Healthcare and Pharmaceutical Medical Claims Processing Services Market Growth O

Medical Claims Processing Services Market - Size,
Share, Emerging Trends, Outlook, and Opportunity
Analysis, 2018 – 2026
Global Medical Claims Processing Services Market Insights, Opportunity
Analysis, and Industry Forecast till 2026
As the global healthcare industry continues to expand, healthcare providers are facing challenges in
maintaining optimal quality of services. Number of claims are increasing with increasing coverage of
medical insurance. Processing such claims along with the administrative tasks, patient care, and other
daily operations is cumbersome and involves high cost and trained personnel. Processing of claims in-
house by the healthcare provider has the risk of delayed payment, error in amounting, and customer
dissatisfaction. Moreover, healthcare providers need to be updated with changes in regulations and
new services and products being launched in the market for in-house processing of claims. Outsourcing
of medical claims ensures minimal error and faster turnover, thereby reducing risk of delayed payment.
According to the American Medical Association (AMA), 20% error rate among health insurers
represents an intolerable level of inefficiency that causes a loss of around US$ 17 billion each year.
This depicts a strong need for adequate and technically advanced claim processing services and
software to reduce the economic burden.
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Earlier, claims were submitted using a paper form. However, with the advent of healthcare IT, most
claims are now electronically made i.e. electronic data interchange. The onset of online medical claim
process reduces paperwork of healthcare providers and also assists in rendering adequate fees for
the services. Usually the medical claims are processed by medical claims examiners or medical
claims adjusters. In case of large number of claims though, medical directors review the claim and
validate its authenticity.
Geographical expansion of global players is leading to increasing competition. Key players are
adopting new operating models to achieve maximum efficiency rate. There are various challenges
related to claims processing such as volume of claims, speed of processing, accuracy, regulatory
compliance, and administrative costs. Therefore, claims processing companies are at the service of
insurance providers to reduce their time and efforts.