Healthcare payer services are services that are outsourced by healthcare insurance payers and providers. The changing dynamics of the healthcare sector are compelling payers to rethink business models and processes to deal with the competition in the market while providing better quality patient care by streamlining the process, reducing costs, and improving customer communication. These are the major concerns for healthcare payers and to overcome the obstacles, healthcare payers are currently outsourcing this service to healthcare payer service providers.

The healthcare payer services market is expected to grow due to increasing number of healthcare payer service providers and increasing pressure of cost cutting. The cost of outsourcing healthcare payer service is less compered to in-house payer services. With increasing technological advancement and increasing adoption of analytics in healthcare, and increasing number of people opting for healthcare insurance, the base of customers is growing day by day. This is likely to propel the growth of the market during the forecast period. However, factors such as increasing incidence of cyber theft, i.e., loss of confidential data, and hidden cost associated with outsourcing is expected to hamper the growth of the healthcare payer service market during the forecast period.

The healthcare payer services market has been segmented by service type, application, end-user, and geography. In terms of service type, the market has been categorized into business process outsourcing (BPO), information technology outsourcing (ITO), and knowledge process outsourcing (KPO). Business process outsourcing is expected to account for larger market share due to increasing cost cutting pressure and rising implementation of ICD-10 codes. Based on application, the healthcare payer services market has been segmented into claims management, HR services, billing and accounts management, analytics and fraud management and others. Claims management is expected to account for larger market share due to increasing number of people enrolling for health insurance.  Claims calculation is very time consuming and tedious. Outsourcing of claims management to healthcare payers service providers reduces cost and saves time for insurance companies. Based on end users, the healthcare payer services market has been segmented into private payers and public payers.

Geographically, the healthcare payer services market has been categorized into five regions. These include North America, Europe, Asia Pacific, Latin America, and Middle East & Africa. North America is expected to account for larger market share due to extensive technological advancements in the region. Rising implementation of ICD-10 codes in the U.S. and increasing number of people opting for health insurance, would boost market growth. Moreover, presence of developed IT and healthcare infrastructure, and increasing number of healthcare payer services providers is expected to propel the growth of the healthcare payer services market in the region. Europe is expected to be the second largest market in healthcare payer services owing to enhanced digitization of healthcare processes and implementation of technologically advanced systems in the region. The major factor that would drive the market in Asia Pacific include the acceptance and demand for high end medical infrastructure, and availability of services at lower cost compared to North America and Europe. China, Japan, and India are the most developing countries in the region and hence would fuel the market growth for healthcare payer services. Latin American countries such as Brazil and Mexico have significant potential for growth due to evolving medical structure and high disposable income.

The major players operating in the healthcare payer services market include UnitedHealth Group, Inc., Cognizant Technology Solutions, IBM Corporation, Genpact, Accenture PLC, Xerox Corporation, Hewlett-Packard, Aetna Inc., EXL Service Holdings, Inc. and Wipro Limited.

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Healthcare Payer Services Market