The healthcare payer services industry is undergoing significant transformation, propelled by mounting margin and regulatory pressures, rapid technological advances, and rising member expectations. A rise in hospital and medical expenses, claims adjustment, and administrative expenses have eroded payers’ net income, intensifying the need for operational efficiency. Members now demand integrated, personalized engagement when navigating health benefits, prompting payers and service providers to modernize claims and care management processes. These dynamics have fueled robust growth in healthcare payer business process transformation services, as reflected by a 10%–20% increase in both active clients and revenue growth among service providers during FY 2023–2024.
Both demand- and supply-side trends are covered in Avasant’s Healthcare Payer Business Process Transformation 2025 Market Insights‚Ñ¢ and Healthcare Payer Business Process Transformation 2025 RadarView‚Ñ¢, respectively. These reports present a comprehensive study of the healthcare payer process services industry and closely examine the market leaders, innovators, disruptors, and challengers. They also provide a view into key market trends and developments impacting the healthcare payer services space.
Avasant evaluated 39 service providers across three dimensions: practice maturity, domain ecosystem, and investments and innovation. Of the 39 providers, we recognized 22 that brought the most value to the market during the past 12 months.
The report recognizes service providers in four categories:
Figure 1 below from the full report illustrates these categories:
“Modernizing claims processing, prior authorization, and payments is vital for payers as they tackle declining income and margins and regulatory pressures,” said Matthew Barlow, partner at Avasant. “AI and ML can help them automate workflows, improve decision accuracy and turnaround times, ultimately improving compliance and cost efficiency.”
The reports provide a number of findings, including the following:
“Members demand tailored experiences when managing their health benefits,” said Aditya Jain, research leader with Avasant. “Payers are deploying Gen AI and value-based care models to deliver personalized recommendations, holistic support, and seamless navigation across digital and traditional channels, driving engagement and better health outcomes.”
This RadarView features detailed profiles of 22 service providers, along with their solutions, offerings, and experience in assisting enterprises and individuals in their healthcare payer journey.
This Research Byte is a brief overview of Avasant’s Healthcare Payer Business Process Transformation 2025 Market Insights‚Ñ¢ and Healthcare Payer Business Process Transformation 2025 RadarView‚Ñ¢ (click for pricing).
Avasant’s research and other publications are based on information from the best available sources and Avasant’s independent assessment and analysis at the time of publication. Avasant takes no responsibility and assumes no liability for any error/omission or the accuracy of information contained in its research publications. Avasant does not endorse any provider, product or service described in its RadarView™ publications or any other research publications that it makes available to its users, and does not advise users to select only those providers recognized in these publications. Avasant disclaims all warranties, expressed or implied, including any warranties of merchantability or fitness for a particular purpose. None of the graphics, descriptions, research, excerpts, samples or any other content provided in the report(s) or any of its research publications may be reprinted, reproduced, redistributed or used for any external commercial purpose without prior permission from Avasant, LLC. All rights are reserved by Avasant, LLC.
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