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™ and Healthcare Payer Business Process Transformation 2025 RadarView™, 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:
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- Leaders: Accenture, Cognizant, EXL, Firstsource, Optum, Sagility, and Wipro
- Innovators: Conduent, HCLTech, NTT DATA, Sutherland, and WNS
- Disruptors: Concentrix, Exela Technologies, Genpact, Infosys, and Smart Data Solutions
- Challengers: Hexaware, Omega Healthcare, Shearwater Health, Vee Healthtek, and Viaante
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:
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- Rise in hospital and medical expenses, claims adjustment, and administrative expenses are impacting the net income and profit margin of healthcare payers.
- There is an increased focus on value-based care programs to deliver comprehensive clinical care, seamless in-person care navigation, cost savings, improved retention rates and health outcomes, and reduced physician burnout.
- Very large clients, with over a billion dollars in annual revenue, contribute 39% of service providers’ revenue.
- Outcome and output/transaction-based pricing models are the most popular, jointly accounting for 58% of healthcare payer service engagements.
“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™ and Healthcare Payer Business Process Transformation 2025 RadarView™ (click for pricing).