Global Healthcare Claim Management Market Size (2024 - 2029)

Healthcare Claims Management Market Analysis

The Global Healthcare Claim Management Market size is estimated at USD 23.84 billion in 2024, and is expected to reach USD 50.70 billion by 2029, growing at a CAGR of 16.29% during the forecast period (2024-2029).

The COVID-19 pandemic is expected to have a significant impact on market growth. Due to the large number of people getting infected and then admitted into hospitals, there has been tremendous pressure since the start of the pandemic on claim management software developers and providers. Claim denials have also sky-rocketed due to the COVID-19 pandemic. For instance, according to a survey conducted by Harmony Healthcare between late April and mid-May 2021, nearly one-third of the respondents in the poll stated that their hospital had an average denial rate exceeding the 'denials danger zone' of 10%. Companies across the world, and especially in countries most affected by COVID-19, have seen a massive increase in claims. For instance, as of February 2021, the General Insurance Council of India stated that general and standalone health insurers had received 908,849 Covid-related claims, amounting to INR 13,752.41 crore. The processing of such a large amount of claims by companies is expected to boost market growth.

The major factors for the growth of the healthcare claim management market include the government initiatives supporting the health insurance market, the rising importance of denials management, and the growing aging population with chronic diseases.

Claims denial by insurers is very common and is a major cause of revenue loss for many healthcare providers. Disjointed systems, processes and workflows within health provider organizations, as well as incompatible IT systems, often lead to untimely denial filings and increased cost to collect. Most importantly, companies don't have the right reporting and diagnostic tools to review denials data. These tools are the first step in denial resolution management. Even as healthcare systems are working towards identifying the root cause of denials, traditional analytics used by many organizations have been a cause of hindrance. Companies devote a lot of time, money and resources just to review trends and analyze denials manually, and to attempt fixes after the fact. As a result, certain types of denials continue, hurting healthcare's bottom line. This is a major reason why there is a greater demand for healthcare claim management to sort out these issues. The sector can use data analytics, robotic process automation (RPA) and Artificial Intelligence (AI) to overcome denial challenges. Using automated discovery and analysis of patterns, AI can help insurance companies address issues at the inception, bring up denials that have a low chance of being accepted and guide agents to close out claims that have a higher chance of being approved. These benefits of using Artificial Inetlligence and other automated processes is expected to boost the growth of the market.

Healthcare Claims Management Industry Segmentation

As per the scope of this report, healthcare claim management refers to services that enable healthcare payers to efficiently manage healthcare provider data and automate claims processes to help the healthcare provider claim submission and get faster approval. 

The market is segmented by solution type (Integrated Solutions and Standalone Solutions), component (Services and Software), delivery mode (On-Premise and Cloud-Based), end-user (Healthcare Payers, Healthcare Providers and Other End Users), and geography (North America, Europe, Asia-Pacific, Middle East and Africa, and South America). The market report also covers the estimated market sizes and trends for 17 different countries across major regions, globally. The report offers the value (in USD million) for the above segments.