Medical Claims Processing Services Market – Global Industry Insights, Trends, Outlook, and Opportunity Analysis

Healthcare providers are encountering problems in maintaining optimal service quality as the global healthcare business continues to grow. The number of claims is increasing as medical insurance coverage expands. Processing such claims, as well as administrative work, patient care, and other everyday activities, is time-consuming and expensive, requiring highly skilled employees. When a healthcare provider processes claims in-house, there is a danger of delayed payment, accounting errors, and client dissatisfaction. Furthermore, healthcare providers must keep up with changes in rules as well as new services and products that are introduced into the market for in-house claim processing. Medical claims outsourcing ensures minimum error and faster turnaround, lowering the risk of payment delays. According to the American Medical Association (AMA), a 20% error rate among health insurers is an unbearable degree of inefficiency that results in an annual loss of roughly US$ 17 billion. This depicts a strong need for adequate and technically advanced claim processing services and software to reduce the economic burden.

Previously, claims were submitted on paper. However, with the introduction of healthcare IT, the majority of claims are now submitted electronically, i.e. electronic data interchange. The introduction of the online medical claim process minimises paperwork for healthcare providers while also assisting in the payment of proper compensation for services. Medical claims are typically processed by medical claims examiners or medical claims adjusters. However, in cases when there are a considerable number of claims, medical directors analyse the claim and certify its legitimacy.

According to Swiss Re, the global insurance penetration rate was a mere 6.2% in 2014, with India having insurance penetration rate on the lower side, at just 3.9% in the same year. Moreover, the study found that the insurance penetration rate fell to 3.2% in 2015 in India. The U.S., Japan, U.K., Australia, Italy, and France are some of the leading countries in the global medical claims processing services market, owing to higher insurance penetration rate, increasing number of claims, and growing demand from healthcare providers. Furthermore, favorable healthcare policy and government initiatives such as Affordable Care Act have also boosted demand for medical claim processing services in the U.S. Europe is quickly emerging as another important medical claims processing services market. However, introduction of Solvency II in Europe may have an adverse impact on the insurance operators in Europe.