Introduction

Managing claims in today’s healthcare system is a complex process. Delayed reimbursements, mounting paperwork, and strict compliance rules create daily pressure.

Medical claims processing software helps by automating tasks such as submitting, tracking, and correcting insurance claims; however, setting up these tools used to require months of IT work.

Now, that’s changing.

Clinics and insurers can now move faster, reduce human errors, and improve payment timelines, thanks to low-code platforms that allow them to build workflows with simple drag-and-drop tools, eliminating the need for coding.

Low-code automation ensures faster billing, easier compliance updates, and fewer denials- all with minimal technical effort.

In this guide, we’ll explore why low-code tools matter in claims management, which features to prioritize, and the best solutions available in 2025.

Whether you run a small practice or manage enterprise-scale billing, these tools will help you automate smarter and process claims faster.

Let’s dive in.

Why Low Code Matters in Claims Processing

Today’s healthcare teams face a real bottleneck: rising workloads, limited technical staff, and ever-changing payer requirements.

But billing delays and compliance issues can’t afford to wait.

That’s where low-code medical claims processing software comes in.

Low-code lets billing teams design, automate, and update workflows without relying on developers. You can drag, drop, and deploy, cutting IT costs and accelerating implementation.

Do you need to update a workflow for a new ICD code or CMS rule? Just tweak the visual builder. No long waits. No complex reprogramming.

Here’s why low-code is transforming claims automation

• Clinics reduce IT dependency and save time by building workflows without writing complex code.
   
• Billing managers have access to flexible tools that can be easily updated based on payer or policy changes.
   
• Workflow changes go live in hours, eliminating the need for lengthy development cycles or external technical teams.
   
• Compliance updates, like new CMS or HIPAA rules, are managed directly through visual logic builders.
   
• New insurance claim rules or edits are applied proactively, preventing future denials or delays.

For teams under pressure, that’s a game changer.

And in 2025, with payer rules shifting fast and digital adoption accelerating, low-code no-code software development give clinics and insurers a real edge.

It’s not just about simplicity. It’s about speed, scale, and staying compliant.

Must-Have Features in Low-Code Claims Software

Not every claims automation solution is created equal. When selecting a tool, prioritize real-world features that enable fast, flexible, and secure claims handling.

Here’s what top low-code medical claims processing software should offer

• Drag-and-Drop Builders: Visually design and edit billing workflows without coding. Adjust forms, steps, and logic in real-time.
   
• Built-In Validation Rules: Automatically scrub claims for missing fields, incorrect codes, or payer-specific edits before submission.
   
• Real-Time Status Alerts: Get instant updates on approvals, rejections, or delays. Know exactly where every claim stands.
   
• API & Integration Support: Connect easily with your EHR, clearinghouse, or insurance portal. Avoid duplicate entries and sync in real-time.
   
• Compliance Tools (HIPAA, CMS): Built-in data protection, access controls, and audit trails ensure your system stays regulation-ready.
   
• Dashboards & Reports: View claim volume, denial trends, average processing time, and more at a glance.
   
• Prebuilt Modules: Utilize ready-made forms and flows to expedite setup. Great for clinics with fewer tech resources.

Without claim validation, you’ll face denials. Without tracking, you’ll miss follow-ups. Without secure compliance features, you risk audits or fines.

Select software that provides your team with visibility, control, and automation from the outset.

Top Low-Code Medical Claims Processing Software 

Choosing the right medical claims processing software can significantly impact operational efficiency in your clinic. 

With low-code tools, even non-tech teams can automate workflows, reduce errors, and cut delays without relying on developers. 

Here are the seven best low-code platforms transforming claims automation in healthcare today.

1. Joget DX

Joget DX is a flexible low-code development platform designed for rapid deployment of healthcare workflows. It's beneficial for small to mid-sized clinics that aim to automate claim submission and tracking without requiring deep developer support.

Key Features

• The visual builder enables fast, drag-and-drop automation of healthcare workflows.
• Custom forms and dashboards streamline every step of claims processing.
• REST APIs connect seamlessly to EHR systems and clearinghouses.
• HIPAA-ready modules include default security and compliance configurations.
• The mobile interface provides billing staff with secure access anywhere, anytime.

Best for: Small to mid-sized clinics seeking affordable claims automation.

G2 Rating: 4.4/5 based on user reviews

With fast setup and intuitive UI, Joget helps streamline claims and reduce admin costs for lean billing teams.

2. Appian Health Cloud

Appian Health Cloud is an enterprise-level low-code platform built for scalability, security, and regulatory compliance. Large hospital systems and payer networks utilize it to manage complex claims workflows and ensure audit readiness.

Key Features

• Enterprise BPM engine automates complex and detailed claims logic quickly.
• Role-based access ensures secure control of sensitive patient data.
• Built-in audit trails and HIPAA logs meet regulatory standards.
• Scales efficiently across departments and multi-location healthcare networks.
• Real-time analytics uncover denial patterns and billing performance gaps.

Best For: Hospital systems and large payers needing security and scalability.

G2 Rating: 4.5/5 on G2

Appian offers rich workflow logic and top-tier compliance tools for high-volume, high-complexity medical billing environments.
 

3. OutSystems Healthcare Suite

OutSystems Healthcare Suite combines advanced automation with low-code simplicity, providing healthcare providers with the tools to design complex billing systems using reusable templates and enterprise-grade security.

Key Features

• Cloud-native architecture optimized for claims and billing scale.
• AI-assisted builders for rapid deployment and form mapping.
• A rich component library accelerates automation design.
• The Visual Logic Editor suits both developers and business users.
• Integrates directly with EHR, billing, and insurance systems.

Best for: Large healthcare groups that need scalability and pre-built components.

G2 Rating: 4.6/5 verified rating

OutSystems empowers enterprise clinics to go live faster, customize deeply, and scale confidently as claims grow.
 

4. Creatio for Healthcare

Creatio merges low-code automation with CRM intelligence, providing billing teams and patient engagement staff with a centralized platform. It’s best for mid-sized clinics that need patient-first workflows alongside claims management.

Key Features

• Unified CRM and claims view drives patient-centered billing automation.
• Omnichannel tools manage alerts, reminders, and patient communications.
• The drag-and-drop simplifies the entire claims process setup.
• Low-code AI tools facilitate rule creation and prediction.
• Healthcare templates support outreach, billing, and follow-up processes.

Best For: Clinics wanting claims automation with built-in patient communication tools.

G2 Rating: 4.7/5 user score

Creatio offers the perfect blend of patient engagement and automated billing for organizations that need both to be in sync.
 

5. Mendix Healthcare Claims Tools

Mendix offers both visual and developer-level customization, making it an ideal solution for hospitals that require full-stack flexibility in claim routing, editing, and reporting across various systems.

Key Features

• Full-stack development for visual and coded customization
• REST/SOAP APIs support integration with complex billing stacks.
• Version control and deployment rollback ensure workflow stability.
• Enterprise-grade hosting with data protection and governance.
• Connectors for SAP, Epic, and insurance platforms.

Best For: Hospitals with in-house IT teams managing billing at scale.

G2 Rating: 4.4/5 on G2

Mendix provides IT-led healthcare orgs with firm control, compliance features, and top-tier automation logic.
 

6. Decisions Platform

Decisions is a rules-first automation platform ideal for payers and enterprise providers handling high-variation claim cases. Its strength lies in complex logic modeling without coding.

Key Features

• Visual rule editor helps automate claim decision workflows efficiently.
• HIPAA-ready templates simplify the setup of compliance-focused systems.
• APIs and SDKs enable seamless, custom third-party integrations.
• Dynamic routing manages complex cases across multiple departments and divisions.
• Built-in audit logs ensure visibility and regulatory transparency.

Best For: Insurance payers and health systems with compliance-heavy claims workflows.

G2 Rating: 4. Rating averages enable insurers to build rule-based workflows that evolve in response to policy updates, claim volumes, or audit needs.
 

7. Zoho Creator – Medical Billing Templates

Zoho Creator offers an entry-level low-code platform for solo clinics and small practices. With medical billing templates and CRM integration, it covers the basics without overwhelming users with unnecessary features.

Key Features

• A drag-and-drop app builder simplifies the design of medical claims workflows.
• Prebuilt forms and reports accelerate billing setup and use.
• Cloud-based access supports mobile-friendly billing and submissions.
• User-based permissions manage roles and secure sensitive data.
• Integrates easily with Zoho CRM, Books, and related apps.

Best For: Solo providers or small clinics just starting with digital claims.

G2 Rating: 4.3/5 verified feedback

Zoho Creator delivers budget-friendly billing automation that’s easy to implement, even for non-technical staff.
 

Use Cases in Clinics, Hospitals, and Insurance

Automated medical claims processing software solutions benefit a range of healthcare settings. In small clinics, these tools handle the entire billing cycle with minimal staff. 

Hospitals use them for high-volume claims, integrating with EHR and RCM systems. Insurance companies utilize claims automation to expedite adjudication and detect fraud. 

Use Case: Clinics – Acadia Primary Care

Acadia Primary Care, a small clinic in San Diego, faced repeated delays and rework due to manual insurance billing.

Challenge

The limited administrative staff struggled with eligibility checks and claim rejections, resulting in slower reimbursements and overworked clinicians. Their outdated billing process couldn't keep pace with evolving payer requirements and the growing patient volume.

Solution
The clinic adopted a low-code solution using Joget DX, which enabled drag-and-drop claims workflows, real-time validation rules, and automatic alerts for missing or incorrect fields. This allowed non-technical staff to manage changes without IT support. 

With integrated clearinghouse APIs, the claims process became brighter, cleaner, and significantly more efficient in less than four weeks.

Results

• Reduced denial rate by 15% via auto-verification and pre-submission alerts.
• Cut administrative time by 30%, boosting staff availability for patients.
• Achieved 20% faster reimbursements after processing errors were eliminated.
• Billing errors fell substantially due to validation before claim submission.
• Enhanced workflow freed clinicians to refocus on direct patient care.
   

Use Case: Hospitals – Auburn Community Hospital 

Auburn Community Hospital, a regional facility in New York, processed thousands of claims monthly with minimal automation.

Challenge
The billing team was bogged down by manual charge entry, outdated systems, and payer delays. As rules changed frequently, the finance department struggled to meet payment SLAs or resolve denials without significant staff effort.

Solution
The hospital adopted a low-code RPA-enhanced solution through AutomationEdge. The system is integrated with their EHR and billing systems, automating eligibility checks, data extraction, and claim routing. 

Staff could visually configure rules and workflows. The automation immediately reduced turnaround times and eased pressure on revenue cycle management teams.

Results

• Processed claims 30% faster through automated data capture and routing
• Denials dropped by 20% through upfront validation and editing logic.
• Reduced manual follow-ups, saving significant nursing and billing labor time.
• The revenue cycle became more predictable with real-time status tracking features.
• Hospital staff shifted focus from paperwork back to patient support.
   

Use Case: Insurance Providers – Omega Healthcare

Omega Healthcare, which manages over 250 million transactions annually, faced delays and inefficiencies in processing high volumes of claims. 

Challenge
Manual document handling and adjudication checks strained teams, introduced human error, and created compliance risks. They needed a scalable system to automate repetitive tasks and maintain accuracy across multiple clients.

Solution
Omega implemented UiPath’s AI-powered automation to extract data from documents, verify coverage, flag exceptions, and handle denial workflows. 

The system was integrated with existing claims processing software and could be easily modified without IT intervention. Low-code customization helped scale automation across departments, ensuring strong audit compliance.

Results

• Saved 15,000 employee hours monthly through process automation with UiPath.
• Documentation time decreased by 40%, significantly accelerating the claim lifecycle.
• Turnaround time cut by 50% due to more brilliant document handling.
• Achieved 99.5% accuracy via AI-powered claim data extraction algorithms.
• Delivered ~30% ROI while scaling automation across 350+ client partners.
   

Top Low-Code Medical Claims Processing Tools

Discover the top platforms that simplify claims workflows through visual automation.

These low-code tools reduce administrative burden, improve compliance, and accelerate reimbursements.

Each tool above offers medical claims processing features, but they differ in focus and price. 

For example, Joget is a flexible low-code platform ideal for custom claims workflows, while Kareo is an out-of-box billing suite for small clinics. More on these, later. 

How to Choose the Right Medical Claims Processing Software

Choosing the best medical claims processing software requires careful evaluation. Not all solutions are suitable for every practice or insurer. 

Look for systems that align with your size and workflow. Key factors to consider include ease of integration, automation capabilities, vendor support, and total cost of ownership. Important criteria:

• Integration: A claims automation solution should work seamlessly with your EHR, practice management, and payer systems to avoid data silos.
• User-Friendly Interface: The medical claims processing software should be intuitive so staff can use it without lengthy training.
• Low-Code Customization: This enables you to adapt forms and workflows without writing code to fit your specific process. Administrators update the claims logic.
• Automation Coverage: Identify which steps are automated (eligibility checks, claim edits, follow-ups) and assess their thoroughness.
• Vendor Support: Ensure the provider offers strong onboarding, training, and regular updates for compliance.
• Cost and ROI: Evaluate total cost (subscriptions, implementation) against expected savings from faster claims and fewer denials.

The right choice depends on your use case. A small clinic might prioritize ease of use and low upfront costs, while a large hospital needs deep analytics and enterprise integrations. 

Try to obtain a demo and request references from your industry. Investing in medical claims processing software is not just buying tools – it’s building a faster, more reliable revenue cycle.

Final Thoughts on Choosing the Best Medical Claims Processing Software

Low-code medical claims processing software is transforming how clinics, hospitals, and insurers manage reimbursements. By reducing manual effort and enhancing accuracy, these tools enable healthcare teams to focus on patient care. 

Whether you’re running a small practice or an extensive healthcare system, selecting the right platform can improve cash flow and minimize errors. Look for a solution that strikes a balance between compliance, customization, and ease of use. Automation isn’t just about speed—it’s about smarter healthcare operations.

Why Joget is Ideal for Claims Automation

• 90% of workflows built using Joget need zero developer involvement.
• Clinics report 40% faster setup compared to legacy claim systems.
• 75% fewer claim errors using Joget’s built-in validation engine.
• Integrates with 95% of common EHR, billing, and clearinghouse systems.
• Updates roll out 60% faster through drag-and-drop configuration tools.

Need expert help your solutions? Relinns Technologies provider joget developers that builds custom low-code claims automation systems tailored to your practice’s needs.

Hire our vetted joget developers for cost-effective project, faster delivery, and enterprise-grade -compliance. We are your ideal low-code partner for modern healthcare claims automation success.

Frequently Asked Questions (FAQs)

Can medical claims processing software generate bilingual or multilingual patient statements?

Yes, many medical claims processing software tools support multilingual billing, enabling better communication and patient understanding across diverse language backgrounds without additional manual effort.

How does automated medical claims processing work with telehealth platforms?

Automated medical claims processing solutions integrate with telehealth systems to extract visit data, create superbills, and streamline claim generation for virtual care, improving reimbursement speed and accuracy.

What analytics are included in claims automation solutions beyond denial tracking?

Claims automation solutions offer predictive insights like payer behavior trends, claim success forecasts, coding error patterns, and real-time dashboards to enhance financial planning and operational performance.

How do software tools manage frequent CMS and insurance policy updates?

Medical claims processing software includes built-in rule engines and update libraries that auto-sync with CMS changes, payer updates, and regulatory shifts, keeping workflows compliant without manual intervention.

What pricing models are offered for medical claims automation platforms?

Vendors typically offer flexible pricing models, such as per-provider, per-claim, or tiered subscription plans, making claims automation solutions scalable for both small practices and enterprise health networks.

Are low-code medical claims systems cloud-based or locally installed?

Most medical claims processing software platforms offer SaaS, hybrid, and on-premise deployment options to accommodate varying security needs, IT policies, and institutional control preferences.