Claims Eval
Ethos Risk Services is a U.S. workers' compensation medical management firm providing utilization review, case management, bill review, and investigations services to insurance carriers, third-party administrators, and self-insured employers under URAC-accredited clinical review processes.
- Company typePrivate
- Founded2005
- HeadquartersRocklin, United States
- Headcount101–250
- GTM typeB2B
- OfferingServices
What Claims Eval does
Claims Eval, operating as Ethos Risk Services, is a U.S. workers' compensation medical management and investigations firm headquartered in St. Petersburg, Florida, with operational history extending back to 2004-2005 and 101-250 employees. The company's core offering is Utilization Management, which determines medical necessity for proposed, ongoing, or previously provided treatments by comparing clinical case facts against evidence-based treatment guidelines. The platform is delivered through eight sub-services — Pre-Certification, Pre-Authorization, Prospective Review, Retrospective Review, Physician/Peer Review, Concurrent Review, and Expedited Review — and is backed by URAC Accreditation (WUM-12) for Workers' Compensation Utilization Management, which supports national coverage through credentialed, board-certified clinical reviewers.
The technology backbone centers on Sightline, a client portal that enables case submission, tracking, and transparent reporting, complemented by a broader medical management suite including Case Management, Medical Bill Review, Medicare Solutions, IME, and Medical Canvassing, as well as an investigations practice spanning Surveillance, Claims Investigations, and Digital Investigations. A premium service tier, Ethos PLUS, layers additional claims management capabilities on top of the core offering.
Ethos Risk generates revenue through professional services arrangements — per-case or contracted engagements — with claims administrators, insurance carriers, and self-insured employers in the U.S. workers' compensation sector. Go-to-market is sales-led and direct, supported by content marketing, social channels, an email/newsletter program, and bottom-of-funnel referral and inbound "Assign a Case" workflows. Pricing is quote-based and customized to claim complexity and service mix rather than publicly disclosed. The firm does not disclose funding, M&A activity, or financial details in the public input set.
Claims Eval firmographics
Firmographics- Name
- Claims Eval
- Legal name
- Ethos Risk
- Website
- https://claimseval.com
- Company type
- Private
- Founded year
- 2005
- Operating status
- Operating
- Headcount range
- 101–250 employees
- Short description
- Ethos Risk Services is a U.S. workers' compensation medical management firm providing utilization review, case management, bill review, and investigations services to insurance carriers, third-party administrators, and self-insured employers under URAC-accredited clinical review processes.
- Ownership category
- akta.pro rank
Claims Eval industry classification
Industry- Product category
- Workers' Compensation Medical Management
- NAICS
- Claims Adjusting (524291)
- SIC
- Insurance Agents, Brokers & Service (6411), Services-Health Services (8000)
- akta.pro primary industry
- Managed Workers’ Compensation (Loss Control, Claims & Return-to-Work Programs) (FSAJAEAH)
- akta.pro secondary industries
- Claims Adjudication & Rules/Edits Configuration Support (BPAAAFAE), Claims Advocacy & Loss Recovery Services (FSAEADAH)
Keywords
Where Claims Eval is headquartered
LocationHeadquarters
- HQ city
- Rocklin
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
Claims Eval business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Others
Revenue model
- Medical Management Services: Professional services revenue generated through utilization management, case management, medical bill review, and related medical management services for workers' compensation claims. Revenue is likely generated through per-case or contracted service arrangements with claims administrators and employers.
Go-to-market motion1 record
Distribution channels1 record
Marketing channels4 records
Claims Eval product offering
Product offeringCore offering
Claims Eval (operating as Ethos Risk) provides medical management and utilization review services for U.S. workers' compensation claims. Its core offering is Utilization Management — comparing the clinical facts of each case against evidence-based treatment guidelines to determine medical necessity for proposed, ongoing, or previously provided medical services, treatments, and prescription medications. The service spans Pre-Certification, Pre-Authorization, Prospective Review, Retrospective Review, Physician/Peer Review, Concurrent Review, and Expedited Review, delivered by licensed nurses and board-certified physicians.
Product overview
Ethos Risk offers a platform-based approach to workers' compensation medical management, with Utilization Management serving as the core service. The platform encompasses eight distinct review modules: Pre-Certification, Pre-Authorization, Prospective Review, Retrospective Review, Physician/Peer Review, Concurrent Review, and Expedited Review. These modules work together to provide comprehensive medical necessity evaluation throughout the treatment lifecycle—from initial treatment proposals through ongoing care to retrospective claims review—using evidence-based treatment guidelines and certified clinical reviewers.
Differentiator
Problem solved
Functional benefit
Brands
- Ethos PLUS: Premium service tier offering enhanced claims management capabilities.
Products and services
- Utilization Management Evidence-based utilization review service for U.S. workers' compensation claims. Compares the clinical facts of each case against specific evidence-based treatment guidelines or criteria to determine whether proposed, ongoing, or previously provided medical services, treatments, or prescription medications are medically necessary. Delivered by licensed nurses and board-certified physicians with proactive, transparent case management from initiation through resolution. Intended for claims administrators, insurance carriers, and self-insured employers managing workers' compensation claims.
- Case Management Medical management service for workers' compensation claims referenced on the company website navigation.
- Medical Bill Review Medical management service for workers' compensation claims referenced on the company website navigation.
- IME (Independent Medical Evaluations) Medical management service for workers' compensation claims referenced on the company website navigation.
- Medicare Solutions Medicare-related medical management service for workers' compensation claims referenced on the company website navigation.
- Investigations Investigations service line for workers' compensation claims, including Surveillance, Claims Investigations, Digital Investigations, and Medical Canvassing sub-services, referenced on the company website navigation.
- Ethos PLUS Sub-brand premium service tier offering enhanced claims management capabilities built on top of the company's core medical management and investigations services.
Quantifiable outcome
- Six-year customer retention with high-performer status
- +1 more outcomes
Companies that use Claims Eval
Customer profileNamed customers3 records
Segments2 records
Ideal customer profiles2 records
Claims Eval technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature2 records
Claims Eval partnerships and signals
Strategic signalScale indicators2 records
Recent moves6 records
Expansion highlights5 records
Claims Eval competitors and assessment
Company assessmentMarket position
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
Claims Eval social profiles
Digital presenceClaims Eval compliance and trust
Trust signalCompliance1 record
Claims Eval financial estimates
Financial estimateRevenue estimate
Valuation estimate
Claims Eval leadership team
Management profileNumber of profiles
Claims Eval funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Claims Eval M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Claims Eval
What does Claims Eval do?
Claims Eval (operating as Ethos Risk) provides medical management and utilization review services for U.S. workers' compensation claims. Its core offering is Utilization Management — comparing the clinical facts of each case against evidence-based treatment guidelines to determine medical necessity for proposed, ongoing, or previously provided medical services, treatments, and prescription medications. The service spans Pre-Certification, Pre-Authorization, Prospective Review, Retrospective Review, Physician/Peer Review, Concurrent Review, and Expedited Review, delivered by licensed nurses and board-certified physicians.
Is Claims Eval a public or private company?
Claims Eval is a private company. It is classified as founder individual operated bootstrapped and is currently operating.
When was Claims Eval founded?
Claims Eval was founded in 2005. It employs 101 to 250 people.
Where is Claims Eval based?
Claims Eval is headquartered in Rocklin, United States, in the North America region.
How does Claims Eval make money?
One revenue line is on record: medical Management Services.
Does Claims Eval have an API?
No public API is recorded for Claims Eval.
What industry is Claims Eval in?
Claims Eval's product category is Workers' Compensation Medical Management. Its primary akta.pro industry code is FSAJAEAH, Managed Workers’ Compensation (Loss Control, Claims & Return-to-Work Programs), with a secondary code of BPAAAFAE, Claims Adjudication & Rules/Edits Configuration Support. Its NAICS code is 524291 and its SIC code is 6411.