医疗理赔管理市场规模、份额和成长分析（按组件、产品类型、部署类型、最终用户行业和地区划分）—2025-2032 年行业预测

全球医疗理赔管理市场规模预计在 2023 年达到 145 亿美元，从 2024 年的 153.1 亿美元成长到 2032 年的 236.8 亿美元，在预测期（2025-2032 年）内复合年增长率为 5.6%。

全球医疗索赔管理市场正经历着一场重大变革，包括医疗系统、支付方和医疗服务提供者在内的各相关人员在寻求更高效的策略来处理日益增长的索赔量，同时最大限度地降低成本和减少错误。这项变革的主要驱动力是医疗服务体系的复杂性以及优化索赔提交、处理和报销流程的迫切需求。技术进步，特别是人工智慧、自动化和云端解决方案的进步，透过提高准确性、加快裁决速度和改进诈欺检测，正在提升索赔管理水准。此外，日益严峻的监管挑战以及对以价值为导向的医疗模式的转变，也推动了对兼具透明度和合规性的解决方案的需求。电子健康记录和数位工具的整合进一步简化了工作流程，巩固了索赔管理在未来医疗收入週期中的关键作用。

全球医疗索赔管理市场驱动因素

全球医疗理赔管理市场的主要驱动力是数位医疗技术和电子健康记录 (EHR) 的日益普及。随着医疗服务提供者和保险公司寻求简化和优化理赔流程，先进软体解决方案的整合使得理赔提交、裁决和支付流程的管理更加有效率。这种自动化转型减轻了管理负担，最大限度地减少了错误，并加快了医疗服务提供者的现金流。此外，不断增长的患者群体和日益复杂的医疗保险计划也使得医疗服务提供者必须改进其理赔管理系统，从而催生了对能够提高营运效率和提升患者满意度的创新解决方案的强劲需求。

全球医疗索赔管理市场的限制因素

全球医疗理赔管理市场的主要限制因素之一是各地区保险法规和医疗保健政策日益复杂。由于保险公司和医疗服务提供者需要应对频繁变化的监管环境，合规要求可能导致营运效率降低和管理成本增加。这种复杂性可能会阻碍小型企业进入市场，并限制现有企业创新和简化理赔处理系统的能力。此外，管理和解读这些法规所需的专业知识可能会限制人才储备，最终阻碍市场成长和服务交付。

全球医疗理赔管理市场趋势

全球医疗理赔管理市场正呈现出人工智慧 (AI) 和自动化技术融合的显着趋势。这些创新正在透过资料提取、提交检验和提升理赔管理的整体效率，变革传统的理赔流程。各机构正加速采用人工智慧驱动的解决方案，以提高准确性、减少错误并加快理赔审批速度，从而缩短报销週期。此外，日常任务的自动化显着降低了营运成本，改变了医疗服务提供者管理患者理赔的方式。这一趋势不仅提高了效率，也增强了医疗机构的整体财务状况。

目录

介绍

• 调查目标
• 调查范围
• 定义

调查方法

• 资讯收集
• 二手资料和一手资料方法
• 市场规模预测
• 市场假设与限制

执行摘要

• 全球市场展望
• 供需趋势分析
• 细分市场机会分析

市场动态与展望

• 市场概览
• 市场规模
• 市场动态
  • 驱动因素和机会
  • 限制与挑战
• 波特分析

关键市场考察

• 关键成功因素
• 竞争程度
• 关键投资机会
• 市场生态系统
• 市场吸引力指数（2024）
• PESTEL 分析
• 总体经济指标
• 价值链分析
• 定价分析

医疗理赔管理市场规模（按组成部分及复合年增长率划分）（2025-2032 年）

• 市场概览
• 软体解决方案
• 服务

医疗理赔管理市场规模（按产品类型和复合年增长率划分）（2025-2032 年）

• 市场概览
• 索赔提交和审核
• 作弊
• 欺诈、浪费和滥用 (FWA) 侦测
• 病患访问和计费解决方案
• 分析与报告

按部署模式和复合年增长率分類的医疗索赔管理市场规模（2025-2032 年）

• 市场概览
• 本地部署
• 云端基础/SaaS

医疗理赔管理市场规模（依最终用户产业划分）及复合年增长率（2025-2032 年）

• 市场概览
• 医疗保健提供者
• 付款方/保险公司
• 政府和公共卫生机构

医疗理赔管理市场规模及复合年增长率（2025-2032）

• 北美洲
  • 美国
  • 加拿大
• 欧洲
  • 德国
  • 西班牙
  • 法国
  • 英国
  • 义大利
  • 其他欧洲地区
• 亚太地区
  • 中国
  • 印度
  • 日本
  • 韩国
  • 亚太其他地区
• 拉丁美洲
  • 巴西
  • 其他拉丁美洲地区
• 中东和非洲
  • 海湾合作委员会国家
  • 南非
  • 其他中东和非洲地区

竞争资讯

• 前五大公司对比
• 主要企业的市场定位（2024 年）
• 主要市场参与者所采取的策略
• 近期市场趋势
• 公司市占率分析（2024 年）
• 主要企业简介
  • 公司详情
  • 产品系列分析
  • 依业务板块进行公司股票分析
  • 2022-2024年营收年比比较

主要企业简介

• Optum（US）
• McKesson Corporation（US）
• athenahealth（US）
• Cognizant（US）
• Oracle（US）
• IBM（US）
• Accenture plc（Ireland）
• Cerner Corporation（US）
• Change Healthcare（US）
• Conifer Health Solutions（US）
• Quest Diagnostics（US）
• eClinicalWorks（US）
• CareCloud（US）
• Allscripts Healthcare Solutions, Inc.（US）
• PLEXIS Healthcare Systems（US）
• Genpact（US）
• WNS Global Services（India）
• NTT DATA, Inc.（Japan）
• The SSI Group, LLC（US）
• Cotiviti（US）

结论与建议

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