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The healthcare claims management sector continues to evolve as the landscape continues to witness new care models, changes in the reimbursement landscape (for virtual care, urgent care, Telehealth, and At-Home care), and a transition to value-based care models such as population-based reimbursement partial and full capitation payment model and disruption from entrants of big techs, big-box retailers, and big telecoms in areas of primary care and platform play in healthcare. In addition to the above shifts in demographic, health consumer empowerment (self-quantified consumer), employer push for value, and regulatory changes are forcing health insurance companies and providers to redesign their claims processing and payment processes and capabilities through technology interventions such as Robotic Process Automation (RPA) and AI in claims predictions, prior-authorization, and pre/post-adjudication, and claims payment.

• This growth opportunity analysis covers the qualitative and quantitative analysis of the selective healthcare claims management software, services, and technology interventions for the United States sector.

• The analysis covers in-depth coverage of the key vendor’s solutions and services across the payer and provider back-office operations including claims intake, preparation, pre/post-adjudication, claims adjustment, and payment.

• It includes vendor’s solutions and services such as Robotic Process Automation (RPA), AI, Clearinghouse, Payment Integrity, Care Management, Revenue Cycle Management, and EMR/EHRs across the provider and payer claims’ value chain.