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Healthcare Payer Operations Transformation 2023

Market Analysis

by John Willmott

published on Jun 15, 2023

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Report Overview:

NelsonHall’s Healthcare Payer Operations Transformation market analysis consists of 88 pages.

Who is this Report for:

NelsonHall’s Healthcare Payer Operations Transformation report is a comprehensive market assessment report designed for:

  • Sourcing managers investigating developments within healthcare payer operations transformation and BPS
  • Vendor marketing, sales and business managers developing strategies to target healthcare payer operations transformation and BPS
  • Financial analysts and investors specializing in the operational transformation & BPS sector.

Scope of this Report:

The report concentrates on the U.S. market for healthcare payer operations transformation and BPS and addresses the following questions:

  • What is the market size and projected growth for the U.S. healthcare BPS market for both the private and government sectors?
  • What services are currently supplied by vendors and how are these evolving?
  • What digital technologies are being deployed in support of these services and operational transformation?
  • What are the benefits currently achieved by users of healthcare payer operations transformation and BPS services?
  • Who are the leading healthcare payer operations transformation and BPS vendors?
  • What are the key capabilities of each vendor?
  • What is the current pattern of delivery locations used for healthcare payer operations transformation and BPS?
  • What services are delivered from onshore and which from offshore?
  • What are the challenges and success factors within healthcare payer operations transformation and BPS?

Key Findings & Highlights:

Service adoption is high in customer administration and claims administration. These are relatively mature services where high levels of automation have been applied. Nonetheless, the drive for operational transformation continues with ongoing developments to enhance hyper-personalization and omni-channel capability in customer administration and BPaaS service development, and payment transformation a key development within claims administration.

Care management is a less mature area with considerable potential for development as the emphasis on whole person care and health equity increases and as healthcare payers seek to proactively manage down their claims outlays.

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Healthcare Payer Operational Transformation 2023

published 2023-05-24 | Project by John Willmott

This NelsonHall Vendor Evaluation & Assessment Tool (NEAT) analyzes the performance of vendors offering healthcare payer services. The NEAT tool allows strategic sourcing managers to assess the capability of vendors across a range of criteria and business situations and identify the best performing vendors overall, and with specific suitability for providing a range of services: member services, claims management, provider management, and care management. Vendors evaluated for this NEAT are: Capgemini, Cognizant, Concentrix, Conduent, Exela, EXL, Firstsource, Gainwell Technologies, Genpact, Infosys, NTT DATA, Sutherland, Wipro, and WNS. To find out more, contact Guy Saunders at [email protected].
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