Staking a claim: The aging population and healthcare reform will support industry revenue

The industry will experience steady growth over the next five years, as the growing senior population creates demand via Medicare. Furthermore, the number of insured people will rise in line with healthcare reform, as people with pre-existing conditions are able to receive insurance. The growing senior population will keep driving demand for the industry's services over the next five years, helping revenue blossom...purchase to read more.

Industry Statistics & Market Size
Annual Growth 11-16
Forecast Growth 16-21
Market Share of Companies

Industry Threats & Opportunities

  • Rising demand for medical claims processing services has attracted new entrants to the industry
  • The aging baby boomers boosted demand for medical claims processing services through 2016
  • Growth in the senior population will boost the number of doctors’ visits, spurring demand
  • Industry Report - Starting a New Business Chapter

    Barriers to entry into the Medical Claims Processing Services industry are moderate. Industry participants must obtain a license within the state in which they operate. Additionally, service agencies must hire knowledgeable staff to maximize the efficiency of claims processing. These two factors can pose significant barriers to entry to operators that are not involved in the medical insurance field. Industry participants must comply with regulatory requirements, which are set on an individual state basis. These requirements are set for the insurance industry as a whole and restrict access to new entrants. Certain activities may also be regulated under investment, securities and futures licensing authorities...purchase to read more.

    Additional Insights for the Medical Claims Processing Services Industry

    IBISWorld identifies 250 Key Success Factors for a business.The most important for the Medical Claims Processing Services Industry are

  • Ability to vary services to suit different needs
  • Automation - reduces costs, particularly those associated with labor
  • Access to highly skilled workforce
  • IBISWorld analysts also discuss how external factors such as Number of physician visits and Number of people with private health insurance in the Medical Claims Processing Services industry impact industry performance..

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    What's in this report

    What is the Medical Claims Processing Services Industry?

    This industry processes and administers medical insurance policies and claims. Businesses help doctors and other healthcare providers collect payments from insurance companies and Medicare.

    Industry Products
  • Policy and claims examinations
  • Claims investigations
  • Back-office, administrative support and consulting
  • Claims processing
  • Industry Activities
  • Medical insurance claims submissions
  • Medical insurance billing
  • Medical insurance claims adjustment
  • Table of Contents

    Industry Definition
    Main Activities
    Similar Industries
    Additional Resources
    Industry Statistics Snapshot
    Industry Structure
    Executive Summary
    Executive Summary
    Key External Drivers
  • Number of physician visits
  • Number of people with private health insurance
  • Federal funding for Medicare and Medicaid
  • Number of adults aged 65 and older

  • Current Performance
  • Rebounding from setbacks
  • Healthcare reform
  • Chart: Revenue Growth

  • Industry Outlook
  • Baby boomers
  • Industry landscape
  • Table: Medical Claims Processing Services Industry Revenue Outlook

  • Industry Life Cycle
  • Life cycle reasons
  • Chart: Benchmarking - Medical Claims Processing Services Industry Lifecycle vs The Economy

  • Supply Chains
    Key Buying Industries
  • Health & Medical Insurance
  • Health & Welfare Funds
  • Healthcare and Social Assistance

  • Key Selling Industries
  • Commercial Leasing
  • Computer Stores
  • Office Furniture Manufacturing

  • Products & Services
  • Claims processing
  • Policy and claims examinations
  • Claims investigations
  • Back-office, administrative support and consulting
  • Chart: Medical Claims Processing Services Industry Products and Services Segmentation

  • Demand Determinants
  • Number of insured
  • Demographic trends
  • Healthcare reform

  • Major Markets
  • Healthcare providers
  • Private insurers
  • Government insurers
  • Chart: Major Market Segmentation for the Medical Claims Processing Services Industry

  • International Trade
    Business Locations
    Chart: Business Locations by State
    Market Share Concentration
    Key Success Factors
    Cost Structure Benchmarks
  • Profit
  • Wages and depreciation
  • Rent and utilities and purchases
  • Other
  • Chart: Cost Structure Benchmarking – Sector vs Medical Claims Processing Services

  • Basis of Competition
  • External competition

  • Barriers to Entry
  • Table: Barrier to Entry Checklist for the Medical Claims Processing Services Industry

  • Industry Globalization
    HMS Holdings,
  • Table: HMS Holdings - financial performance

  • Capital Intensity
  • Chart: Level of Capital Intensity for the Medical Claims Processing Services Industry
  • Chart: Tools of the Trade: Growth Strategies for Success

  • Technology & Systems
    Revenue Volatility
  • Chart: Volatility vs Industry Growth

  • Regulation & Policy
    Industry Assistance
    Table: Industry Data for the Medical Claims Processing Services Industry
  • Industry Revenue (2007-2021)
  • Industry Gross Product (2007-2021)
  • Establishments (2007-2021)
  • Businesses (2007-2021)
  • Employment (2007-2021)
  • Wages (2007-2021)
  • Median age of the population (2007-2021)

  • Table: Annual Percentage Change for Key Industry Data
    Table: Key Ratios for Industry Key Data
  • A joint federal and state program that provides subsidized health insurance to low-income families and certain individuals with disabilities.
  • Medicare
  • A federal government health insurance program geared toward individuals aged 65 and older and certain younger people with disabilities.
  • Patient Protection And Affordable Care Act (Ppaca)
  • A US act signed into law by President Obama in 2010. The law provides provisions for public and private health insurance coverage.
  • What Our Customers Say

    Why buy this report?

    The Medical Claims Processing Services Industry Research Report measures market size, analyses current and future trends, and provides an indication of market share for the industry’s largest companies. IBISWorld’s collection of industry market research reports gives you insightful, up-to-date information on the supply chains, economic drivers, and key buyers and markets for hundreds of industries.

    IBISWorld industry market research reports enable you to:
    • Find out about key industry trends
    • Identify threats and opportunities
    • Inform your decisions for marketing, strategy and planning
    • Quickly build competitive intelligence
    This report on Medical Claims Processing Services:
    • Provides Market Size information to assist with planning and strategic decisions.
    • Includes the necessary information to perform SWOT, PEST and STEER analysis.
    • Helps you understand market dynamics to give you a deeper understanding of industry competition and the supply chain.
    • Analyses key performance and operational metrics so that you can benchmark against your own business, that of your customers’ businesses, or your competitors’ businesses.
    The Medical Claims Processing Services market research report includes:
    • Historical data and analysis for the key drivers of this industry
    • A five-year forecast of the market and noted trends
    • Detailed research and segmentation for the main products and markets
    • An assessment of the competitive landscape and market shares for major companies
    • And of course, much more

    IBISWorld reports on thousands of industries around the world. Our clients rely on our information and data to stay up-to-date on industry trends across all industries. With this IBISWorld Industry Research Report on Medical Claims Processing Services, you can expect thoroughly researched, reliable and current information that will help you to make faster, better business decisions.

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