MedRisk

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).

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

Headquarters

HQ city

King Of Prussia

HQ country

United States

HQ region

North America

Offices5 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure

Revenue model

1. 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.
2. 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.
3. Network Solutions: PPO network access, provider negotiations, and optimized reimbursement strategies. Revenue from network access fees and savings share arrangements.
4. 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

Core 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

Named customers5 records

Segments5 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability8 records

Feature6 records

Partnerships

Seven partnerships are on record, tiered core and minor.

• Horizon Mutual Holdings, Inc.coreStrategic or Co-development Partner · 2 February 2026Acquisition 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.
• ConduentcoreStrategic or Co-development Partner · 3 May 2024Acquisition 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.
• MedatacoreStrategic or Co-development Partner · 9 January 2024Acquisition 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 or Co-development PartnerStrategic 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 or Co-development PartnerStrategic 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 AmericaminorOthersMedRisk 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.
• SPNetcoreStrategic or Co-development PartnerSPNet 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

Market position

Competitive moat6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/medrisk
• LinkedInlinkedin.com/company/medrisk-inc.

Compliance6 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles10 records

Subsidiaries3 records

Funding overview

Funding rounds1 record

Investors1 record

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A4 records

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about MedRisk