The global healthcare claims management market size is calculated at USD 50.32 billion in 2025 and is expected to reach around USD 334.6 billion by 2034, growing at a CAGR of 23.43% for the forecasted period.
Ottawa, Nov. 14, 2025 (GLOBE NEWSWIRE) — The global healthcare claims management market size was valued at USD 40.77 billion in 2024 and is predicted to hit around USD 334.6 billion by 2034, rising at a 23.43% CAGR, a study published by Towards Healthcare a sister firm of Precedence Research.
This market is surging because healthcare providers and payers are under growing pressure to process the ever-rising volume of claims more efficiently, reduce errors and denials, and adopt digital workflows that cut cost and improve reimbursement speed.
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Key Takeaways:
- North America dominated the global healthcare claims management market in 2024.
- Asia-Pacific is anticipated to grow at the fastest rate in the market during the forecast period.
- By product, the medical billing segment held a dominant presence in the market in 2024.
- By product, the claims processing segment is predicted to witness significant growth in the market over the forecast period.
- By component, the software segment held the largest share of the healthcare claims management market in 2024.
- By component, the services segment is anticipated to show lucrative growth in the market over the studied years.
- By solution type, the integrated solutions segment led the global market in 2024.
- By solution type, the standalone solutions segment is projected to expand significantly in the market in the coming years.
- By deployment mode, the web-based segment registered its dominance over the global market in 2024.
- By deployment mode, the cloud-based segment is expected to grow at the fastest rate in the market during the forecast period.
- By end-use, the healthcare providers segment held the major share of the healthcare claims management market in 2024.
- By end-use, the healthcare payers segment is anticipated to grow with the highest CAGR in the market during the studied years.
Market Overview:
The global healthcare claims management market is poised for strong momentum as healthcare organisations seek to streamline the claims workflow between providers and payers. Key drivers include, the digitisation of claims processes, value-based care initiatives, greater regulatory oversight, and increases in insurance coverage in countries across the globe. The market covers a broad scope including software, services, integrated and standalone solutions, and web-based and cloud-based solutions, that support healthcare providers and payers. As a result, the ecosystem is rapidly evolving – with companies investing in automation, artificial intelligence (AI), and analytics to manage the complexity and volume of claims.
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Key Metrics and Overview
| Metric | Details | |
| Market Size in 2024 | USD 40.77 Billion | |
| Projected Market Size in 2034 | USD 334.6 Billion | |
| CAGR (2025 – 2034) | 23.43 | % |
| Leading Region | North America | |
| Market Segmentation | By Product, By Component, By Solution Type, By Deployment Mode, By End-Use, By Region | |
| Top Key Players | Athena Health, Cerner Corporation, ClaimXperience, Exela Technologies, Experian Health, IBM, Inova Care, Medlogix, Oracle Health, PLEXIS Healthcare Systems, Tego Insurance, WNS | |
Major Growth Drivers:
What Factors are Contributing to Growth in the Healthcare Claims Management Market?
- Escalating healthcare costs and insurance volumes: As more people gain access to insurance and more patients with chronic diseases are seen, healthcare providers have been faced with more claims and increasing demands to eliminate administrative burdens that are often associated with processing claims. This is driving the adoption of claims management systems that can grow with the practice needs while also improving write-offs and accuracy of reimbursement.
- Digital shift and automation with AI: The movement towards replacing poor quality, manual claims processing with intelligent software (i.e. machine learning, clinical coding validation, and real-time analytics) is driving the demand for better methods for claims management.
- Value-based care (and the complexity that comes with regulations): As reimbursement moves from paying for services, to paying for value and outcomes, the claim or payment workflows have become more complex requiring practices to have systems in place that would manage all of the compliance and denial management, while being able to track performance metrics.
- Emerging markets and increasing penetration rates for insurance: The increasing capacity for healthcare infrastructure, private insurance coverage, and government initiatives in certain areas of the globe (i.e. Asia-Pacific), are going to be greater because there are simply more claims being produced through these emerging markets that would need to be managed with a modern claim management system.
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Key Drifts:
Major Drifts to Support the Healthcare Claims Management Market:
A trend worthy of highlighting is the increasing use of cloud-based and web-based deployment models. Cloud-based solutions are gaining considerable traction for real-time analytics, scalability, and access across stakeholders. Another big trend is denial management and fraud prevention capabilities integrated into claims platforms, which now have AI modules to flag error patterns within claims, predict denials, or detect oddities and fraud. This capability moves the market from a focus on simply submitting claims to prevention and intelligence. Finally, there’s a trend in combining everything into an integrated revenue cycle management (RCM) suite of claims, billing, patient eligibility and payment posting as a single solution, streamlining a truly efficient claims lifecycle for providers and payers, and ultimately patient experience.
Significant Challenge:
Despite strong growth, the market is impeded by a major challenge: the volume of claim denials and complex reimbursement workflows to implement. Many claims still require rework, or resubmission using inaccurate coding, and/or errors with regulatory compliance, which complicates the reimbursement workflow to the point of delayed ROI to the implementer, as well as extensive change management. Also, legacy systems and data silos continue to hinder full digital transformation, which makes many organizations pause and/or wait to adopt new claims management.
Regional Analysis:
North America:
North America is still the largest region in the healthcare claims management market. Highly evolved healthcare infrastructure, high insurance penetration, regulatory obligations and key vendors are all present. Many U.S. and Canadian providers and payers have begun to modernise billing and claims workflows, to invest in automation and analytics and to transition from paper-based systems to digital solutions. As a result, the North American market leads in value and serves as a sandbox for cutting-edge technology like AI-driven adjudication and cloud-based deployment.
Asia-Pacific:
The healthcare claims management market is expected to have the highest growth rates in the Asia-Pacific region. The rapid evolution of healthcare infrastructure, expanding insurance coverage, increasing incomes and adoption of digital health technologies is increasing demand. Countries in Asia-Pacific like India and China and Southeast Asia are witnessing increases in hospital admissions, increases in the burden of chronic disease and transitions to reimbursements, creating a demand for automated claims workflows. Many of these markets are leapfrogging legacy systems which give cloud-native and AI-enabled solutions an opportunity for strong differentiation.
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Segmental Insights:
By Product:
In 2024, the medical billing segment was the largest in the market, as providers focused on managing the routine billing process, capturing charges accurately, and reducing the number of denials or delays in reimbursements. As billing was the first step before the claim could be processed, investments in billings were high and almost universally adopted across the market. For the remainder of the forecast, the claims-processing segment will see the most significant growth in the market over the forecast period. As payers and providers move beyond billing only, towards intelligent adjudication, denial management, appeals and analytics, the claims-processing section of the product portfolio becomes the growth engine.
By Component:
By component, the software segment should have held the largest share of the healthcare claims management market in 2024, as software licenses, platforms, AI modules, and analytics tools accounted for the majority of investments as organizations upgraded from legacy systems. On the other hand, the services segment should show a healthy growth dynamic in the market over the studied years. Consulting, managed services, implementation, coding validation, and outsourcing of claims processing tasks are expected to grow, even as mature providers will look to external organizations to support the task of running and optimising claims workflows.
By Solution Type:
The integrated solution segment was the largest in the global claims management market in 2024, service providers who are offering fully-integrated solutions that cover billing, claims, reimbursements, analytics, and provider-payer collaboration were the leading investment type. Meanwhile, the standalone solution segment is expected to grow significantly in the global market during the forecast period, as smaller providers, payers, and regional players will gravitate toward modular, individual solutions rather than fully-integrated suites, resulting in expedited deployment timelines, lower upfront costs, and adoption in incremental steps.
By Deployment Mode:
By deployment mode, the web-based segment claimed the market share in the global claims management market in 2024, indicating that the majority of organisations have transitioned their claims management platform to a browser-based model for ease-of-use reasons, and flexibility. Conversely, the cloud-based segment is expected to grow at the fastest rate during the forecast period, cloud-based solutions provide significant benefits of scalability, access to cross-geographies, real-time collaboration, and improved resiliency, which are increasingly required for claims ecosystems.
By End-use:
The end-use of the healthcare market claims management is segmented into healthcare providers and healthcare payers. The healthcare providers segment accounted for the largest share in 2024, as hospitals, clinics, physician networks, and ambulatory services are the primary users of claims and billing workflows. Healthcare payers are expected to grow with the highest CAGR in the market over the forecast period, as insurers, third-party administrators, and payers are putting more investment toward claims management solutions as they look to effectively manage costs, track denials, reduce fraud, and ultimately improve reimbursement.
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Recent Developments:
In early 2025, Claritev Corporation and Burjeel Holdings’s Claims Care unit entered a strategic partnership (signed MoU April 2025, formalised May 2025) to roll out advanced claims-analytics and revenue-cycle management solutions in the Middle East & North Africa region.
Healthcare Claims Management Market Key Players List:
- Athena Health
- Cerner Corporation
- ClaimXperience
- Exela Technologies
- Experian Health
- IBM
- Inova Care
- Medlogix
- Oracle Health
- PLEXIS Healthcare Systems
- Tego Insurance
- WNS
Segments Covered in the Report
By Product
- Medical Billing
- Professional
- Institutional
- Claims Processing
By Component
- Software
- Services
By Solution Type
- Integrated Solutions
- Standalone Solutions
By Deployment Mode
- Cloud-based
- On-premise
- Web-based
By End-Use
- Healthcare Providers
- Healthcare Payers
By Region
- North America
- US
- Canada
- Asia Pacific
- China
- Japan
- India
- South Korea
- Thailand
- Europe
- Germany
- UK
- France
- Italy
- Spain
- Sweden
- Denmark
- Norway
- Latin America
- Brazil
- Mexico
- Argentina
- Middle East and Africa (MEA)
- South Africa
- UAE
- Saudi Arabia
- Kuwait
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