ExamWorks

What ExamWorks does

ExamWorks, LLC is a privately held healthcare services company founded in 2008 and headquartered in Atlanta, Georgia, that provides independent medical examinations (IME), peer and medical record reviews, bill reviews, and Medicare Secondary Payer compliance services to insurance carriers, third-party administrators, self-insured organizations, law firms, and government agencies. The company claims the largest credentialed expert medical panel in the industry and operates across the United States, United Kingdom, Australia, and Canada through 17+ local service centers and wholly-owned subsidiaries including ExamWorks Compliance Solutions (ECS), ABI Document Support Services, Network Medical Review Co. (NMR), Premex Group, and ExamWorks UK.

ExamWorks' core operational backbone is a proprietary Virtual Private Cloud Computing Network and Platform-as-a-Service that the company pioneered for the IME industry in 2008, with active/active real-time replicated data centers for disaster recovery. Built on this infrastructure are several purpose-built platforms: Nextrum, a web-based adjuster dashboard for bill review, document management, and workflow rules; eSummary, a document management system for medical record retrieval and summarization; the Enterprise Platform supporting custom portals, workflow enhancements, and systems integration; and the Dr. App iOS mobile application for physician case management. ExamWorks maintains URAC IME accreditation (active through December 2026), HITRUST CSF certification, and annual SOC 2 Type II reporting.

The business model is professional services and transaction-fee based, with revenue generated per examination, per review, and per bill negotiation. Pricing is quote-based and negotiated through account executives at local service centers, with no publicly disclosed pricing or subscription tiers. Distribution combines direct enterprise sales through local service centers, a secure web portal for online referrals by registered users, and traditional referral channels (fax, courier, email, telephone). The company is led by CEO Raul Gutierrez and Executive Chairman Miguel Fernandez de Castro, and appointed Isabelle Winkles — formerly CFO of Braze through its IPO — as CFO effective June 1, 2026.

Name

ExamWorks

Legal name

ExamWorks, LLC

Website

https://theevaluationgroup.com

Company type

Private

Founded year

2008

Operating status

Operating

Short description

ExamWorks provides independent medical examinations, peer reviews, bill reviews, and Medicare compliance services to property and casualty insurance carriers, TPAs, self-insureds, law firms, and government agencies across the US, UK, and Australia.

Ownership category

akta.pro rank

Product category

Independent Medical Examination and Claims Review Services

NAICS

Other Scientific and Technical Consulting Services (54169)

SIC

Services-Offices & Clinics Of Doctors Of Medicine (8011), Services-Computer Programming Services (7371)

akta.pro primary industry

Second Opinion & Expert Medical Review Platforms (HLALADAI)

Keywords

• Independent medical examinations
• Medical record reviews
• Bill review services
• Medicare compliance solutions
• Claims management services

Headquarters

HQ city

Atlanta

HQ country

United States

HQ region

North America

Offices17 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Independent Medical Examinations (IME): Credentialed physicians perform independent medical examinations to establish expert opinions on diagnosis validity. Services include various examination types such as Agreed Medical Examination, Catastrophic Examination, Disability Examination, Workers' Compensation Examination, and more.
2. Peer and Medical Record Reviews: Paper-based evaluations by credentialed physicians providing expert opinions on appropriateness of care and medical necessity. Includes prospective, concurrent, retrospective reviews and appeals.
3. Bill Review Services: Industry-leading bill review and casualty claim services including Hospital Bill Line Item Review, Medical Bill Review, Physician Bill Review, and Medical Bill Negotiation. Includes national PPO network access.
4. Medicare Compliance Services: Comprehensive MSP compliance services including Medicare Set-Asides (MSAs), Clinical/Evidence-Based MSAs, Liability MSAs, Medical Cost Projections, Life Care Plans, Section 111 Mandatory Insurer Reporting, and Conditional Payment Resolution.
5. Medical Record Retrieval and Document Management: Record retrieval, document management, authorization and subpoena preparation, electronic summaries, and large volume specialized duplication services.
6. Credentialing Services: Physician credentialing services including National Practitioner Data Bank monitoring, primary source verification, re-credentialing, and physician recruiting.

Go-to-market motion2 records

Distribution channels4 records

Marketing channels4 records

Core offering

ExamWorks provides independent medical examinations (IME), peer and medical record reviews, bill review, Medicare Secondary Payer compliance services, and medical record retrieval/document management to insurance carriers, third-party administrators, self-insureds, law firms, and government agencies. Services are delivered through a proprietary Virtual Private Cloud Computing Network and Enterprise Platform that integrates scheduling, record retrieval, workflow management, quality assurance, and report delivery, supported by a credentialed national medical panel.

Product overview

ExamWorks is a B2B healthcare services company operating a unified Enterprise Platform built on a proprietary Virtual Private Cloud Computing Network. The platform integrates all core services—Independent Medical Examinations (IME), Peer and Medical Record Reviews, Bill Review, and Medicare Compliance Solutions (ECS)—with supporting modules including eSummary for document management, Nextrum for adjuster workflows, Agile Development Services for custom integrations, Credentialing for physician network management, Medical Record Retrieval, and a Medical Panel of credentialed specialists. Clients access services through secure web portals and mobile applications, all processed within ExamWorks' private cloud infrastructure.

Differentiator

Problem solved

Functional benefit

Brands

• ExamWorks Compliance Solutions (ECS): Medicare Secondary Payer compliance services including MSAs, Conditional Payment Resolution, and Section 111 Reporting
• ABI Document Support Services
• Nextrum
• Dr. App

Products and services

• Independent Medical Examinations (IME) Medical examinations performed by credentialed physicians to establish informed expert opinions on the validity and nature of a diagnosis, including state-specific and specialty examinations. Used by insurance carriers, TPAs, self-insureds, law firms, and government agencies for claims adjudication under workers' compensation, auto, disability, and liability coverages.
• Peer and Medical Record Reviews Evaluations prepared by credentialed physicians providing expert opinions on the appropriateness of care, medical necessity, and related issues. Includes prospective, concurrent, retrospective reviews and appeals for payors and utilization review entities.
• Bill Review Comprehensive bill review and casualty claim services including Hospital Bill Line Item Review, Medical Bill Review, Physician Bill Review, Litigation Bill Review, Medical Bill Negotiation, and surgical cost estimates. Leverages an electronically integrated national PPO network for cost-effective outcomes.
• Medicare Compliance Solutions (ECS) Medicare Secondary Payer (MSP) compliance services including Medicare Set-Aside allocations, evidence-based MSAs, liability MSAs, medical cost projections, life care plans, Section 111 Mandatory Insurer Reporting, and conditional payment resolution. Delivered through ExamWorks Compliance Solutions (ECS) subsidiary.
• Medical Record Retrieval and Document Management Full-service medical record retrieval and document management including authorization and subpoena preparation, record retrieval, electronic summaries (via eSummary), large volume specialized duplication services, and material conversion. Accessible via desktop and mobile.
• Enterprise Platform (Virtual Private Cloud Network) Fully integrated proprietary platform incorporating every aspect of an independent medical review service — scheduling, record retrieval, workflow management, quality assurance, transcription, and report delivery — housed within a virtual private cloud network with active/active replicated data centers for disaster recovery. Includes custom portals, applications, workflow enhancements, and systems integration.
• Credentialing Services Physician credentialing services including National Practitioner Data Bank monitoring, primary source verification, re-credentialing, and physician training per URAC IME Organizational Quality standards.
• Agile Development Services Custom application development, web portal build, management reporting, systems integration, and workflow enhancements delivered by ExamWorks' Information Systems Group for enterprise clients.

Quantifiable outcome

• Over 70% reduction in Treasury collection incidents through programmatic approaches
• +1 more outcomes

Named customers5 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Partnerships

Six partnerships are on record, tiered core, strategic and minor.

• URACcoreOthersURAC is an independent accrediting body for healthcare services. ExamWorks is accredited by URAC under IME Standards, providing payors, examinees, providers, purchasers, regulators and employers assurances that practices are quality-focused and fair.
• PwCcoreOthersPwC is ExamWorks' auditor of record for financial audits.
• National PPO Network PartnerscoreTechnology or IntegrationRegional and nationally recognized PPO networks providing access to over 800,000 contracted physicians, ancillary and facility provider discounts. Networks are electronically integrated with bill review workflow.
• Benefits Coordination & Recovery Center (CMS)strategicOthersPartnership with CMS Centers for Medicare and Medicaid Services for Section 111 Mandatory Insurer Reporting and conditional payment resolution.
• Massachusetts General Hospital - Aspire ProgramminorOthersCorporate social responsibility initiative supporting children, teens, and adults with high cognitive autism spectrum disorder.
• Kids' ChanceminorOthersPartnership facilitating collegiate scholarships to children of injured workers across all 50 states.

Scale indicators7 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Genex Services: Genex provides independent medical examinations, case management, and utilization review for workers' compensation, auto, and disability claims — directly competing with ExamWorks' IME and peer review core across the same P&C insurance and TPA buyer base.
• MES Solutions: MES Solutions delivers independent medical examinations, peer reviews, and bill review services for insurance carriers, attorneys, and government agencies — a near-identical service portfolio to ExamWorks' IME/peer review/bill review offering.
• Medical Consultants Network (MCN): MCN is a national IME provider serving insurance carriers, TPAs, and attorneys with physician-led independent medical exams, peer reviews, and related claims services, overlapping directly with ExamWorks' medical panel and IME business.
• AIM Specialty Health: AIM Specialty Health (a Carelon company) provides peer review, utilization management, and clinical appropriateness reviews for payers — competing with ExamWorks' peer review and medical record review streams for the same insurer/payer clients.
• MedRisk: MedRisk manages physical medicine and IME programs for workers' compensation insurers and TPAs, with peer review and utilization management services that directly parallel ExamWorks' workers' comp IME and peer review offerings.
• One Call Care Management: One Call Care Management (formerly One Call) provides IME, peer review, and utilization management for workers' compensation carriers and employers — directly competing with ExamWorks' IME and peer review services in the workers' comp channel.

Broad incumbents

• Broadspire (Crawford & Company): Broadspire, part of Crawford & Company, is a third-party administrator and claims management provider that includes IME, bill review, and Medicare compliance services as part of a broader managed-care platform — overlapping with multiple ExamWorks service lines.
• Mitchell International: Mitchell International provides claims management technology and services for P&C carriers, including bill review and medical management workflows that compete with ExamWorks' bill review and Nextrum platform.
• Sedgwick: Sedgwick is a large global claims and managed-care services provider serving insurance carriers and employers with IME, utilization review, and bill review capabilities — a broader incumbent overlapping with ExamWorks' end-to-end claims services.
• Concentra: Concentra operates occupational health clinics and IME-adjacent services for employers and insurers, including disability evaluation and workers' comp services — competing with ExamWorks' IME and disability examination offerings at scale.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/examworks-group-inc-

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 records

Subsidiaries6 records

Funding overview

Funding rounds

Investors

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

M&A

Investments

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

Frequently asked questions about ExamWorks