Summary

Healthcare Payer Service Market Research Report Information by Service Type (Business Process Outsourcing Services, IT Outsourcing Services, and Knowledge Process Outsourcing Services) by Application (Claims Management, Integrated Front Office and Back Office Operations, Member Management, Provider Management, Billing and Accounts Management, Analytics and Fraud Management, Human Resource, Clinical Decision-Making, Patient Engagement, and Others), by End User (Private Payers and Public Payers), by Region Forecast to 2032

Overview of the Market
In 2022, the healthcare payer services market was estimated to be worth USD 69.32 billion. According to projections, the Healthcare Payer Service Market will expand at a compound annual growth rate (CAGR) of 8.81% from 2023 to 2032, from USD 73.01 billion to USD 156.04 billion.
Several variables, including the aging of the population in emerging nations, the rising expense of healthcare, and modifications to employer-sponsored health insurance, are contributing to the rise in enrollment in healthcare insurance. About 31 million Americans were enrolled in late 2020 and early 2021, according to the Assistant Secretary for Planning and Evaluation. Additionally, in 2022 and early 2023, approximately 40.2 million Americans signed up for Marketplace and Medicaid expansion coverage.
Additionally, secondary research indicates that increasing awareness of the advantages of adopting health insurance, lowering the cost of health insurance products, and the government providing opportunities for people to try health insurance at a subsidized rate are the main reasons for the high increase in health insurance enrollment in low- and middle-income countries. As a result, the market for healthcare payer services is expanding due to growing health insurance enrollment and awareness.

Perspectives on Market Segments
Business process outsourcing, IT outsourcing, and knowledge process outsourcing are among the service types that are included in the Healthcare Payer Service Market segmentation.
Applications such as claims management, integrated front office and back-office operations, member and provider management, billing and accounts management, analytics and fraud management, human resources, clinical decision-making, patient engagement, and others are the basis for the segmentation of the healthcare payer service market.
Both public and private payers are included in the end-user segmentation of the healthcare payer service market.
Regional Perspectives
The market is divided into four regions by the study: North America, Europe, Asia-Pacific, and the Rest of the World. In 2022, the biggest market share was held by the healthcare payer services market in North America. This is because of the region's sophisticated healthcare system, the expanding adherence to healthcare regulations, and the well-established presence of significant market participants.
From 2023 to 2032, the Asia-Pacific healthcare payer services market is anticipated to expand at a substantial rate. This is a result of increased investments and reforms aimed at modernizing China's healthcare system, the introduction of new ICT regulations in Japan, and the growing number of patients in the Asia-Pacific area afflicted with chronic conditions like cancer, orthopedic disorders, and cardiovascular diseases.
Africa, Latin America, and the Middle East make up the rest of the world. The market for healthcare payer services in the aforementioned regions is anticipated to expand as a result of regional investments in healthcare infrastructure and technology advancements.
Key Players
Oracle Corporation (US), IQVIA Holding, Inc. (US), HCL Technologies Limited (India), Accenture (Ireland), Cognizant (US), Dell Inc. (US), Genpact (US), Omega Healthcare Management Services (India), Infosys Limited (India), and NTT DATA, Inc. (Japan) are important players in the healthcare payer services market.

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Table of Contents

TABLE OF CONTENTS
1 EXECUTIVE SUMMARY 16
2 MARKET INTRODUCTION 18
2.1 DEFINITION 18
2.2 SCOPE OF THE STUDY 18
2.3 RESEARCH OBJECTIVE 18
2.4 MARKET STRUCTURE 19
3 RESEARCH METHODOLOGY 20
3.1 OVERVIEW 20
3.2 DATA FLOW 22
3.2.1 DATA MINING PROCESS 22
3.3 PURCHASED DATABASE: 23
3.4 SECONDARY SOURCES: 24
3.4.1 SECONDARY RESEARCH DATA FLOW: 25
3.5 PRIMARY RESEARCH: 26
3.5.1 PRIMARY RESEARCH DATA FLOW: 27
3.5.2 PRIMARY RESEARCH: NUMBER OF INTERVIEWS CONDUCTED 28
3.5.3 PRIMARY RESEARCH: REGIONAL COVERAGE 28
3.6 APPROACHES FOR MARKET SIZE ESTIMATION: 29
3.6.1 REVENUE ANALYSIS APPROACH 29
3.7 DATA FORECASTING 30
3.7.1 DATA FORECASTING TECHNIQUE 30
3.8 DATA FORMULATIONLING 31
3.8.1 MICROECONOMIC FACTOR ANALYSIS: 31
3.8.2 DATA FORMULATIONLING: 32
3.9 TEAMS AND ANALYST CONTRIBUTION 34
4 MARKET DYNAMICS 35
4.1 INTRODUCTION 35
4.2 DRIVERS 36
4.2.1 INCREASING NUMBER OF HEALTHCARE INSURANCE ENROLLMENTS 36
4.2.2 RISING CASES OF HEALTHCARE FRAUD 36
4.3 RESTRAINTS 37
4.3.1 HIGH RISK OF DATA BREACHES AND LOSS OF CONFIDENTIALITY 37
4.4 OPPORTUNITY 38
4.4.1 INCREASING ADOPTION OF ADVANCED DATA ANALYTICS 38
5 MARKET FACTOR ANALYSIS 39
5.1 VALUE CHAIN ANALYSIS 39
5.1.1 CUSTOMER ACQUISITION (PREPURCHASE QUERY) 40
5.1.2 SERVICE CUSTOMIZATION 40
5.1.3 CUSTOMER PURCHASE SUPPORT 40
5.1.4 CUSTOMER FULFILMENT & POST-PURCHASE SUPPORT 40
5.2 PORTER’S FIVE FORCES MODEL 41
5.2.1 THREAT OF NEW ENTRANTS 41
5.2.2 BARGAINING POWER OF SUPPLIERS 41
5.2.3 THREAT OF SUBSTITUTES 42
5.2.4 BARGAINING POWER OF BUYERS 42
5.2.5 INTENSITY OF RIVALRY 42
5.3 COVID-19 IMPACT ANALYSIS 42
5.3.1 DEMAND-SUPPLY ANALYSIS 42
5.3.2 PRICING ANALYSIS 42
5.3.3 IMPACT ON KEY PLAYERS 42
5.4 QUALITATIVE OVERVIEW ON “EVALUATING WORKFLOW GAPS IN HEALTHCARE TRANSACTIONAL PROCESSES BETWEEN MEDICAL INSURANCE PAYERS AND LABORATORIES OR PHARMACIES 43
6 GLOBAL HEALTHCARE PAYER SERVICES MARKET, BY SERVICE TYPE 44
6.1 OVERVIEW 44
6.2 BUSINESS PROCESS OUTSOURCING SERVICES 46
6.3 IT OUTSOURCING SERVICES 47
6.4 KNOWLEDGE PROCESS OUTSOURCING SERVICES 47
7 GLOBAL HEALTHCARE PAYER SERVICES MARKET, BY APPLICATION 48
7.1 OVERVIEW 48
7.2 CLAIMS MANAGEMENT 51
7.3 INTEGRATED FRONT OFFICE AND BACK OFFICE OPERATIONS 52
7.4 MEMBER MANAGEMENT 52
7.5 PROVIDER MANAGEMENT 53
7.6 BILLING AND ACCOUNTS MANAGEMENT 53
7.7 ANALYTICS AND FRAUD MANAGEMENT 54
7.8 HUMAN RESOURCE 54
7.9 CLINICAL DECISION-MAKING 54
7.10 PATIENT ENGAGEMENT 55
7.11 OTHERS 55
8 GLOBAL HEALTHCARE PAYER SERVICES MARKET, BY END USER 56
8.1 OVERVIEW 56
8.2 PRIVATE PAYERS 58
8.3 PUBLIC PAYERS 58
9 GLOBAL HEALTHCARE PAYER SERVICES MARKET, BY REGION 59
9.1 OVERVIEW 59
9.2 NORTH AMERICA 61
9.2.1 US 64
9.2.2 CANADA 66
9.3 EUROPE 68
9.3.1 GERMANY 72
9.3.2 FRANCE 73
9.3.3 UK 75
9.3.4 ITALY 76
9.3.5 SPAIN 78
9.3.6 REST OF EUROPE 79
9.4 ASIA-PACIFIC 81
9.4.1 CHINA 85
9.4.2 INDIA 86
9.4.3 JAPAN 88
9.4.4 SOUTH KOREA 89
9.4.5 AUSTRALIA 91
9.4.6 REST OF ASIA-PACIFIC 92
9.5 REST OF THE WORLD 94
9.5.1 MIDDLE EAST & AFRICA 98
9.5.2 SOUTH AMERICA 99
10 COMPETITIVE LANDSCAPE 101
10.1 INTRODUCTION 101
10.2 MARKET SHARE ANALYSIS, 2022 101
10.3 COMPETITOR DASHBOARD 102
10.4 PUBLIC PLAYERS STOCK SUMMARY 103
10.5 COMPARATIVE ANALYSIS: KEY PLAYERS FINANICAL 103
10.6 KEY DEVELOPMENTS & GROWTH STRATEGIES 104
10.6.1 ACQUISITION 104
10.6.2 COLLABORATION 104
11 COMPANY PROFILES 105
11.1 ORACLE CORPORATION 105
11.1.1 COMPANY OVERVIEW 105
11.1.2 FINANCIAL OVERVIEW 106
11.1.3 SERVICES OFFERED 106
11.1.4 KEY DEVELOPMENTS 107
11.1.5 SWOT ANALYSIS 108
11.1.6 KEY STRATEGIES 108
11.2 IQVIA HOLDING, INC. 109
11.2.1 COMPANY OVERVIEW 109
11.2.2 FINANCIAL OVERVIEW 110
11.2.3 SERVICES OFFERED 110
11.2.4 KEY DEVELOPMENTS 111
11.2.5 SWOT ANALYSIS 111
11.2.6 KEY STRATEGIES 112
11.3 HCL TECHNOLOGIES LIMITED 113
11.3.1 COMPANY OVERVIEW 113
11.3.2 FINANCIAL OVERVIEW 114
11.3.3 SERVICES/SOLUTIONS OFFERED 114
11.3.4 KEY DEVELOPMENTS 115
11.3.5 SWOT ANALYSIS 115
11.3.6 KEY STRATEGIES 116
11.4 ACCENTURE 117
11.4.1 COMPANY OVERVIEW 117
11.4.2 FINANCIAL OVERVIEW 118
11.4.3 PRODUCTS OFFERED 118
11.4.4 KEY DEVELOPMENTS 119
11.4.5 KEY STRATEGIES 119
11.5 COGNIZANT 120
11.5.1 COMPANY OVERVIEW 120
11.5.2 FINANCIAL OVERVIEW 121
11.5.3 PRODUCTS OFFERED 121
11.5.4 KEY DEVELOPMENTS 122
11.5.5 SWOT ANALYSIS 122
11.5.6 KEY STRATEGIES 123
11.6 DELL INC. 124
11.6.1 COMPANY OVERVIEW 124
11.6.2 FINANCIAL OVERVIEW 125
11.6.3 PRODUCTS OFFERED 125
11.6.4 KEY DEVELOPMENTS 125
11.6.5 KEY STRATEGIES 126
11.7 GENPACT 127
11.7.1 COMPANY OVERVIEW 127
11.7.2 FINANCIAL OVERVIEW 128
11.7.3 PRODUCTS OFFERED 128
11.7.4 KEY DEVELOPMENTS 129
11.7.5 KEY STRATEGIES 129
11.8 OMEGA HEALTHCARE MANAGEMENT SERVICES 130
11.8.1 COMPANY OVERVIEW 130
11.8.2 FINANCIAL OVERVIEW 130
11.8.3 SERVICES OFFERED 131
11.8.4 KEY DEVELOPMENTS 131
11.8.5 KEY STRATEGIES 131
11.9 INFOSYS LIMITED 132
11.9.1 COMPANY OVERVIEW 132
11.9.2 FINANCIAL OVERVIEW 133
11.9.3 SERVICES OFFERED 133
11.9.4 KEY DEVELOPMENTS 135
11.9.5 SWOT ANALYSIS 136
11.9.6 KEY STRATEGIES 136
11.10 NTT DATA, INC 137
11.10.1 COMPANY OVERVIEW 137
11.10.2 FINANCIAL OVERVIEW 138
11.10.3 SERVICES OFFERED 138
11.10.4 KEY DEVELOPMENTS 139
11.10.5 KEY STRATEGIES 139