医疗理赔管理市场规模、份额和成长分析（按组件、产品类型、部署模式、最终用户产业和地区划分）－2026-2033年产业预测

全球医疗理赔管理市场规模预计到 2024 年将达到 153.1 亿美元，到 2025 年将达到 161.7 亿美元，到 2033 年将达到 250 亿美元，预测期（2026-2033 年）的复合年增长率为 5.6%。

全球医疗理赔管理格局正经历重大变革，相关人员都在寻求简化理赔流程，同时降低相关成本和错误率。医疗系统的复杂性、不断增长的患者数量以及优化理赔流程的迫切需求，共同推动了技术进步，尤其是在人工智慧、自动化和云端运算领域的进步，这些进步正透过提高准确性、加快理赔速度和增强诈欺检测能力，彻底改变着理赔管理。日益严格的监管要求以及医疗模式转向价值导向医疗的转变，促使保险公司和医疗服务提供者更加重视透明度和合规性。电子健康记录 (EHR) 和数位健康解决方案的整合，使计费系统能够整合财务和临床数据，从而使理赔管理成为未来医疗收入週期中不可或缺的重要组成部分。

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因素之一是医疗机构日益重视降低营运成本和提高效率。随着医疗成本的持续上涨，医疗服务提供者和保险公司正将高效的理赔处理作为优先事项，以改善收入週期管理。在理赔管理系统中采用人工智慧、机器学习和自动化等先进技术有助于缩短处理时间并最大限度地减少错误。此外，监管合规要求也促使医疗服务提供者投资于有效的理赔管理解决方案，从而推动了对能够准确提交和追踪理赔的综合系统的需求。

全球医疗索赔管理市场的限制因素

全球医疗保健理赔管理市场面临的主要限制因素之一是不同地区和国家监管法规的复杂性和多样性。医疗保健法规在不同地区差异显着，这使得在多个司法管辖区运营的公司面临合规挑战，并导致营运成本增加。此外，这些法规还在不断变化，需要对理赔管理流程进行持续调整，进一步加剧了其复杂性。此类不一致之处会降低理赔处理效率，阻碍对先进技术的投资，增加理赔被拒的风险，并最终影响医疗保健产业组织的盈利和永续性。

全球医疗理赔管理市场趋势

全球医疗理赔管理市场正经历重大变革，人工智慧 (AI) 和自动化技术的整合势在必行。这些创新正在改变产业的面貌，它们透过简化理赔流程、增强资料提取和确保提交检验，取代了传统的人工方法。理赔审核自动化不仅缩短了报销时间，还最大限度地减少了错误，提高了准确性，最终降低了医疗机构的营运成本。这一趋势凸显了医疗产业致力于提高理赔管理效率和准确性的决心，并将人工智慧驱动的解决方案定位为医疗营运发展演进的关键组成部分。

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（2025）
• PESTEL 分析
• 总体经济指标
• 价值链分析
• 定价分析

全球医疗理赔管理市场规模（按组成部分及复合年增长率划分）（2026-2033 年）

• 软体解决方案
• 服务

全球医疗理赔管理市场规模（按产品类型和复合年增长率划分）（2026-2033 年）

• 索赔提交和审核
• 诈欺罪
• 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

全球医疗理赔管理市场规模（按部署模式和复合年增长率划分）（2026-2033 年）

• 本地部署
• 基于云端/SaaS

全球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（2026-2033 年）

• 医疗保健提供者
• 付款方/保险公司
• 政府和公共卫生机构

全球医疗理赔管理市场规模及复合年增长率（2026-2033）

• 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（2025 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（2025 年）
• 主要企业公司简介
  • 公司详情
  • 产品系列分析
  • 依业务板块进行公司股票分析
  • 2023-2025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 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