理賠處理軟體市場規模、佔有率和成長分析（按部署類型、組織規模、產業、類型、功能和地區分類）－2026-2033年產業預測

全球理賠處理軟體市場規模預計在 2024 年達到 479.8 億美元，從 2025 年的 522 億美元成長到 2033 年的 1025 億美元，在預測期（2026-2033 年）內複合年成長率為 8.8%。

全球理賠處理軟體市場正經歷變革，其主要驅動力是人工智慧的進步，人工智慧正在推動詐騙偵測和預測分析的自動化。對自動化需求的不斷成長、向雲端解決方案的逐步轉型以及嚴格的合規要求，都對該行業產生了顯著影響。此外，客戶對理賠處理流程中無縫數位化體驗的期望，也迫使服務提供者提升自助服務能力並規範處理流程。這些發現表明，市場正在不斷發展，以滿足技術進步和消費者需求，最終提高理賠處理系統的效率和使用者滿意度。

全球理賠處理軟體市場促進因素

全球保險理賠處理軟體市場的主要促進因素之一是保險和醫療保健產業對自動化日益成長的需求。隨著各機構努力提高營運效率、減少處理錯誤並提升客戶滿意度，採用先進的保險理賠處理解決方案至關重要。這些先進的軟體系統能夠實現即時追蹤、簡化工作流程並提高數據準確性，最終加快理賠速度。此外，日益複雜的監管要求和對全面數據分析的需求進一步加速了對創新理賠處理解決方案的需求，使其成為企業在瞬息萬變的市場環境中保持競爭力的必備工具。

全球理賠處理軟體市場面臨的限制因素

全球理賠處理軟體市場面臨的主要限制因素之一是網路威脅和資料外洩的日益增加。由於保險理賠處理涉及敏感的個人和財務資訊，企業必須在網路安全措施方面投入巨資，以防止資料被盜並確保符合監管要求。這些高級安全要求導致營運成本和複雜性增加，這可能會阻礙小規模企業採用先進的理賠處理解決方案。此外，保險和醫療產業缺乏標準化可能會阻礙軟體互通性，使整合工作更加複雜，並限制整體市場成長潛力。

全球計費軟體市場趨勢

全球保險理賠處理軟體市場正經歷著人工智慧驅動的個人化趨勢，這正在重塑保險理賠的管理方式。隨著保險公司積極採用先進的人工智慧技術，他們能夠為客戶提供更個人化的理賠體驗。這種個人化服務能夠加強溝通，主動指導客戶準備所需文件，並根據個人理賠記錄、行為分析和風險評估進行主動跟進。轉向以客戶為中心的預測性生態系統的轉變有望顯著簡化理賠流程，同時提升客戶滿意度，並將人工智慧定位為理賠管理發展演變的核心要素。

目錄

介紹

• 調查目標
• 調查範圍
• 定義

調查方法

• 資訊收集
• 二手資料和一手資料方法
• 市場規模預測
• 市場假設與限制

執行摘要

• 全球市場展望
• 供需趨勢分析
• 細分市場機會分析

市場動態與展望

• 市場規模
• 市場動態
  • 促進因素和機遇
  • 限制與挑戰
• 波特分析

關鍵市場考察

• 關鍵成功因素
• 競爭程度
• 關鍵投資機會
• 市場生態系統
• 市場吸引力指數（2025）
• PESTEL 分析
• 總體經濟指標
• 價值鏈分析
• 定價分析

全球理賠處理軟體市場規模（按部署方式及複合年成長率分類）（2026-2033 年）

• 基於雲端的
• 本地部署

全球理賠處理軟體市場規模（依組織規模及複合年成長率分類）（2026-2033 年）

• 中小企業
• 主要企業

全球理賠處理軟體市場規模（依垂直產業分類）及複合年成長率（2026-2033 年）

• 保險
• 衛生保健
• 製造業
• 政府
• 運輸/物流

全球理賠處理軟體市場規模（按類型和複合年成長率分類）（2026-2033 年）

• 產物保險）
• 醫療保險
• 工傷意外賠償保險

全球理賠處理軟體市場規模（按功能和複合年成長率分類）（2026-2033 年）

• 資料管理
• 工作流程管理
• 報告與分析
• 一體化

全球理賠處理軟體市場規模及複合年成長率（2026-2033）

• 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（2025 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（2025 年）
• 主要企業公司簡介
  • 公司詳情
  • 產品系列分析
  • 依業務板塊進行公司股票分析
  • 2023-2025年營收年比比較

主要企業簡介

• Guidewire Software（United States）
• Duck Creek Technologies（United States）
• Sapiens International Corporation NV（Israel）
• FINEOS（Ireland）
• Insurity（United States）
• Pegasystems Inc.（United States）
• OneShield Software（United States）
• Majesco（United States）
• Hyland Software, Inc.（United States）
• EIS（United States）
• LexisNexis（United States）
• Riskonnect（United States）
• Newgen Software Technologies Limited（India）
• BriteCore（United States）
• Snapsheet（United States）
• ClaimVantage（Ireland）
• Origami Risk（United States）
• Oracle Corporation（United States）
• IBM（United States）
• DXC Technology Company（United States）

結論與建議

Global Claims Processing Software Market size was valued at USD 47.98 Billion in 2024 and is poised to grow from USD 52.2 Billion in 2025 to USD 102.5 Billion by 2033, growing at a CAGR of 8.8% during the forecast period (2026-2033).

The global claims processing software market is experiencing transformative changes, primarily driven by advancements in artificial intelligence, which facilitates automation in fraud detection and predictive analytics. The growing need for automation, combined with a progressive transition towards cloud-based solutions and stringent compliance mandates, significantly influences this sector. Furthermore, client expectations for seamless digital experiences throughout the claims process compel providers to improve their self-service functionalities and standardize processing timelines. These insights indicate that the market is evolving to meet both technological advancements and consumer demands, ultimately enhancing efficiency and user satisfaction within claims processing systems.

Top-down and bottom-up approaches were used to estimate and validate the size of the Global Claims Processing Software 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 Claims Processing Software Market Segments Analysis

Global Claims Processing Software Market is segmented by Deployment, Organization Size, Industry Vertical, Type, Functionality and region. Based on Deployment, the market is segmented into Cloud-based and On-premises. Based on Organization Size, the market is segmented into Small and Medium Enterprises (SMEs) and Large Enterprises. Based on Industry Vertical, the market is segmented into Insurance, Healthcare, Manufacturing, Government and Transportation and Logistics. Based on Type, the market is segmented into Property and Casualty (P&C), Health and Workers' Compensation. Based on Functionality, the market is segmented into Data Management, Workflow Management, Reporting and Analytics and Integration. Based on region, the market is segmented into North America, Europe, Asia Pacific, Latin America and Middle East & Africa.

Driver of the Global Claims Processing Software Market

One of the key market drivers for the global claims processing software market is the increasing demand for automation in the insurance and healthcare sectors. As organizations seek to enhance operational efficiency, reduce processing errors, and improve customer satisfaction, the adoption of advanced claims processing solutions becomes imperative. These sophisticated software systems enable real-time tracking, streamlined workflows, and enhanced data accuracy, ultimately leading to faster claims resolution. Additionally, the growing complexity of regulatory requirements and the need for comprehensive data analytics further propel the need for innovative claims processing solutions, making them indispensable for organizations aiming to remain competitive in a dynamic market landscape.

Restraints in the Global Claims Processing Software Market

One significant market restraint for the global claims processing software market is the increasing prevalence of cyber threats and data breaches. As claims processing involves sensitive personal and financial information, companies must invest heavily in cybersecurity measures to protect against data theft and ensure compliance with regulations. These heightened security requirements can lead to increased operational costs and complexity, potentially deterring smaller players from adopting advanced claims processing solutions. Furthermore, the lack of standardization across different insurance and healthcare sectors can hinder software interoperability, complicating integration efforts and limiting the market's overall growth potential.

Market Trends of the Global Claims Processing Software Market

The Global Claims Processing Software market is experiencing a notable trend towards AI-driven personalization, reshaping how insurance claims are managed. As insurers increasingly adopt advanced artificial intelligence technologies, they are able to deliver a more tailored claims experience for clients. This personalization allows for enhanced communication, anticipatory guidance on required documentation, and proactive follow-up actions based on individual claimant histories, behavioral insights, and risk assessments. The shift towards a predictive, customer-centric ecosystem is set to streamline claim-processing cycles significantly while simultaneously boosting customer satisfaction, positioning AI as a pivotal component in the evolution of claims management.

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 Claims Processing Software Market Size by Deployment & CAGR (2026-2033)

• Market Overview
• Cloud-based
• On-premises

Global Claims Processing Software Market Size by Organization Size & CAGR (2026-2033)

• Market Overview
• Small and Medium Enterprises (SMEs)
• Large Enterprises

Global Claims Processing Software Market Size by Industry Vertical & CAGR (2026-2033)

• Market Overview
• Insurance
• Healthcare
• Manufacturing
• Government
• Transportation and Logistics

Global Claims Processing Software Market Size by Type & CAGR (2026-2033)

• Market Overview
• Property and Casualty (P&C)
• Health
• Workers' Compensation

Global Claims Processing Software Market Size by Functionality & CAGR (2026-2033)

• Market Overview
• Data Management
• Workflow Management
• Reporting and Analytics
• Integration

Global Claims Processing Software Market Size & CAGR (2026-2033)

• North America (Deployment, Organization Size, Industry Vertical, Type, Functionality)
  • US
  • Canada
• Europe (Deployment, Organization Size, Industry Vertical, Type, Functionality)
  • Germany
  • Spain
  • France
  • UK
  • Italy
  • Rest of Europe
• Asia Pacific (Deployment, Organization Size, Industry Vertical, Type, Functionality)
  • China
  • India
  • Japan
  • South Korea
  • Rest of Asia-Pacific
• Latin America (Deployment, Organization Size, Industry Vertical, Type, Functionality)
  • Brazil
  • Rest of Latin America
• Middle East & Africa (Deployment, Organization Size, Industry Vertical, Type, Functionality)
  • 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

• Guidewire Software (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Duck Creek Technologies (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Sapiens International Corporation N.V. (Israel)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• FINEOS (Ireland)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Insurity (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Pegasystems Inc. (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• OneShield Software (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Majesco (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Hyland Software, Inc. (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• EIS (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• LexisNexis (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Riskonnect (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Newgen Software Technologies Limited (India)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• BriteCore (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Snapsheet (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• ClaimVantage (Ireland)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Origami Risk (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Oracle Corporation (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• IBM (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• DXC Technology Company (United States)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments

Conclusion & Recommendations