MedRisk
MedRisk is a managed care organization that delivers AI-enabled medical bill review, utilization review, care coordination, and provider network solutions for workers' compensation and auto casualty payers, TPAs, and self-insured employers across the United States.
- Company typePrivate
- Founded1999
- HeadquartersKing Of Prussia, United States
- Headcount251–500
- GTM typeB2B
- OfferingServices
What MedRisk does
MedRisk is a privately-held managed care organization founded in 1994 and headquartered in King of Prussia, Pennsylvania, that provides integrated medical cost-containment and care management services for the workers' compensation and auto casualty markets. The company operates an enterprise software-and-services platform that unifies medical bill review, utilization review, case management, nurse triage and first-aid, provider network access, electronic payment processing, and state regulatory reporting under four product pillars (Faster Recovery, Smarter Spending, Optimized Payments, Insights Management). Customer segments include insurance carriers, self-insured employers, third-party administrators (TPAs), state funds, and public entities, with named enterprise customers such as Davies North America, CCMSI, and an unnamed Fortune 100 risk management leader.
Underlying the platform is a proprietary AI stack that combines predictive analytics on 30+ years of claims data (approximately 40 million medical bills processed annually), generative AI for unstructured clinical document intelligence and payer-rule interpretation, and agentic AI for workflow orchestration across the claim lifecycle. The company has built and acquired a national provider network (anchored by the SPNet division and the 2026 acquisition of the Horizon Casualty Services PPO Network) and pairs it with a Salesforce-based adjuster/provider portal and a $50M annual technology investment.
MedRisk generates revenue through managed services fees, per-claim administration fees, subscription-style network access fees, and transaction processing fees on bill review and electronic payments. Distribution is enterprise-direct via a field sales organization and strategic TPA partnerships, supplemented by broker and agent channels. The company is backed by TA Associates (2016 growth equity), operates delivery centers in the Philippines, Guatemala, and India, and has pursued an aggressive M&A program—acquiring Medata (January 2024), Conduent's Casualty Claims Solutions business including Strataware for $240 million (May 2024), and the Horizon Casualty Services PPO Network (February 2026).
MedRisk firmographics
Firmographics- Name
- MedRisk
- Legal name
- MedRisk, LLC
- Website
- http://www.medrisknet.com
- Company type
- Private
- Founded year
- 1999
- Operating status
- Operating
- Headcount range
- 251–500 employees
- Short description
- MedRisk is a managed care organization that delivers AI-enabled medical bill review, utilization review, care coordination, and provider network solutions for workers' compensation and auto casualty payers, TPAs, and self-insured employers across the United States.
- Ownership category
- akta.pro rank
Where MedRisk is headquartered
LocationHeadquarters
- HQ city
- King Of Prussia
- HQ country
- United States
- HQ region
- North America
Offices5 records
Markets served
MedRisk business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure
Revenue model
- Managed Care Solutions: Integrated software-and-services platform delivering medical cost-containment solutions to workers' compensation and auto casualty industries. Revenue generated through management fees, per-claim administration, and network access fees.
- Medical Bill Review: Bill review and audit services including clinical audits, financial audits, and negotiation services. Acquired through StrataCare and Conduent's Casualty Claims Solutions business.
- Network Solutions: PPO network access, provider negotiations, and optimized reimbursement strategies. Revenue from network access fees and savings share arrangements.
- Payment Solutions: Electronic payment processing and frictionless payment services for providers. Revenue from transaction processing fees.
Go-to-market motion1 record
Distribution channels4 records
Marketing channels6 records
MedRisk product offering
Product offeringCore offering
MedRisk is a managed care organization that delivers an integrated software-and-services platform for workers' compensation and auto casualty claims management. Its core services include medical billing review, utilization review, case management, nurse triage and first-aid services, state reporting, provider network access (PPO), payment integrity, and data-driven care coordination. The offering combines human clinical expertise with AI-powered analytics to accelerate patient recovery, control medical costs, and ensure compliance for payers, employers, and TPAs.
Product overview
MedRisk is a managed care organization offering an integrated software-and-services platform that unifies medical billing review, utilization review, case management, nurse triage/first-aid services, and state reporting. The company operates primarily through its core MedRisk Platform supplemented by acquired brands StrataCare/Strataware (bill review solutions), Medata (cost management and clinical solutions), and SPNet (physical therapy network). The platform delivers four integrated service modules: Faster Recovery (care coordination), Smarter Spending (network and cost management), Optimized Payments (payment processing), and Insights Management (data analytics). The recent acquisition of Horizon Casualty Services PPO Network further expands network capabilities.
Differentiator
Problem solved
Functional benefit
Brands
- SPNet: Physical therapy network and utilization review services, a division of MedRisk focused on network solutions and care coordination.
Products and services
- MedRisk Managed Care Platform Integrated software-and-services platform unifying medical billing review, utilization review, case management, nurse triage/first-aid services, and state reporting for workers' compensation and auto casualty claims. Sold to insurance carriers, self-insured employers, and TPAs.
- Faster Recovery Care coordination service that aligns triage, scheduling, patient engagement, and clinical insights to support injured worker recovery. Uses analytics foundation to detect risk early and deploy resources effectively.
- Smarter Spending Network solutions, expert negotiations, and strategic bill routing service that ensures cost containment, compliance, and strong provider relationships for payers.
- Optimized Payments Streamlined authorization and secure electronic payment services that reduce administrative burden for providers and improve stakeholder payment experiences.
- Insights Management Data analytics service that captures, analyzes, and translates complex claims and clinical data into actionable intelligence for payers, TPAs, and providers.
- Strataware (StrataCare) Workers' compensation and auto casualty bill review and payment integrity solutions, providing medical billing review and audit services. Operates as an acquired MedRisk brand.
- Medata Cost management and clinical solutions providing data-driven insights for customers, patients, and providers in workers' compensation. Operates as an acquired MedRisk brand.
- SPNet Physical therapy provider network, utilization review, and care coordination services focused on improving outcomes and managing costs for injured workers. Operates as a wholly-owned MedRisk division.
- Horizon Casualty Services PPO Network PPO network business providing provider network access for casualty claims, expanding MedRisk's network capabilities and comprehensive suite of solutions.
Quantifiable outcome
- Days from injury to initial conservative treatment for lumbar spine conditions dropped 50% between 2021 and 2025
- +5 more outcomes
Companies that use MedRisk
Customer profileNamed customers5 records
Segments5 records
Ideal customer profiles3 records
MedRisk technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
AI capability8 records
Feature6 records
MedRisk partnerships and signals
Strategic signalPartnerships
Seven partnerships are on record, tiered core and minor.
- Horizon Mutual Holdings, Inc.coreAcquisition of Horizon Casualty Services (HCS) PPO Network business from Horizon Mutual Holdings, Inc. Expands MedRisk's network capabilities and comprehensive suite of solutions in the casualty claims industry. Strengthens ability to deliver faster recovery, smarter spending, and optimized payments.
- ConduentcoreAcquisition of Conduent's Casualty Claims Solutions business including Strataware products for $240 million in cash. Expected to close Q3 2024. Expands MedRisk's offerings in workers' compensation and auto casualty bill review solutions. Current employees transfer to MedRisk.
- MedatacoreAcquisition of Medata, a provider of cost management and clinical solutions in the United States. Expands care management and cost containment offerings, improves claims outcomes, and enhances data-driven insights for customers, patients, and providers.
- Davies North AmericacoreStrategic partnership where Davies leverages MedRisk's integrated network and data analytics. Tight integration reduces administrative costs; Davies monitors network penetration to keep clients within network. MedRisk provides utilization review and cost management for injured workers.
- CCMSIcoreStrategic partnership with CCMSI (Commercial Casualty Marketing Specialists). Skip Brechtel, EVP of Strategic Partnerships at CCMSI, participates in thought leadership content. CCMSI delivers MedRisk's network and analytics tools to clients for outcome improvement.
- Kids' Chance of AmericaminorMedRisk supports Kids' Chance of America, a charity providing scholarships to children of workers injured on the job. Participation at national conferences demonstrates corporate social responsibility commitment.
- SPNetcoreSPNet is a division of MedRisk specializing in utilization review and network optimization. Greg Nichols serves as President of SPNet. Provides data analytics tools for identifying trends and cost savings opportunities.
Scale indicators7 records
Recent moves6 records
Expansion highlights6 records
MedRisk competitors and assessment
Company assessmentMarket position
Competitive moat6 records
Key highlights7 records
Customer concentration
MedRisk social profiles
Digital presenceMedRisk compliance and trust
Trust signalCompliance6 records
MedRisk financial estimates
Financial estimateRevenue estimate
Valuation estimate
MedRisk leadership team
Management profileNumber of profiles
Profiles10 records
MedRisk subsidiaries and ownership
Company hierarchySubsidiaries3 records
MedRisk funding detail
Funding detailFunding overview
Funding rounds1 record
Investors1 record
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
MedRisk M&A and investment
M&A and investmentM&A4 records
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about MedRisk
What does MedRisk do?
MedRisk is a managed care organization that delivers an integrated software-and-services platform for workers' compensation and auto casualty claims management. Its core services include medical billing review, utilization review, case management, nurse triage and first-aid services, state reporting, provider network access (PPO), payment integrity, and data-driven care coordination. The offering combines human clinical expertise with AI-powered analytics to accelerate patient recovery, control medical costs, and ensure compliance for payers, employers, and TPAs.
Is MedRisk a public or private company?
MedRisk is a private company. It is classified as private equity controlled and is currently operating.
When was MedRisk founded?
MedRisk was founded in 1999. It employs 251 to 500 people.
Where is MedRisk based?
MedRisk is headquartered in King Of Prussia, United States, in the North America region.
How does MedRisk make money?
Four revenue lines are on record. Managed Care Solutions are the primary driver. The others are medical Bill Review, network Solutions and payment Solutions.
Does MedRisk have an API?
No public API is recorded for MedRisk.