The Global Claims Processing Software Market size is expected to reach $59 billion by 2028, rising at a market growth of 8.5% CAGR during the forecast period.
Claims management software is software that allows businesses to create and execute automated end-to-end claims operations that are highly agile, intelligent, and ready to generate revenue. Companies become able to easily establish intelligent, dynamic business rules that completely capture company objectives as well as best practices, and then utilize those rules to drive automated processes that consistently apply the best thinking across enterprises using claims software. Customer-focused, cost-effective, and adaptable claims processing processes are required by insurers, healthcare professionals, and manufacturing enterprises.
Insurance claims processing software can be used by leading organizations within these industries in order to minimize operational inefficiencies and legacy difficulties, cut training and maintenance costs, and enhance the customer experience. Automated processes are as smart as the business regulations that drive them, and these platforms fulfill business requirements and capability that is significantly more sophisticated and flexible than competing alternatives. Claims processing software empowers businesses more than any other business management solution.
For instance, a medical claim is an invoice sent to a health insurance company by a doctor or medical facility after a patient has received treatment. It outlines the services a patient received as well as the charges imposed by the doctor or facility. These services are described using a large number of standardized medical codes known as Current Procedural Terminology (CPT) codes, which help to speed up the claims review and payment process.
Claims processing is a complex process with over 20 stages that each claim must pass through before being authorized. If a claim passes all of these checks with flying colors, the insurance company authorizes it and begins processing any insurance payouts. If it doesn't, it will either be rejected or returned for more information.
The market research report covers the analysis of key stake holders of the market. Key companies profiled in the report include Duck Creek Technologies, Inc., FINEOS Corporation Holdings plc, Hyland Software, Inc., Hawksoft, Inc., HIPAAsuite, Newgen Software Technologies Limited, Pegasystems, Inc., Quick Silver Systems, Inc., Ventiv Technology, and A1 Enterprise, Inc.
By Component
Claims management software is software that allows businesses to create and execute automated end-to-end claims operations that are highly agile, intelligent, and ready to generate revenue. Companies become able to easily establish intelligent, dynamic business rules that completely capture company objectives as well as best practices, and then utilize those rules to drive automated processes that consistently apply the best thinking across enterprises using claims software. Customer-focused, cost-effective, and adaptable claims processing processes are required by insurers, healthcare professionals, and manufacturing enterprises.
Insurance claims processing software can be used by leading organizations within these industries in order to minimize operational inefficiencies and legacy difficulties, cut training and maintenance costs, and enhance the customer experience. Automated processes are as smart as the business regulations that drive them, and these platforms fulfill business requirements and capability that is significantly more sophisticated and flexible than competing alternatives. Claims processing software empowers businesses more than any other business management solution.
For instance, a medical claim is an invoice sent to a health insurance company by a doctor or medical facility after a patient has received treatment. It outlines the services a patient received as well as the charges imposed by the doctor or facility. These services are described using a large number of standardized medical codes known as Current Procedural Terminology (CPT) codes, which help to speed up the claims review and payment process.
Claims processing is a complex process with over 20 stages that each claim must pass through before being authorized. If a claim passes all of these checks with flying colors, the insurance company authorizes it and begins processing any insurance payouts. If it doesn't, it will either be rejected or returned for more information.
COVID-19 Impact Analysis
The COVID-19 pandemic has had a favorable impact on the claims processing software market since customers of health insurance as well as general insurance required claims settlement due to persistent health difficulties and business losses. The insurance companies found it difficult to cope with the unexpected increase in claim settlements, so they began to use claims processing software that could readily handle huge numbers of claims at once. Furthermore, it accelerated the process, saving personnel time and effort. As a result, during the COVID-19 pandemic, demand for insurance claims processing software surged.Market Growth Factors
Increased Productivity and Standardization along with the reduced cost
Manual processes take a long time and are more prone to result in incorrect paperwork along with other administrative problems. Traditional claims management solutions are not only more prone to mistakes, but they can also become obsolete. One of the most significant advantages of claims processing software is that it completely eliminates the need for these manual processes. It cuts down on errors, saves time, and improves data accuracy. Any company's growth depends on its ability to organize and standardize its operations. The company's adjustment department should have established methods that everyone can follow.Enhanced data accuracy, security, and integration
Insurance claims management systems ensure that accurate data is processed, resulting in better service and increased customer satisfaction. It enables insurance companies to compete successfully in the market by eliminating manual mistake. By automating the entire process, it is possible to reduce and eliminate human error. This helps employees save time and increase their productivity, allowing them to better serve their clients. The software intelligently extracts specific data items to make integration easier, then evaluates them against the policy. It sends out multi-level notifications automatically and efficiently raises alerts for unrecognized loss reports.
Market Restraining Factors
Higher initial and maintenance cost of claims processing software
Claims processing software is a very efficient and effective solution for the management of claims processing procedures. It significantly saves time and the cost of an enterprise. However, the initial cost of acquiring necessary hardware and software is a key barrier to the migration of enterprises from traditional claims processing to contemporary and automated claims processing software. Training for the entire workforce to learn how to enter and utilize the software is another add-on to the start-up cost. Once the system is in place, all client records must be transferred to electronic format, which takes a lot of time and money to do.Component Outlook
Based on Component, the market is segmented into Software (Without Services) and Services. In 2020, the software (without services) segment acquired the largest revenue share of the claims processing software market. The growth of the segment is increasing due to claim processing software's ability to provide a full perspective of claims, making it easier to identify discrepancies and detect potential fraud early on. Furthermore, claims processing software is far more capable of detecting errors than the human eye.Enterprise Size Outlook
Based on Enterprise Size, the market is segmented into Large Enterprises and Small & Medium-sized Enterprises. In 2021, the small and medium-sized enterprises segment witnessed a substantial revenue share of the claims processing market. The expediting growth of this segment is attributed to the cost-efficiency of claims processing software. This software significantly saves time and allows the organization to leverage that time in any other operation.End User Outlook
Based on End User, the market is segmented into Insurance Companies, Insurance Intermediaries, Agents & Brokers, and Others. In 2020, the insurance companies segment registered the largest revenue share of the claims processing software market. This is due to the fact that the insurance claims management system enables insurance businesses to function more efficiently by providing faster access to claims data. The program also enables increased process visibility by tracking the performance of claim processes.Regional Outlook
Based on Regions, the market is segmented into North America, Europe, Asia Pacific, and Latin America, Middle East & Africa. In 2020, North America accounted for the largest revenue share of the claims processing market. This is due to the fact that North America has seen a higher rate of adoption of cloud-based solutions as a result of growing digitalization in the insurance and e-commerce sectors, which boosts the regional market's growth potential significantly.The market research report covers the analysis of key stake holders of the market. Key companies profiled in the report include Duck Creek Technologies, Inc., FINEOS Corporation Holdings plc, Hyland Software, Inc., Hawksoft, Inc., HIPAAsuite, Newgen Software Technologies Limited, Pegasystems, Inc., Quick Silver Systems, Inc., Ventiv Technology, and A1 Enterprise, Inc.
Strategies Deployed in Claims Processing Software Market
Partnerships, Collaborations and Agreements:
- May-2022: Pegasystems collaborated with Tech Mahindra, a leader in digital transformation, consulting, and business reengineering solutions and services distribution. Under this collaboration, the companies is expected to develop an expanded ecosystem in order to drive introduce innovative industry solutions to enable the accelerated digital transformation of customers.
- May-2022: HawkSoft joined hands with InsuredMine, an innovative technology company. With this collaboration, the companies aimed to offer a two-way API integration between their platforms.
- Mar-2022: Duck Creek Technologies partnered with Whatfix, a global leader in the digital adoption platforms space. Through this partnership, the companies aimed to offer improved customer experience to claims handlers of insurance carriers by leveraging using Duck Creek Claims. In addition, this partnership is expected to significantly cut time and compliance costs.
- Jan-2022: HawkSoft and vipHomeLink, a Morristown, N.J.-based InsurTech focused on digital home management solutions, have announced a formal partnership. vipHomeLink is the latest company to join HawkSoft’s Referral Partner Program. Through this new relationship, vipHomeLink will offer a suite of digital home management tools for homeowners.
- Nov-2021: Pegasystems teamed up with Google Cloud, Google's suite of cloud computing services. With this collaboration, the companies aimed to enhance customer experience by offering improved data insights and personalization options to healthcare facilities. Moreover, Pegasystems is expected to integrate Google Cloud’s Healthcare Data Engine into its lineup of intelligent healthcare solutions under this collaboration.
- Oct-2021: Duck Creek Technologies teamed up with TIREA, a vendor of IT and Communication Networks for Insurance companies. Under this collaboration, TIREA is expected to offer its extensive expertise to Duck Creek solutions in order to streamline its integration across the Spanish market
- Jul-2021: FINEOS came into a partnership with Beneva, a Canadian insurance company. Under this partnership, FINEOS is expected to offer its SaaS technology to Beneva for streamlined claims management processes as well as enhanced customer services.
- Apr-2021: Duck Creek came into a partnership with Mindtree, a leader in digital transformation and technology services. Following this partnership, the companies aimed to enhance the customer experience for UPC Insurance customers with the deployment of SaaS-based core systems. Moreover, it includes claims, billing, data insights, policy, and insurance technology solutions along with the integration of several applications on a single integrated platform.
- Feb-2021: FINEOS entered into a partnership with Partners Life, a New Zealand-based insurance company. Through this partnership, the companies aimed to focus on substituting prevailing claims systems as well as processes along with a varied value proposition. Moreover, this partnership is expected to introduce major operational advantages, like integrated, efficient, and automated workflow processes along with precise claims covering life.
- Feb-2021: Newgen partnered with Glia, a leader in Digital Customer Service. This partnership aimed to improve Newgen's banking solutions through the integration of Newgen's online account opening and lending portals with the digital customer service capabilities of Glia.
- Sep-2020: Pegasystems extended its partnership with DXC Technology, an American multinational information technology services, and consulting company. Following this extended partnership, DXC Technology is expected to leverage Pega’s software to distribute solutions through DXC-developed IP and blueprints across Australia and New Zealand region.
- Jun-2020: Hyland partnered with Duck Creek Technologies, a leader in providing insurance core system solutions. Following this partnership, the companies aimed to introduce an integration of Hyland's OnBase Accelerator and the Duck Creek Platform in order to bolster and streamline data management and offer a complete view.
Product Launches and Product Expansions:
- Mar-2022: The FINEOS introduced a range of updates in its cloud-native FINEOS Platform. This product expansion aimed to meet the requirements across the full customer spectrum throughout employers, employees, and insurers in order to increase the effectiveness of sales and service along with accelerating the market time of new products. Furthermore, it is expected to offer an enhanced customer experience to the customer.
- Mar-2022: Pegasystems introduced version 8.7 of its Pega Infinity software package. The product expansion aimed to offer automation, artificial intelligence, updates in low-code, and cloud architecture to help companies in innovating quick and enhanced experiences for customers and employees.
- Nov-2021: Newgen launched iBPS 5.0 SP2, the latest version of its low-code process automation platform. The new solution aimed to offer various new improvements to its customization options, robotic process automation, containerized deployment, rule engine, mobile app capabilities, data handling, and other features to facilitate businesses to bolster digital transformation initiatives by offering them the access to a wider range of features for the Newgen Software platform.
- Jul-2021: Newgen rolled out NewgenONE, a comprehensive digital transformation platform. With this launch, the company aimed to streamline sophisticated business processes, manage unorganized data, and accelerate customer engagement on the basis of evolving customer demands.
- May-2021: Pegasystems introduced intelligent automation features to its Pega Platform. This product expansion aimed to automate applications, like healthcare claims processing, IoT-connected device analysis, and financial fraud detection. Moreover, the new version deploys machine learning, event stream processing, and natural language processing capabilities throughout business actions.
Acquisition and Merger:
- Jan-2022: Newgen took over Number Theory, an India-based AI/ML data science platform company. Through this acquisition, the company aimed to strengthen its NewgenONE, a code digital transformation platform of the company with data analytics and AI/ML modeling capabilities of Number Theory.
- Aug-2020: FINEOS acquired Limelight Health, a leader in providing rating, quoting, and underwriting solutions. This acquisition aimed to offer an end-to-end SaaS core product offering from quote, rate, and underwrite via billing absence and claims management, and policy administration to the worldwide accident, life, and health industry.
Scope of the Study
Market Segments Covered in the Report:
By Component
- Software (Without Services)
- Services
- Large Enterprises
- Small & Medium-sized Enterprises
- Insurance Companies
- Insurance Intermediaries
- Agents & Brokers
- Others
- North America
- US
- Canada
- Mexico
- Rest of North America
- Europe
- Germany
- UK
- France
- Russia
- Spain
- Italy
- Rest of Europe
- Asia Pacific
- China
- Japan
- India
- South Korea
- Singapore
- Malaysia
- Rest of Asia Pacific
- LAMEA
- Brazil
- Argentina
- UAE
- Saudi Arabia
- South Africa
- Nigeria
- Rest of LAMEA
Key Market Players
List of Companies Profiled in the Report:
- Duck Creek Technologies, Inc.
- FINEOS Corporation Holdings plc
- Hyland Software, Inc.
- Hawksoft, Inc.
- HIPAAsuite
- Newgen Software Technologies Limited
- Pegasystems, Inc.
- Quick Silver Systems, Inc.
- Ventiv Technology
- A1 Enterprise, Inc.
Unique Offerings from the Publisher
- Exhaustive coverage
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Table of Contents
Chapter 1. Market Scope & Methodology
Chapter 2. Market Overview
Chapter 3. Competition Analysis - Global
Chapter 4. Global Claims Processing Software Market by Component
Chapter 5. Global Claims Processing Software Market by Enterprise Size
Chapter 6. Global Claims Processing Software Market by End User
Chapter 7. Global Claims Processing Software Market by Region
Chapter 8. Company Profiles
Companies Mentioned
- Duck Creek Technologies, Inc.
- FINEOS Corporation Holdings plc
- Hyland Software, Inc.
- Hawksoft, Inc.
- HIPAAsuite
- Newgen Software Technologies Limited
- Pegasystems, Inc.
- Quick Silver Systems, Inc.
- Ventiv Technology
- A1 Enterprise, Inc.
Methodology
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