Healthcare Payer BPO Market Size, Share & Trends Analysis Report By Services (Claims Management, Integrated Front Office Service & Back Office Operations, Member Management, HR), By Region, And Segment Forecasts, 2024 - 2030

Report Overview

The global healthcare payer BPO market size was valued at USD 32.4 billion in 2023 and is projected to grow at a compound annual growth rate (CAGR) of 6.9% from 2024 to 2030. Key drivers attributing to the market's growth include the increasing global geriatric population, regulatory changes, technological advancements, rising healthcare costs, and the need to improve the payer’s operational efficiency and customer satisfaction. According to the World Health Organization (WHO), the global population aged 80+ is set to triple by 2050, reaching 426 million, while the 60+ population will double to 2.1 billion. This rapidly aging population is more susceptible to various health issues such as cardiovascular diseases, cancers, and respiratory problems, creating a significant growth opportunity for the healthcare sector.

North America payer BPO market by type of service, 2012 - 2022 (USD Billion)

The rising burden of diseases is increasing insurance companies' workloads. To manage this, they need to invest heavily in technology and skilled manpower, leading to higher operational costs and driving market growth. As per the data mentioned in PETERSON-KFF Health System Tracker, the total health expenditure in the U.S. was USD 4,300,000.0 million in 2022, thrice that in 2000. This expenditure represents the total amount spent on insurance administration, health research, and other healthcare activities, including expenditures from both public and private funds.

Private and public organizations are outsourcing payer administrative functions to significantly reduce costs, improve operational efficiency, and streamline overall service delivery to clients. The outsourcing vendors deploy full-time resources to provide round-the-clock customer support to providers, patients, and other stakeholders using several tools, including artificial intelligence (AI) and data analytics.

Services Outlook Insights

Claims management services dominated the market and accounted for 32.3% in 2023. It involves verifying and approving medical claims from providers. Automation and AI are revolutionizing this process. Robotic process automation (RPA), advanced analytics, and machine learning are used for automated claim reviews and fraud detection. Major players such as UnitedHealth Group partner with companies such as Cognizant and Microsoft to develop technology-driven solutions that minimize errors and expedite claim processing. For instance, in April 2023, cognizant announced an expansion of their longstanding healthcare partnership with Microsoft, which would allow healthcare payers and providers easy access to advanced technology solutions, streamlined claims management, and improved interoperability.

The provider management services segment is expected to grow at the fastest CAGR of 8.66% over the forecast period owing to the increasing number of healthcare providers and the constant rise in customers, claims, etc. The increasing administrative burden on healthcare providers to maintain quality, improve patient satisfaction, and support efficient data management makes it necessary to adopt provider management services.

Regional Insights & Trends

North America healthcare payer BPO market dominated the global market in 2023. Major factors contributing to the growth of this region include the increasing geriatric population, the growing burden of diabetes due to lifestyle changes, the increasing penetration of health insurance in emerging economies, and the increasing use of technology for operational efficiency. For instance, in October 2020, Humana partnered with Heal to integrate with telehealth platforms, similar to Aetna's adoption of Nuance's virtual assistant. The key presence of the market leaders, such as Accenture, EXL Service Holdings, Inc., and Capgemini, and having their regional operational headquarters, contribute to market growth.

U.S. Healthcare Payer BPO Market Trends

The U.S. healthcare payer BPO market dominated the North America market with a significant market share in 2023 due to several technological advancements undertaken by the players in the region. The U.S. healthcare payer BPO market is highly competitive and fragmented, with several large and small players offering a range of services to payers. Service providers are constantly expanding their capabilities and offerings to meet the evolving needs of the payers, such as compliance with the Affordable Care Act (ACA), consumerism, value-based care, and digital transformation. For instance, in May 2020, Cognizant announced the acquisition of Collaborative Solutions, one of the leading global consultancies specializing in Workday enterprise cloud applications for finance and human resources, to strengthen its cloud offerings for the healthcare payer market.

Europe Healthcare Payer BPO Market Trends

Europe healthcare payer BPO market was identified as a lucrative region in this industry. This can be attributed to several government initiatives, collaborations between BPO services and healthcare companies, and increasing consumer demands for timely service, which are some of the major factors propelling the market growth in the region.

The UK Healthcare Payer BPO market is expected to grow rapidly in the coming years due to technological breakthroughs and continuous evolution in healthcare services. For instance, in July 2024, healthcare entities in the UK collaborated with Cynergy BPO to effortlessly leverage international BPO capabilities, thereby upgrading their service offerings while complying with the regulatory framework of the country. This shift in outsourcing for healthcare services by UK-based companies contributes to augmenting the market growth.

Asia Pacific Healthcare Payer BPO Market Trends

Asia Pacific healthcare payer BPO market is anticipated to witness significant growth due to the significantly increasing investments in healthcare payer BPO technologies across the region. High economic development, increased public and private healthcare expenditures, penetration of insurance services in urban and rural centers, and favorable government policies are key factors attributed to market growth. For instance, in October 2022, PING AN HEALTHCARE AND TECHNOLOGY COMPANY LIMITED. launched cloud-based BPO platform "Ping An Smart Healthcare” to showcase the trend towards value-added services, supporting payers in areas such as chronic disease management and cost optimization.

India Healthcare Payer BPO market is expected to grow rapidly in the coming years due to increased penetration of insurance services and constant outsourcing of non-core healthcare duties in India by several global companies. According to the article published by Insurance Edge in July 2024, India became a prominent hub for customer-centric services due to various advantages such as a skilled workforce, cultural compatibility with global clients, etc. Healthcare BPO services in this region benefit companies with high-quality services at a fraction of the cost. In addition, different business organizations initiate strategic initiatives in the country to augment the market growth in the forecast period.

China Healthcare Payer BPO market is anticipated to grow significantly in the comping years attributing to the rising adoption of technologies in the service, government initiatives, cost effective workforce and more.

Healthcare Payer BPO Company Share & Insights

Some of the key companies in the Healthcare Payer BPO market include Cognizant, Xerox Corporation, Hinduja Global Solution Limited, ExlService Holdings, Inc., Hewlett Packard Enterprise Development LP, Accenture, Genpact, HCL Technologies Limited, Wipro, and Capgemini. Organizations in the market are focusing on increasing customer base to gain a competitive edge in the industry. Therefore, key players are taking several strategic initiatives, such as mergers and acquisitions, and partnerships with other healthcare or BPO companies.

• Cognizant's healthcare payer BPO services focus on enhancing operational efficiency, improving member satisfaction, and reducing costs for health insurance companies. They offer solutions such as claims processing, member enrollment, and care management, leveraging technology and analytics to streamline workflows and support better decision-making.

• Wipro offers Business Process Outsourcing (BPO) services specifically tailored for healthcare payers. They handle various tasks within the claims lifecycle, from enrollment and eligibility verification to claims processing and member/provider administration. Wipro leverages automation and technology to streamline these processes, aiming to improve efficiency, reduce costs, and enhance the overall experience for healthcare payers and their members.

Recent Developments

• In June 2024, Capgemini and Simplify Healthcare collaborated to enhance payer operational efficiency, control costs, and improve customer experience. This collaboration was intended to add value to health plans and their members.

• In May 2024, Wipro announced that it will assist Independent Health with Wipro’s Medicare Prescription Payment Plan (MPPP360) platform to streamline the payment process in Western New York

Healthcare Payer BPO Market Report Scope

Global Healthcare Payer BPO Market Report Segmentation

This report forecasts revenue growth at global, regional, and country levels and provides an analysis of the latest industry trends in each of the sub-segments from 2018 to 2030. For this study, Grand View Research has segmented the global healthcare payer BPO market report based on services and region.

• Services Outlook (Revenue, USD Million, 2018 - 2030)

  • Claims Management Services

  • Integrated Front Office Service & Back Office Operations

  • Member Management Services

  • Provider Management Services

  • Billing & Accounts Management Services

  • Analytics & Fraud Management Services

  • HR Services

• Regional Outlook (Revenue, USD Million, 2018 - 2030)

  • North America

    • U.S.

    • Canada

    • Mexico

  • Europe

    • UK

    • Germany

    • France

    • Italy

    • Spain

    • Denmark

    • Sweden

    • Norway

  • Asia Pacific

    • Japan

    • China

    • India

    • Australia

    • South Korea

    • Thailand

  • Latin America

    • Brazil

    • Argentina

  • Middle East and Africa (MEA)

    • South Africa

    • Saudi Arabia

    • UAE

    • Kuwait