July 12, 2024

Medical Claims Processing Services Market Driven by Growing Healthcare Expenditure

Medical claims processing services play a pivotal role in healthcare reimbursement by streamlining and simplifying the tasks related to claim submission, validation and payment disbursement. These services help healthcare providers to efficiently manage the complexities involved in insurance documentation, coding, billing and collection. Through centralized operations and digital platforms, medical claims processing services provide a single point of contact to healthcare organizations for claim management. This significantly reduces the paperwork, administrative costs and turnaround time for providers.

The global Medical Claims Processing Services Market is estimated to be valued at US$ 40.6 billion in 2023 and is expected to exhibit a CAGR of 4.4% over the forecast period 2023 to 2030, as highlighted in a new report published by Coherent Market Insights.

Market key trends:
Growing healthcare expenditure across the globe has been a major driver for the medical claims processing services market over the past few years. According to data released by the Centers for Medicare and Medicaid Services, the total healthcare expenditure in the U.S. reached $4.1 trillion in 2020, representing 19.7% of the country’s GDP. Rising per capita healthcare costs and prevalence of chronic diseases is expected to further accelerate spending in the coming years. This has increased the volume of medical insurance claims, creating demand for efficient processing solutions. Another key trend is the increasing adoption of cloud-based platforms and AI/ML-enabled automation technologies by medical claims processing service providers to enhance productivity, while reducing turnaround times and errors. Major companies are focusing on developing digital platforms and tools for faster claims processing through e-submissions and automated approvals. This is expected to transform the market landscape over the forecast period.

Porter’s Analysis

Threat of new entrants: Low barriers to entry allows new players to enter the market easily. However, existing major players have strong brand recognition and economies of scale.

Bargaining power of buyers: Large healthcare providers and insurers have significant bargaining power as they can negotiate on pricing and service quality.

Bargaining power of suppliers: Suppliers of medical claims processing have low bargaining power due to presence of numerous players.

Threat of new substitutes: alternative technologies are evolving rapidly which can disrupt conventional medical claims processing in future.

Competitive rivalry: Intense competition exists among major players like UnitedHealth Group, Anthem Inc., Humana Inc. They are competing on innovation, pricing and services.

Key Takeaways

The global Medical Claims Processing Services market is expected to witness high growth during the forecast period of 2023 to 2030. The global Medical Claims Processing Services Market is estimated to be valued at US$ 40.6 billion in 2023 and is expected to exhibit a CAGR of 4.4% over the forecast period 2023 to 2030.

Regional analysis comprises- North America accounts for the largest share in the global market. Growing instances of chronic diseases has increased demand for medical insurance which is driving growth of claims processing in the region. Asia Pacific is expected to grow at the fastest rate during the forecast period due to increasing healthcare spending, demand for insurance, and digitization.

Key players operating in the medical claims processing services market are UnitedHealth Group, Anthem Inc., Humana Inc., Aetna Inc., and Centene Corporation. UnitedHealth Group is the market leader due to its vast network and scale of operations across regions. Other major players are focusing on expansions, mergers and acquisitions to strengthen their market presence.

*Note:

  1. Source: Coherent Market Insights, Public sources, Desk research

2. We have leveraged AI tools to mine information and compile it