의료 청구 관리 시장 규모, 점유율, 성장 분석 : 구성요소별, 제품 유형별, 도입 모드별, 최종 이용 산업별, 지역별 - 업계 예측(2026-2033년)

Global Healthcare Claims Management Market size was valued at USD 15.31 Billion in 2024 and is poised to grow from USD 16.17 Billion in 2025 to USD 25 Billion by 2033, growing at a CAGR of 5.6% during the forecast period (2026-2033).

The global healthcare claims management landscape is experiencing significant transformation as stakeholders seek to enhance the efficiency of claim handling while reducing associated costs and errors. Driven by the intricate nature of healthcare systems, growing patient volumes, and the urgent need to optimize claims processes, advancements in technology-particularly in artificial intelligence, automation, and cloud computing-are revolutionizing claims management by boosting accuracy, expediting adjudication, and enhancing fraud detection capabilities. As regulatory demands intensify and the healthcare paradigm shifts toward value-based care, there is an increasing emphasis on transparency and compliance for insurers and providers alike. The integration of electronic health records and digital health solutions further enables claims systems to merge financial and clinical data, establishing claims management as a vital component of the healthcare revenue cycle's future.

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

One of the key market drivers for the Global Healthcare Claims Management Market is the increasing focus on reducing operational costs and enhancing efficiency within healthcare organizations. As medical expenses continue to rise, providers and insurers are prioritizing streamlined claims processing to improve revenue cycle management. The adoption of advanced technologies, such as artificial intelligence, machine learning, and automation in claims management systems, enables quicker processing times and minimizes errors. Additionally, regulatory compliance requirements are pushing healthcare entities to invest in effective claims management solutions, driving the demand for comprehensive systems that can facilitate accurate claims submission and tracking.

Restraints in the Global Healthcare Claims Management Market

One of the key market restraints for the global healthcare claims management market is the complexity and variability of regulations across different regions and countries. Healthcare regulations can differ significantly, leading to challenges in compliance and increased operational costs for companies operating in multiple jurisdictions. Additionally, the constant evolution of these regulations requires ongoing adjustments in claims management processes, adding further complexity. This inconsistency can hinder the efficiency of claims processing, deter investment in advanced technologies, and increase the risk of claim denials, ultimately affecting the profitability and sustainability of organizations within the healthcare sector.

Market Trends of the Global Healthcare Claims Management Market

The Global Healthcare Claims Management market is witnessing a significant shift towards the integration of artificial intelligence (AI) and automation technologies. These innovations are transforming the landscape by streamlining claims processing, enhancing data extraction, and ensuring submission validation, thereby replacing traditional manual methods. The automation of claims adjudication not only expedites reimbursement timelines but also minimizes errors and boosts accuracy, ultimately leading to reduced operational costs for healthcare organizations. This trend highlights the industry's commitment to improving efficiency and accuracy in claims management, positioning AI-driven solutions as essential components in the evolution of healthcare operations.

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, 2025
• PESTEL Analysis
• Macro-Economic Indicators
• Value Chain Analysis
• Pricing Analysis

Global Healthcare Claims Management Market Size by Component & CAGR (2026-2033)

• Market Overview
• Software Solutions
• Services

Global Healthcare Claims Management Market Size by Product Type & CAGR (2026-2033)

• 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 (2026-2033)

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

Global Healthcare Claims Management Market Size by End-User Industry & CAGR (2026-2033)

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

Global Healthcare Claims Management Market Size & CAGR (2026-2033)

• 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, 2025
• Strategies Adopted by Key Market Players
• Recent Developments in the Market
• Company Market Share Analysis, 2025
• Company Profiles of All Key Players
  • Company Details
  • Product Portfolio Analysis
  • Company's Segmental Share Analysis
  • Revenue Y-O-Y Comparison (2023-2025)

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