의료 청구 관리 시장 규모, 점유율, 성장 분석 : 컴포넌트별, 제품 유형별, 도입 형태별, 최종사용자 산업별, 지역별 - 업계 예측(2025-2032년)

Global Healthcare Claims Management Market size was valued at USD 14.5 billion in 2023 and is poised to grow from USD 15.31 billion in 2024 to USD 23.68 billion by 2032, growing at a CAGR of 5.6% during the forecast period (2025-2032).

The global healthcare claims management market is undergoing significant transformation as stakeholders, including systems, payers, and providers, seek more efficient strategies to handle the surging volume of claims while minimizing costs and errors. This shift is largely driven by the intricate nature of healthcare delivery and the pressing need to optimize claims submission, processing, and reimbursement. Technological advancements, particularly in artificial intelligence, automation, and cloud solutions, are enhancing claims management through greater accuracy, faster adjudication, and improved fraud detection. Furthermore, as regulatory challenges mount and the focus shifts toward value-based care, the demand for transparent and compliant solutions grows. The integration of electronic health records and digital tools further streamlines operational workflows, solidifying claims management's vital role in healthcare revenue cycles moving forward.

Top-down and bottom-up approaches were used to estimate and validate the size of the Global Healthcare Claims Management market and to estimate the size of various other dependent submarkets. The research methodology used to estimate the market size includes the following details: The key players in the market were identified through secondary research, and their market shares in the respective regions were determined through primary and secondary research. This entire procedure includes the study of the annual and financial reports of the top market players and extensive interviews for key insights from industry leaders such as CEOs, VPs, directors, and marketing executives. All percentage shares split, and breakdowns were determined using secondary sources and verified through Primary sources. All possible parameters that affect the markets covered in this research study have been accounted for, viewed in extensive detail, verified through primary research, and analyzed to get the final quantitative and qualitative data.

Global Healthcare Claims Management Market Segments Analysis

Global Healthcare Claims Management Market is segmented by Component, Product Type, Deployment Mode, End-User Industry and region. Based on Component, the market is segmented into Software Solutions and Services. Based on Product Type, the market is segmented into Claims Submission & Adjudication, Fraud, Waste and Abuse (FWA) Detection, Patient Access & Billing Solutions and Analytics & Reporting. Based on Deployment Mode, the market is segmented into On-Premises and Cloud-Based / SaaS. Based on End-User Industry, the market is segmented into Healthcare Providers, Payers / Insurance Companies and Government & Public Health Organizations. Based on region, the market is segmented into North America, Europe, Asia Pacific, Latin America and Middle East & Africa.

Driver of the Global Healthcare Claims Management Market

A key market driver for the Global Healthcare Claims Management Market is the increasing adoption of digital health technologies and electronic health records (EHRs). As healthcare providers and insurers seek to streamline and optimize their claims processing, the integration of advanced software solutions facilitates more efficient management of claims submissions, adjudication, and payment processes. This shift toward automation reduces administrative burdens, minimizes errors, and accelerates cash flow for providers. Additionally, rising patient volumes and the complexity of healthcare plans necessitate enhanced claims management systems, creating a strong demand for innovative solutions that improve operational efficiency and enhance patient satisfaction.

Restraints in the Global Healthcare Claims Management Market

One significant market restraint for the global healthcare claims management market is the increasing complexity of insurance regulations and healthcare policies across various regions. As insurers and providers navigate a landscape marked by frequent regulatory changes, the need for compliance can lead to operational inefficiencies and heightened administrative costs. This complexity may deter smaller players from entering the market or limit the capabilities of existing companies to innovate and streamline claim processing systems. Moreover, the need for specialized expertise to manage and interpret these regulations may restrict the talent pool, ultimately hindering market growth and service delivery.

Market Trends of the Global Healthcare Claims Management Market

The Global Healthcare Claims Management market is experiencing a significant trend towards the integration of artificial intelligence (AI) and automation technologies. These innovations are transforming traditional claims processing by streamlining data extraction, submission validation, and overall claims management. Organizations are increasingly adopting AI-driven solutions to enhance accuracy, minimize errors, and accelerate claims adjudication, resulting in faster reimbursement cycles. Moreover, the automation of routine tasks is leading to significant reductions in operational costs, showcasing a shift in how healthcare providers manage patient claims. This trend not only improves efficiency but also strengthens the overall financial health of healthcare organizations.

Table of Contents

Introduction

• Objectives of the Study
• Scope of the Report
• Definitions

Research Methodology

• Information Procurement
• Secondary & Primary Data Methods
• Market Size Estimation
• Market Assumptions & Limitations

Executive Summary

• Global Market Outlook
• Supply & Demand Trend Analysis
• Segmental Opportunity Analysis

Market Dynamics & Outlook

• Market Overview
• Market Size
• Market Dynamics
  • Drivers & Opportunities
  • Restraints & Challenges
• Porters Analysis
  • Competitive rivalry
  • Threat of substitute
  • Bargaining power of buyers
  • Threat of new entrants
  • Bargaining power of suppliers

Key Market Insights

• Key Success Factors
• Degree of Competition
• Top Investment Pockets
• Market Ecosystem
• Market Attractiveness Index, 2024
• PESTEL Analysis
• Macro-Economic Indicators
• Value Chain Analysis
• Pricing Analysis

Global Healthcare Claims Management Market Size by Component & CAGR (2025-2032)

• Market Overview
• Software Solutions
• Services

Global Healthcare Claims Management Market Size by Product Type & CAGR (2025-2032)

• Market Overview
• Claims Submission & Adjudication
• Fraud
• Waste and Abuse (FWA) Detection
• Patient Access & Billing Solutions
• Analytics & Reporting

Global Healthcare Claims Management Market Size by Deployment Mode & CAGR (2025-2032)

• Market Overview
• On-Premises
• Cloud-Based / SaaS

Global Healthcare Claims Management Market Size by End-User Industry & CAGR (2025-2032)

• Market Overview
• Healthcare Providers
• Payers / Insurance Companies
• Government & Public Health Organizations

Global Healthcare Claims Management Market Size & CAGR (2025-2032)

• North America (Component, Product Type, Deployment Mode, End-User Industry)
  • US
  • Canada
• Europe (Component, Product Type, Deployment Mode, End-User Industry)
  • Germany
  • Spain
  • France
  • UK
  • Italy
  • Rest of Europe
• Asia Pacific (Component, Product Type, Deployment Mode, End-User Industry)
  • China
  • India
  • Japan
  • South Korea
  • Rest of Asia-Pacific
• Latin America (Component, Product Type, Deployment Mode, End-User Industry)
  • Brazil
  • Rest of Latin America
• Middle East & Africa (Component, Product Type, Deployment Mode, End-User Industry)
  • GCC Countries
  • South Africa
  • Rest of Middle East & Africa

Competitive Intelligence

• Top 5 Player Comparison
• Market Positioning of Key Players, 2024
• Strategies Adopted by Key Market Players
• Recent Developments in the Market
• Company Market Share Analysis, 2024
• Company Profiles of All Key Players
  • Company Details
  • Product Portfolio Analysis
  • Company's Segmental Share Analysis
  • Revenue Y-O-Y Comparison (2022-2024)

Key Company Profiles

• Optum (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• McKesson Corporation (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• athenahealth (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Cognizant (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Oracle (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• IBM (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Accenture plc (Ireland)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Cerner Corporation (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Change Healthcare (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Conifer Health Solutions (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Quest Diagnostics (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• eClinicalWorks (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• CareCloud (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Allscripts Healthcare Solutions, Inc. (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• PLEXIS Healthcare Systems (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Genpact (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• WNS Global Services (India)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• NTT DATA, Inc. (Japan)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• The SSI Group, LLC (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Cotiviti (U.S.)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments

Conclusion & Recommendations