U.S. Business Process As A Service (BPaaS) In Healthcare Payers Market Size to Hit USD 14.73 Bn by 2035

According to Nova One Advisor, the U.S. business process as a service (BPaaS) in healthcare payers market size is calculated at USD 8.84 billion in 2026 and is expected to be worth around USD 14.73 billion by 2035, growing at a compound annual growth rate (CAGR) of 5.84% over the forecast period 2026 to 2035. A Study Published by Nova One Advisor, a Sister Firm of Precedence Research.

Ottawa, Jan. 15, 2026 (GLOBE NEWSWIRE) -- The U.S. business process as a service (BPaaS) in the healthcare payers market size is calculated at USD 8.35 billion in 2025, grew to USD 8.84 billion in 2026, and is projected to reach around USD 14.73 billion by 2035. The market is projected to expand at a CAGR of 5.84% between 2026 and 2035.

Key Takeaways

By solution coverage, the end-to-end traditional BPaaS segment dominated the market in 2025.
By solution coverage, the end-to-end best-of-breed BPaaS segment is expected to expand at the highest CAGR in the coming years.
By buyer type, the commercial buyers segment led the market in 2025.
By buyer type, the medicare advantage segment is expected to grow at the fastest rate during the projection period.
By value chain processes, the claims management segment dominated the market in 2025.
By value chain processes, the member engagement segment is likely to expand at a significant rate in the upcoming period.
By buyer size, the large buyers segment held the largest share of the market in 2025.
By buyer size, the midsized buyers segment is expected to grow at a rapid pace between 2026 and 2035.

What is U.S. Business Process As A Service (BPaaS) In Healthcare Payers?

Business process as a service in healthcare payers is an advanced way for organizations to handle significant responsibilities using cloud-driven tools. Instead of building systems or hiring large teams to manage, such as billing, claims, and consumer support, businesses collaborate with suppliers that run these solutions over the internet. BPaaS supports the payers and providers, such as doctors, in tackling their mundane challenges more effectively without the burden of manual work. BPaaS isn’t merely outsourcing; it is the impression of doing with less.

BPaaS is renovating the medical care organizations operate precisely. Shifting to flexible, cloud-based services supports to enhance speed, accuracy, and effectiveness. Whether claims processing, enhancing patient communication, or managing provider data, BPaaS healthcare services bring structure and effortlessness to a challenging system. The BPaaS model provides a supplementary efficient, convenient, and affordable way of running routine processes of a medicalcare business.

What are the Key Drivers in the U.S. Business Process As A Service (BPaaS) In Healthcare Payers Market?

BPaaS supports insurers enhances their cost effectiveness and makes their processes more elastic and agile. It supports insurers healthier manage the underwriting function and also the novel business processes. BpaaS is the delivery of business process outsourcing (BPO) solutions as a cloud-driven subscription service. Health plans influence BpaaS to improve and optimize internal operations, like claims administration, suitability, and other people/time-heavy back-office processes while still retaining control of their business. Medical care suppliers are using BPaaS to manage administrative tasks, like patient scheduling, billing, and claims processing. By outsourcing these functions to dedicated BPaaS providers, medical care organizations focus on delivering high-quality patient care.

Key Differences Between BPaaS and BPO in Health Insurance

Factor	BPaaS	BPO
Technology	Utilizes cloud-based platforms, AI, and automation to optimize processes	Relies more on human labor with some technology integration
Scalability	Easily scales to handle fluctuating workloads with minimal cost increase	Scaling up requires more human resources, increasing costs
Cost Structure	Pay-as-you-go model with predictable pricing	Priced based on workforce and service hours
Efficiency	Automation reduces errors and speeds up processes like claims adjudication	Dependent on manual workflows, which can lead to delays and inconsistencies
Customization	Highly configurable and adaptable to specific insurance needs	Limited customization based on service agreements
Compliance & Security	Built-in compliance features for regulations like HIPAA	Requires strict oversight to ensure compliance with data security laws

What are the Ongoing Trends in the U.S. Business Process As A Service (BPaaS) In Healthcare Payers Market?

In December 2025, Cognizant announced a strategic partnership with Bupa Hong Kong, a leading health insurance specialist in Hong Kong, to deliver Cognizant's first AI-driven Business-Process-as-a-Service (BPaaS) services for claims modernization in the region. The five-year engagement represents the massive Intuitive Operations and Automation (IOA) services deal for Cognizant in Hong Kong.
In December 2025, The U.S. General Services Administration (GSA) has employed a landmark OneGov agreement with Amazon Web Services (AWS), providing up to $1 billion in savings for federal agencies adopting cloud services, modernizing IT systems and progressing AI capabilities

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U.S. Business Process As A Service (BPaaS) In Healthcare Payers Market Report Scope

Report Attribute	Details
Market Size in 2026	USD 8.84 Billion
Market Size by 2035	USD 14.73 Billion
Growth Rate From 2026 to 2035	CAGR of 5.82%
Base Year	2025
Forecast Period	2026 to 2035
Segments Covered	Solution coverage, Buyer Size, Buyer type, Value chain processes
Market Analysis (Terms Used)	Value (US$ Million/Billion) or (Volume/Units)
Report Coverage	Revenue forecast, company ranking, competitive landscape, growth factors, and trends
Key Companies Profiled	Accenture; Cognizant; HCL Technologies Limited; IBM; Infosys; NTT DATA Corporation; Optum; TATA Consultancy Services Limited; UST; Wipro; EXL; Softheon Inc.; Genpact; Change Healthcare; Firstsource; Celegence; Highmark Health

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What is the Emerging Challenge in the Business Process As A Service (BPaaS) In Healthcare Market?

1. Data Security & Privacy Risks

One of the most significant challenges is protecting sensitive health information when outsourcing processes to a third-party service provider. Healthcare data breaches have serious legal and financial consequences, and strict standards such as HIPAA, GDPR, and other country-specific laws make compliance complex. Ensuring robust encryption, access controls, and secure cloud environments remains a top concern for healthcare organizations using BPaaS.

2. Integration with Legacy Healthcare Systems

Healthcare payers and providers often operate long-standing IT systems that are not built for easy integration with modern cloud-based BPaaS platforms. These legacy systems can use proprietary data formats and non-standard interfaces, making interoperability and data migration costly, slow, and technically challenging.

3. Regulatory Compliance Complexity

The healthcare industry is among the most regulated sectors in the world. BPaaS providers must keep up with evolving regulations across regions (HIPAA in the U.S., GDPR in the EU, data localization laws in Asia, etc.). Navigating these multiple compliance regimes, especially for global BPaaS deployments, adds complexity and can slow adoption.

4. Vendor Dependency & Control Issues

Outsourcing core business processes can lead to reliance on external vendors for mission-critical operations like claims processing or member services. This can make it difficult for healthcare payers to retain control, switch providers, or adapt service levels quickly, potentially leading to long-term vendor lock-in.

5. Resistance to Organizational Change

Transitioning to BPaaS solutions requires process redesign, new workflows, and staff training. Resistance from employees, lack of internal digital skills, or cultural resistance to outsourcing can impede successful adoption.

6. Dependence on Connectivity & Service Reliability

Nowadays BPaaS relies heavily on cloud infrastructure and continuous internet connectivity. Interruptions in network service or cloud outages can directly affect business continuity, which is especially critical for healthcare operations that require real-time data access.

7. Lack of Standardization & Skilled Personnel

There’s a broader industry challenge around standardization in BPaaS solutions (e.g., standardized workflows, metrics, SLAs) and a shortage of professionals skilled in both healthcare processes and cloud technology. This creates implementation hurdles and slows adoption, especially in emerging markets.

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Segmental Insights

By Solution Coverage

Why Did the End-to-end Traditional BPaaS Segment Dominate the U.S. Business Process As A Service (BPaaS) In Healthcare Payers Market in 2025?

The end-to-end traditional BPaaS segment dominated the market with the largest share in 2025 due to it provides a more efficient, flexible, and faster services compared to traditional business technology. By leveraging automation, cloud technology, and managed services, BPaaS enbles companies to focus on their core competencies while improving operational effectiveness. Lowers capital expenditure on software licenses, infrastructure, and maintenance, ever-changing to expectable subscription models and reducing operational expenses.

The end-to-end best-of-breed BPaaS segment is expected to expand at the highest CAGR throughout the projection period due to the best-of-breed stratergies characteristically include quick implementation and acceptance, consumer-friendly interfaces, advanced functionality, and, perhaps important, the capability to integrate with other best-of-breed services.

By Buyer Type

How Does the Commercial Buyers Segment Lead the Market in 2025?

The commercial buyers segment led the U.S. business process as a service (BPaaS) in healthcare payers market while holding the largest share in 2025 as commercial buyers includes industries such as healthcare, finance, and retail that leverage the model to increase operational excellence rather than just fulfilling regulatory mandates. BPaaS supports companies in efficiently managing their operations and maintaining good consumer relationships.

The medicare advantage segment is expected to expand at a rapid pace through the forecast period as medicare advantage model lowers reliance on physical processing, lowering mistake rates in significant functions such as claims and payments. It also offeres predictable expenses, built-in compliance, and faster reporting, main advantages for health plans facing government pressure and the requirement for precise, and timely data.

By Value Chain Processes

What Claims Management the Dominant Segment in the U.S. Business Process as A Service (BPaaS) In Healthcare Payers Market?

The claims management segment led the U.S. business process as a service (BPaaS) in healthcare payers market in 2024 as BPaaS platform precisely handle claims rapidly and more accurately via using rule-based checks and automation. it mitigates manual challenges and rework. Claims management in many processses, systems, and stakeholders. Insurance claims business process outsourcing (BPO) includes giving specific parts and the entirety of the claims lifecycle to specialized third-party providers.

The member engagement segment is expected to grow at the fastest rate over the forecast period as members interconnect questions and challenges in a safe communications way that timestamps every notification. Members receive a appropriate acknowledgment and, presently after that, a status update in the same protected environment, which alerts them when the challenges is resolved or stipulates the requires for more data.

By Buyer Size

How Does the Large Buyers Segment Lead the Market in 2025?

The large buyers segment held the biggest share of the U.S. business process as a service (BPaaS) in healthcare payers market in 2025, as large buyers majorly concentrating on streamlining administrative responsibilities like claims processing, member management, and government compliance, also large medical care buyers seeking to automate patient information, billing, and back-office functions to enhance effectiveness and patient care, driven by digital transformation requirements and expenses pressures

The midsized buyers segment is expected to expand at a rapid pace throughout the forecast period as midsized buyers established higher BPaaS acceptance than larger organizations. Midsized buyers often favor public cloud BPaaS deployment because of its low expenses, simple of setup, and scalability.

By Regional Insight

How did the U.S. Grow Notably in the Market in 2025?

In the U.S. business process as a service (BPaaS) in healthcare payers market is dominated by The U.S. regulations has speed-ups by assigning hundreds of millions of dollars toward cloud-based BPaaS acceptance in the federal agencies. U.S. organization leverage massive partner ecosystems involving independent software vendors and hyperscalers to provides integrated stacks rather than fragmented serviceses. Broad adoption of public cloud platforms permits U.S. enterprises to host outsourced processes deprived of heavy physical infrastructure spending.

For Instance, In July 2025, Veritas Prime, a leading worldwide HR & Payroll technology and professional services firm, announced two major international expansion milestones as it doubles down on delivery excellence and Business Process as a Service (BPaaS) innovation across the Americas

Key Companies & Market Share Insights

Accenture
Cognizant
HCL Technologies Limited
IBM
Infosys Limited
NTT DATA Corporation
Optum
TATA Consultancy Services Limited
UST
Wipro
EXL
Softheon, Inc.
Genpact
Change Healthcare
Firstsource
Celegence
Highmark Health

Recent Developments

March 2025: Cognizant announced the launch of its new BPaaS-based "CuraPayer Suite" designed to streamline value-based reimbursement processing for Medicare Advantage plans. This marks a strategic push toward integrating care quality metrics into claims workflows.
January 2025: Accenture entered a partnership with GuideWell to deploy a BPaaS solution focused on end-to-end claims and provider data management for Florida Blue, targeting over 5 million members.
November 2024: Optum introduced a predictive analytics BPaaS module to support care management in chronic disease programs, enhancing member outreach and adherence tracking.
September 2024: EXL Service expanded its U.S. BPaaS operations by acquiring a healthcare analytics startup specializing in payer workflows and regulatory compliance automation.
June 2024: Wipro launched a HIPAA-compliant BPaaS platform tailored for midsized commercial payers in the U.S., featuring AI-led fraud detection and real-time member service tools.

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Segments Covered in the Report

This report forecasts revenue growth at country levels and provides an analysis of the latest industry trends in each of the sub-segments from 2021 to 2035. For this study, Nova one advisor, Inc. has segmented the U.S. Business Process As A Service (BPaaS) In Healthcare Payers market.

By Solution Coverage

Traditional BPaaS
End-to-end Traditional BPaaS
Process-specific Traditional BPaaS
Best-of-breed BPaaS
End-to-end Best-of-breed BPaaS
Process-specific Best-of-breed BPaaS

By Buyer Type

Government Buyers
Medicare Advantage
Managed Medicaid
Commercial Buyers
Individual Health Plan
Employer-sponsored Health Plan

By Value Chain Processes

Claims Management
Member Engagement
Care Management
Others

By Buyer Size

Small Buyers
Midsized Buyers
Large Buyers

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