Claims Processing Software Global Market Report 2024

The claims processing software market size has grown strongly in recent years. It will grow from $39.8 billion in 2023 to $43.39 billion in 2024 at a compound annual growth rate (CAGR) of 9.0%. The growth witnessed in the historical period regarding claims processing software can be attributed to several factors. These include the increased adoption of paperless processing methods, expansion within the healthcare industry, digitization efforts within the insurance sector, initiatives aimed at enhancing customer experiences, and growing concerns regarding data security and privacy measures. These factors collectively contributed to the advancement and adoption of claims processing software during that period.

The claims processing software market size is expected to see strong growth in the next few years. It will grow to $60.12 billion in 2028 at a compound annual growth rate (CAGR) of 8.5%. The projected growth in the upcoming period for claims processing software is anticipated to be driven by several key factors. These include the implementation of real-time claims processing capabilities, the introduction of mobile solutions for claims processing, government initiatives aimed at digital transformation across various sectors, the establishment of customer self-service portals to enhance user experiences, and the utilization of predictive analytics for more accurate risk assessment and management. Major anticipated trends in the forecast period encompass the integration of artificial intelligence (AI) and machine learning technologies, the adoption of blockchain for heightened security measures, integration with Internet of Things (IoT) devices for enhanced data gathering, incorporation of telehealth and virtual healthcare services, the implementation of cloud-based solutions for claims processing, and the utilization of robotic process automation to streamline and automate claim processing workflows. These trends are expected to shape and revolutionize the landscape of claims processing software in the forecasted period.

The growth of the claims processing software market is expected to be propelled by the focus on lowering compliance risk exposure. Compliance risk refers to the potential consequences an organization may face for not adhering to industry laws, regulations, internal policies, or best practices. Claims processing software providers stand to benefit significantly from reducing compliance risk, as it can enhance operational efficiency, cut costs, and bolster their reputation and credibility in the market. Lowering compliance risk also positions them to offer more reliable and efficient solutions to customers, ultimately leading to revenue growth. An example of this is seen in Accenture plc's data from August 2022, revealing that insurers using claims processing software experienced a 38% reduction in fraudulent claims, a 60% reduction in manual intervention, and a 70% reduction in claims settlement time.

The claims processing software market is expected to be driven by the increasing healthcare expenditure. As healthcare costs rise, insurers and healthcare providers need efficient claims processing to reduce administrative expenses and enhance patient care. Claims processing software plays a crucial role in automating workflows, reducing errors, and improving overall operational efficiency, resulting in cost savings. The Centers for Medicare & Medicaid Services reported in March 2022 that national health spending was predicted to reach approximately $6.8 trillion by 2030, with an annual increase of 5.1% between 2021 and 2030. The rising healthcare expenditure underscores the need for efficient claims processing solutions.

Technological advancements represent a key trend in the claims processing software market. Major players are focusing on innovative technologies to strengthen their market position. Advanced technologies such as chatbots, optical character recognition, advanced analytics, robotic process automation (RPA), and artificial intelligence (AI) have improved the efficiency and accuracy of claims processing. IBM, for instance, launched IBM Robotic Process Automation 21.0.3 in July 2022, showcasing a 200% increase in return on investment (ROI) within the first year of RPA deployment in financial services. RPA and AI are employed for tasks such as collecting customer information, extracting claims data, performing background checks, and more, contributing to the technological advancement in claims processing software.

Major companies in the claims processing software market are strategically focusing on the introduction of advanced solutions to boost their revenues. One such innovative solution is the AI-based claim acceleration suite, a cloud-based automation toolkit leveraging artificial intelligence (AI) and machine learning to streamline health insurance prior authorization and claims processing. For instance, Google Cloud launched an AI-enabled Claims Acceleration Suite in April 2023. This solution transforms unstructured data into structured data, employing the Claims Data Activator to help health plans and providers reduce administrative burdens and costs. The suite enables quicker and more informed decisions, enhancing patient care. Notably, Bupa and Blue Shield of California have implemented this solution to increase efficiency and improve the experiences of patients and providers.

In October 2022, TPG Inc., a prominent US-based private equity firm, acquired Change Healthcare's healthcare claims analytics and payment accuracy software solution, ClaimsXten, for $2.2 billion. This acquisition positions TPG Inc. to expand its capabilities in the healthcare claims processing domain, leading to increased efficiency, enhanced data analytics, and improved revenue. Change Healthcare, the provider of the acquired solution, is recognized for its healthcare claims management software.

Major companies operating in the claims processing software market report are Duck Creek Technologies, FINEOS, Hyland Software Inc., Hawksoft Inc., HIPPAsuite, Newgen Software Technologies Limited, Pegasystems Inc., Quick Silver Systems Inc., Ventiv Technology, A1 Enterprise Inc., Applied Systems, Jenesis Software, EIS Group Software, EZLynx, Guidewire Software, ClaimLogiq, Vee Technologies, TriZetto Provider Solutions, Mphasis Limited, Casentric LLC, MedeAnalytics, MedLinks, TriWest Healthcare Alliance, HCL Technologies, HealthEdge Software Inc., Cognizant, McKesson Corporation, HealthTrio LLC, BriteCore, InstaMed, Change Healthcare, Tech Mahindra, eCatalyst Healthcare Solutions, Virtusa, The SSI Group LLC, ClaimVantage, Riskonnect Inc., ReSource Pro, NTT Data, Baker Tilly, EXL Service, Tritech Financial Systems.

North America was the largest region in the claims processing software market in 2023. The regions covered in the claims processing software market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa. The countries covered in the claims processing software market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Canada, Italy, Spain.

The primary components of claims processing software consist of software and services. Software refers to a comprehensive set of instructions, data, or computer programs utilized to operate systems and perform specific functions. This software is utilized across various scales of enterprises, including large corporations and small to medium-sized entities such as insurance companies, insurance intermediaries, agents, brokers, and other related entities within the insurance domain.

The claims processing software market research report is one of a series of new reports that provides claims processing software market statistics, including claims processing software industry global market size, regional shares, competitors with a claims processing software market share, detailed claims processing software market segments, market trends, and opportunities, and any further data you may need to thrive in the claims processing software industry. This claims processing software market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.


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