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、部署模式、最終用戶產業和地區分類）－2026-2033年產業預測

全球醫療理賠管理市場規模預計到 2024 年將達到 153.1 億美元，到 2025 年將達到 161.7 億美元，到 2033 年將達到 250 億美元，預測期（2026-2033 年）的複合年成長率為 5.6%。

全球醫療理賠管理格局正經歷重大變革，相關人員都在尋求簡化理賠流程，同時降低相關成本和錯誤率。醫療系統的複雜性、不斷成長的患者數量以及最佳化理賠流程的迫切需求，共同推動了技術進步，尤其是在人工智慧、自動化和雲端運算領域的進步，這些進步正透過提高準確性、加快理賠速度和增強詐欺檢測能力，徹底改變著理賠管理。日益嚴格的監管要求以及醫療模式轉向價值導向醫療的轉變，促使保險公司和醫療服務提供者更加重視透明度和合規性。電子健康記錄 (EHR) 和數位健康解決方案的整合，使計費系統能夠整合財務和臨床數據，從而使理賠管理成為未來醫療收入週期中不可或缺的重要組成部分。

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促進因素之一是醫療機構日益重視降低營運成本和提高效率。隨著醫療成本的持續上漲，醫療服務提供者和保險公司正將高效的理賠處理作為優先事項，以改善收入週期管理。在理賠管理系統中採用人工智慧、機器學習和自動化等先進技術有助於縮短處理時間並最大限度地減少錯誤。此外，監管合規要求也促使醫療服務提供者投資於有效的理賠管理解決方案，從而推動了對能夠準確提交和追蹤理賠的綜合系統的需求。

全球醫療索賠管理市場的限制因素

全球醫療保健理賠管理市場面臨的主要限制因素之一是不同地區和國家監管法規的複雜性和多樣性。醫療保健法規在不同地區差異顯著，這使得在多個司法管轄區運營的公司面臨合規挑戰，並導致營運成本增加。此外，這些法規還在不斷變化，需要對理賠管理流程進行持續調整，進一步加劇了其複雜性。此類不一致之處會降低理賠處理效率，阻礙對先進技術的投資，增加理賠被拒的風險，並最終影響醫療保健產業組織的盈利和永續性。

全球醫療理賠管理市場趨勢

全球醫療理賠管理市場正經歷重大變革，人工智慧 (AI) 和自動化技術的整合勢在必行。這些創新正在改變產業的面貌，它們透過簡化理賠流程、增強資料提取和確保提交檢驗，取代了傳統的人工方法。理賠審核自動化不僅縮短了報銷時間，還最大限度地減少了錯誤，提高了準確性，最終降低了醫療機構的營運成本。這一趨勢凸顯了醫療產業致力於提高理賠管理效率和準確性的決心，並將人工智慧驅動的解決方案定位為醫療營運發展演進的關鍵組成部分。

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

全球醫療理賠管理市場規模（按組成部分及複合年成長率分類）（2026-2033 年）

• 軟體解決方案
• 服務

全球醫療理賠管理市場規模（按產品類型和複合年成長率分類）（2026-2033 年）

• 索賠提交和審核
• 詐欺罪
• 欺詐、浪費和濫用 (FWA) 偵測
• 病患訪問和計費解決方案
• 分析與報告

全球醫療理賠管理市場規模（按部署模式和複合年成長率分類）（2026-2033 年）

• 本地部署
• 基於雲端/SaaS

全球醫療理賠管理市場規模（依最終用戶產業分類）及複合年成長率（2026-2033 年）

• 醫療保健提供者
• 付款方/保險公司
• 政府和公共衛生機構

全球醫療理賠管理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

• 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

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