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醫療理賠管理市場規模、佔有率和成長分析（按組件、產品類型、部署類型、最終用戶行業和地區分類）—2025-2032 年行業預測

市場調查報告書

商品編碼

1865242

醫療理賠管理市場規模、佔有率和成長分析（按組件、產品類型、部署類型、最終用戶行業和地區分類）—2025-2032 年行業預測

Healthcare Claims Management Market Size, Share, and Growth Analysis, By Component, By Product Type, By Deployment Mode, By End-User Industry, By Region - Industry Forecast 2025-2032

出版日期: 2025年11月06日 | 出版商:

SkyQuest | 英文 186 Pages | 商品交期: 3-5個工作天內

價格

簡介目錄

全球醫療理賠管理市場規模預計在 2023 年達到 145 億美元，從 2024 年的 153.1 億美元成長到 2032 年的 236.8 億美元，在預測期（2025-2032 年）內複合年成長率為 5.6%。

全球醫療索賠管理市場正經歷著一場重大變革，包括醫療系統、支付方和醫療服務提供者在內的各相關人員在尋求更高效的策略來處理日益成長的索賠量，同時最大限度地降低成本和減少錯誤。這項變革的主要驅動力是醫療服務體系的複雜性以及最佳化索賠提交、處理和報銷流程的迫切需求。技術進步，特別是人工智慧、自動化和雲端解決方案的進步，透過提高準確性、加快裁決速度和改進詐欺檢測，正在提升索賠管理水準。此外，日益嚴峻的監管挑戰以及對以價值為導向的醫療模式的轉變，也推動了對兼具透明度和合規性的解決方案的需求。電子健康記錄和數位工具的整合進一步簡化了工作流程，鞏固了索賠管理在未來醫療收入週期中的關鍵作用。

全球醫療索賠管理市場促進因素

全球醫療理賠管理市場的主要驅動力是數位醫療技術和電子健康記錄 (EHR) 的日益普及。隨著醫療服務提供者和保險公司尋求簡化和最佳化理賠流程，先進軟體解決方案的整合使得理賠提交、裁決和支付流程的管理更加有效率。這種自動化轉型減輕了管理負擔，最大限度地減少了錯誤，並加快了醫療服務提供者的現金流。此外，不斷成長的患者群體和日益複雜的醫療保險計劃也使得醫療服務提供者必須改進其理賠管理系統，從而催生了對能夠提高營運效率和提升患者滿意度的創新解決方案的強勁需求。

全球醫療索賠管理市場的限制因素

全球醫療理賠管理市場的主要限制因素之一是各地區保險法規和醫療保健政策日益複雜。由於保險公司和醫療服務提供者需要應對頻繁變化的監管環境，合規要求可能導致營運效率降低和管理成本增加。這種複雜性可能會阻礙小型企業進入市場，並限制現有企業創新和簡化理賠處理系統的能力。此外，管理和解讀這些法規所需的專業知識可能會限制人才儲備，最終阻礙市場成長和服務交付。

全球醫療理賠管理市場趨勢

全球醫療理賠管理市場正呈現出人工智慧 (AI) 和自動化技術融合的顯著趨勢。這些創新正在透過資料提取、提交檢驗和提升理賠管理的整體效率，變革傳統的理賠流程。各機構正加速採用人工智慧驅動的解決方案，以提高準確性、減少錯誤並加快理賠核准速度，從而縮短報銷週期。此外，日常任務的自動化顯著降低了營運成本，改變了醫療服務提供者管理患者理賠的方式。這一趨勢不僅提高了效率，也增強了醫療機構的整體財務狀況。

北美洲
- 美國
- 加拿大
歐洲
- 德國
- 西班牙
- 法國
- 英國
- 義大利
- 其他歐洲地區
亞太地區
- 中國
- 印度
- 日本
- 韓國
- 亞太其他地區
拉丁美洲
- 巴西
- 其他拉丁美洲地區
中東和非洲
- 海灣合作理事會國家
- 南非
- 其他中東和非洲地區

競爭資訊

前五大公司對比
主要企業的市場定位（2024 年）
主要市場參與者所採取的策略
近期市場趨勢
公司市佔率分析（2024 年）
主要企業簡介
- 公司詳情
- 產品系列分析
- 依業務板塊進行公司股票分析
- 2022-2024年營收年比比較

主要企業簡介

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）

結論與建議

簡介目錄

Product Code: SQMIG35D2370

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.

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