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Table of Content
April 2025
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Principal Consultant
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The global healthcare claims management market size is calculated at USD 40.77 billion in 2024, grew to USD 50.32 billion in 2025, and is projected to reach around USD 334.6 billion by 2034. The market is expanding at a CAGR of 23.43% between 2025 and 2034.
| Metric | Details |
| Market Size in 2024 | USD 40.77 Billion |
| Projected Market Size in 2034 | USD 334.6 Billion |
| CAGR (2025 - 2034) | 23.43% |
| Leading Region | North America |
| Market Segmentation | By Product, By Component, By Solution Type, By Deployment Mode, By End-Use, By Region |
| Top Key Players |
Athena Health, Cerner Corporation, ClaimXperience, Exela Technologies, Experian Health, IBM, Inova Care, Medlogix, Oracle Health, PLEXIS Healthcare Systems, Tego Insurance, WNS |
Healthcare claims management refers to a comprehensive process of handling medical claims from submission to final settlement. The major components of claims management include claims submission, adjudication, payment processing, denial management, and claims appeal. A robust claims management strategy streamlines the entire claims process, improves cost control, and enhances customer satisfaction. Several companies provide claims management services to reduce the complexity of claims processing and excessive administration costs.
The market is expanding due to various factors, including the availability of numerous insurance policies from the government and private organizations. The rising prevalence of chronic disorders leads to an increasing number of hospital admissions, potentiating the demand for insurance claims. The growing need for high-quality healthcare services and the rising adoption of advanced technologies increase the overall healthcare costs, necessitating medical claims.
Artificial intelligence (AI) and machine learning (ML) algorithms streamline the entire claims process. They can analyze a vast amount of data and identify patterns of fraudulent activity, preventing healthcare organizations from financial losses and unnecessary payouts. AI can automatically extract claims data, reducing human intervention and manual errors. AI-enabled advanced data analytics and predictive analytics improve risk assessment and customer service. Incorporating AI and ML algorithms in claims processing enhances data sharing and collaboration. Thus, AI reduces the burden on administrative staff, improves cash flow for healthcare providers, and decreases patients’ wait times.
Increasing Hospital Admissions
The major growth factor of the market is the increasing hospital admissions due to the rising prevalence of chronic disorders, road accidents, and other illnesses and infections. The most common chronic disorders are cardiovascular disease, cancer, diabetes, and chronic respiratory diseases. It is estimated that 1 in 3 people globally suffer from multiple chronic disorders. The increasing geriatric population also contributes to an increase in hospital admissions, as they are more prone to developing chronic disorders. The World Health Organization (WHO) estimated that by 2050, 2.1 billion people will be over 60 years old. Healthcare claims management services and solutions simplify the process for healthcare professionals, allowing them to focus more on patient care.
Claim Denials
The major challenge of the healthcare claims management market is the claim denials and appeals. Denials can occur due to incorrect patient information, coding errors, or a lack of preauthorization. Managing such claims can be time-consuming and resource-intensive. It is estimated that hospitals and health systems spend around $20 billion to overturn claim denials annually.
Robotic Process Automation
Robotic process automation (RPA) expedites the healthcare claims processing, enhancing accuracy and reducing costs. RPA is a software bot that records tasks performed by humans on computers and subsequently performs the same task without human intervention. It automates routine tasks like data entry, form filling, and routine claims to different departments, allowing healthcare staff to focus on more complex tasks. It also helps in regulatory compliance and policy management. RPA significantly enhances the speed and accuracy of claims processing by automating repetitive tasks. It plays a vital role in increasing employee satisfaction, engagement, and productivity by removing unnecessary tasks. Thus, integrating RPA in claims processing creates ample opportunities for healthcare organizations.
By product, the medical billing segment held a dominant presence in the healthcare claims management market in 2024. Medical billing is the primary stage of insurance claims, as it involves creating and submitting claims to insurance companies for reimbursement. It is a detailed statement of the diagnoses, processes, and medications of patients. The increasing number of hospital admissions potentiates the need for medical billing. Technological advancements introduce automation in the medical billing process, reducing the burden on administrative staff.
By product, the claims processing segment is predicted to witness significant growth in the market over the forecast period. Claims processing refers to the handling and settling of claims submitted by healthcare providers and patients. It is a very tedious and complex process, and more prone to fraudulent activities, requiring a proper claims management system. The advent of digitization streamlines the claim management and boosts its efficiency and accuracy. Appropriate management services decrease the chances of claim denials.
By component, the software segment held the largest share of the healthcare claims management market in 2024. Numerous companies develop AI-based software solutions to automate healthcare claims processing. Advanced technologies, such as AI and ML, transform the entire claims process from billing to payment. Software leads to more accurate billing, reduced manual errors, and invoice tracking. The increasing investments from government and private organizations to adopt advanced solutions promote the use of software. Software enables healthcare staff to have complete control over the system and maintain privacy.
By component, the services segment is anticipated to show lucrative growth in the market over the studied years. Healthcare claims processing services provide relevant expertise to healthcare staff, reducing administrative burdens. Services eliminate the need for extra staff to process healthcare claims, contributing to cost control. It also obviates favorable infrastructure in any healthcare organization.
By solution type, the integrated solutions segment led the global healthcare claims management market in 2024. Integrated claims processing solutions combine multiple software solutions and function as a single system. These solutions eliminate the need for multiple standalone systems, reducing the chances of data redundancy and inconsistency. They enable real-time updates of data, leading to consistency and accuracy. Integrated solutions offer a general overview of the entire business operation, facilitating effective decision-making.
By solution type, the standalone solutions segment is projected to expand significantly in the market in the coming years. Standalone solutions focus on a specific task involved in claims processing. They individually prioritize medical billing, claims processing, and reimbursement. It allows professionals to get a deeper understanding of the individual processes and take necessary actions. Standalone solutions are more cost-effective and preferred mostly by small- and medium-sized healthcare organizations. Moreover, they have a simple implementation process and are easy to use.
By deployment mode, the web-based segment registered its dominance over the global healthcare claims management market in 2024. The rising adoption of the Internet promotes the use of web-based claims management. Web-based servers bring multiple insurance companies from a country, simplifying the management team’s task. The portal enables healthcare staff and patients to streamline the claim settlement process, increasing its speed. Web servers can also support any computer system, eliminating the need for a specialized system.
By deployment mode, the cloud-based segment is expected to grow at the fastest rate in the market during the forecast period. The advent of cloud-based technologies augments the segment’s growth. Cloud system enables healthcare providers, payers, and patients to access their claims data from anywhere and at any time. It can store and share a large amount of patient claim data. It offers a centralized solution, reducing time and resources to deliver improved performance.
By end-use, the healthcare providers segment held the major share of the healthcare claims management market in 2024. Healthcare providers require a claims management team to reduce the burden of claims processing and focus more on patient care. The tedious task of medical billing and maintaining patient records is done by a healthcare provider. Healthcare providers ensure that they receive proper reimbursement and reduce financial losses in an organization.
By end-use, the healthcare payers segment is anticipated to grow with the highest CAGR in the market during the studied years. Healthcare payers collect premiums, process claims received by healthcare providers or patients, and ensure coverage. Claims management software and services provide tailored solutions, simplifying their tasks. They also reduce the chances of fraudulent activities.
North America dominated the global healthcare claims management market in 2024. The rising prevalence of chronic disorders and the increasing number of hospital admissions drive the market. The rising adoption of advanced technologies in healthcare organizations leads to a robust healthcare infrastructure, which increases medical costs. Most of the people in North America are aware of various reimbursement policies by the government and private organizations. The presence of key players also augments the healthcare claims management market growth.
Approximately 129 million people in the U.S. are affected by at least 1 chronic disorder. As of 2023, approximately 92% or 305.2 million people have health insurance in the U.S. The Centers for Medicare and Medicaid Services is an official U.S. government healthcare insurance service. As of April 2024, approximately 67.3 million people are enrolled in Medicare coverage.
.webp "Hospital & Medical Expenses (In Billion Dollars)")
In 2023, Canada’s insurers covered around 30 million people, including 27 million with health coverage. The Canadian Life & Health Insurance Association reported that insurers paid approximately $128 billion in benefits, an increase of 13% from 2022. The increasing expenditure was mainly due to prescription drug costs and paramedical services like massage and physiotherapy.
Asia-Pacific is anticipated to grow at the fastest rate in the healthcare claims management market during the forecast period. The increasing healthcare expenditure and favorable government policies are the major growth factors. The growing geriatric population also potentiates the demand for healthcare claims processing. More people are becoming aware of the potential benefits of healthcare claims, especially in developing countries, resulting in increased coverage.
The National Healthcare Security Administration (NHSA) reported that 1.326 billion people in China, accounting for 95% of the total population, are enrolled in basic medical insurance. China has roughly 200 licensed insurance companies. It is estimated that China’s healthcare expenditure will reach RMB 205 trillion yuan by 2030.
The Indian government plans to launch a Unified portal, the National Health Claim Exchange (NHCX), for health insurance claims processing across hospitals all over the country. The portal will accelerate the pre-authorization time and discharge approvals, and bring down insurance premiums in the future.
Europe is expected to grow at a notable rate in the healthcare claims management market in the foreseeable future. The booming healthcare sector and technological advancements potentiate the need for insurance coverage. According to a recent WHO data collected through the UHC Watch digital platform, up to 20% of households across Europe experience catastrophic health spending, restricting people from paying for their basic needs. Favorable government initiatives and increasing expenditure foster market growth.
As of 2023, there are around 96 statutory health insurance funds in Germany, covering 87% of the German population. Germany accounts for the highest level of current healthcare expenditure among other EU countries. The continuous innovation in healthcare technology increases healthcare spending. Germany ranks third in the 2024 World Index of Healthcare Innovation.
Craig Goldstein, CEO of Medlogix, commented on the acquisition of ReviewWorks, saying that ReviewWorks has done a phenomenal job of delivering quality solutions to a growing base of national and regional clients. Both companies share a commitment to exceptional medical outcomes that drive tangible ROI’s and increased client satisfaction for their customers.
By Product
By Component
By Solution Type
By Deployment Mode
By End-Use
By Region
April 2025
April 2025
April 2025
April 2025