrations
No
Electronic claims
No
Fraud management
No
Reporting
No
Product Features
Claims Processing
Adjustor Management
Yes
Case Management
Yes
Claim Resolution Tracking
Yes
Co-Pay & Deductible Tracking
Yes
Compliance Management
Yes
Customer Management
Yes
Electronic Claims
Yes
Forms Management
Yes
Paper-Based Claims
Yes
Payor Management
Yes
Policy Administration
Yes
Medical Billing
Claims Processing
Yes
Claims Scrubbing
Yes
Code & Charge Entry
Yes
Compliance Tracking
Yes
Customizable Dashboard
Yes
Dunning Management
Yes
Invoice History
Yes
Patient Eligibility Checks
Yes
Practice Management
Yes
Quotes/Estimates
Yes
Remittance Advice
Yes