US health insurance carriers face escalating pressures, from soaring costs and workforce shortages to rising member expectations and complex compliance demands. In this environment, traditional administrative processes and outdated systems are proving inadequate. To address these challenges, health plans are embracing next-generation Business-Process-as-a-Service (BPaaS) as a strategic transformation enabler. Unlike earlier models, next-generation BPaaS integrates cloud-based platforms, generative and agentic AI, digital twins, and robust data strategies into unified, scalable service ecosystems. This report explores how next-generation BPaaS helps healthcare payers drive outcomes such as higher auto-adjudication, reduced total cost of ownership, improved regulatory readiness, and enhanced member experiences. It also introduces a 4D transition framework – Discover, Decide, Drive, and Deepen – to guide payers through readiness assessment, provider selection, and continuous optimization. With intelligent platforms, multi-shore delivery, and AI-led decision-making at the core, next-generation BPaaS is enabling health plans to shift from transactional efficiency to strategic transformation.

The healthcare payer outsourcing market is rapidly evolving as payers strive to enhance efficiency, control costs, meet member expectations, and navigate complex regulations. With a growing focus on member-centricity and streamlined core administrative processes, Business Process as a Service (BPaaS) has emerged as a key strategic solution. Payers now demand modular, contextualized, and scalable solutions tailored to specific business lines, such as Medicare or Medicaid. In response, providers are innovating with Line-of-Business (LoB)-specific solutions, robust platform partnerships, and comprehensive consulting capabilities to support payers on their BPaaS transformation journeys. In this report, we provide comprehensive, fact-based snapshots of 14 healthcare payer BPaaS solution providers. The report examines the providers’ revenue scale, client base, deployment models, revenue split by offerings, value chain coverage, plan sizes, plan types, key clients, and proprietary solutions and tools. This research enables healthcare payers to identify suitable providers to transform their business processes and achieve differentiation. Scope Industry: healthcare Geography: US Contents In this report, we examine 14 healthcare payer BPaaS solutions providers based on their: Scale of operations including revenue, client base, deployment model, revenue split by offerings, value chain, plan size, and plan type Key clients and proprietary solutions and tools offered Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

The healthcare payer outsourcing market is rapidly evolving, driven by healthcare payers' need to enhance efficiency, manage costs, meet member expectations, and navigate complex regulations. As the industry shifts toward member-centricity and robust core administrative processes, an integrated platform and operations play, more commonly referred to as Business Process-as-a Service (BPaaS) solutions have emerged as a strong strategic solution to streamline operations. The healthcare payers are demanding modular, contextualized, and scalable solutions that takes care of their specific needs for different business lines such as Medicare or Medicaid. As a result, providers are developing innovative solutions (such as Line-of-Business (LoB) specific or ‘in-a-box’ solutions), robust platform and digital partnerships, and comprehensive consulting capabilities across the value chain to help chart out the BPaaS transformation journey for payers. In this report, we analyze 14 healthcare payer BPaaS solutions providers featured on the Healthcare Payer BPaaS Solutions PEAK Matrix®. The report positions providers relative to each other and evaluates their strengths and limitations. The study will enable healthcare payers to identify suitable providers to transform their business processes and differentiate themselves. Scope Industry: Healthcare Geography: US The assessment is based on Everest Group’s annual RFI process for the calendar year 2023, interactions with leading healthcare payer BPaaS solutions providers, client references, and Everest Group’s ongoing analysis of the payer BPaaS solutions market Contents The Healthcare Payer BPaaS Solutions PEAK Matrix® Assessment 2024 The payer BPaaS solutions provider landscape Providers’ key strengths, limitations, and capabilities Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

What is the Everest Group BPS Top 50™? The Everest Group BPS Top 50 is a global list of the 50 largest third-party providers, based on their Business Process Services (BPS) revenues and year-on-year growth. BPS is also referred to as Business Process Outsourcing (BPO). First released in 2015, Everest Group publishes this list every year. Why the Everest Group BPS Top 50™? The global third-party BPS industry is valued at close to US$300 billion. Over the years, this industry has evolved significantly, both in breadth and depth of services. What started as a cost optimization concept focusing on “non-core” and “back-office” business processes, today permeates the entire business process value chain, addressing a wide variety of business objectives. The industry continues to attract many providers from a broad range of backgrounds and heritages. Everest Group estimates there are more than 250 providers with more than US$50 million in revenues offering BPS services worldwide. Some are pure-play BPS providers, while others offer business services as part of a broader portfolio (IT services, consulting, technology products, etc.). Some are focused on a particular domain or geography, while others are broad-based. Some are listed, while others are privately held. This list helps enterprises to identify the scaled-up providers and evaluate their functional coverage. It also enables BPS providers to compare themselves with other industry participants. This list is not an analysis of provider capabilities but rather a factual representation of their business performance as measured by their revenues and growth in a particular year – see the methodology on page 3. Please refer to specific  Everest Group PEAK Matrix reports® reports for a detailed assessment of of service providers’ performance across various BPS segments. How is the BPS Top 50 determined? There are two distinct steps involved in determining the BPS Top 50: Qualification – only the 50 largest providers, based on their BPS revenue, qualify for the BPS Top 50 assessment Rank determination – providers are ranked based on overall BPS revenue and year-on-year growth; growth has two sub-parameters: absolute growth (measured as change in BPS revenue in US$ million) and percentage growth (measured as percentage change in BPS revenue)  

The healthcare industry is transforming rapidly, driven by rising costs, stricter regulations, and a growing emphasis on member experience. This pressure highlights the need for healthcare payers to improve efficiency and effectiveness, especially in light of recent cybersecurity incidents such as the one involving Change Healthcare. Robust information security protocols are essential in this complex environment, where innovative solutions can streamline operations, ensure scalability, and deliver cost-effective care. Amid these challenges, Business Process as a Service (BPaaS) has emerged as a transformative force in healthcare. BPaaS offers a new approach to managing administrative and clinical tasks, leveraging platform-based solutions, deep healthcare expertise, and cutting-edge technology to empower healthcare payers. By embracing BPaaS, organizations can streamline processes, achieve greater scalability, and pursue operational excellence. In this report, we explore the role of BPaaS solutions within the healthcare payer landscape. It provides a comprehensive analysis of the challenges that healthcare enterprises face and demonstrates how BPaaS can effectively address them. The report offers insights into various BPaaS solutions, including their core elements and the outcomes they deliver. Additionally, it examines successful use cases of specialized BPaaS solutions designed to address specific pain points. Furthermore, the report highlights the increasing adoption and potential of BPaaS-led transformation in payviders. Lastly, it provides guidance on evaluating and selecting BPaaS solution providers to navigate the evolving healthcare landscape effectively. Scope Industry: healthcare Geography: global Contents In this report, we examine: The challenges in the enterprise market and how BPaaS can help solve these issues Broad-based BPaaS solutions, including their key elements and the operational efficiency benefits they offer Specialized BPaaS solutions, highlighting successful use cases and targeted approaches to address specific pain points The unique intersection of BPaaS in payviders, including Provider Sponsored Health Plans (PSHPs) BPaaS’ role in navigating the ever-evolving terrain of the healthcare landscape Membership(s) Healthcare Payer and Provider Business Process Outsourcing Excellence

What is the Everest Group BPS Top 50™? The Everest Group BPS Top 50™ is a global list of the 50 largest third-party providers, based on their Business Process Services (BPS) revenues and year-on-year growth. BPS is also referred to as Business Process Outsourcing (BPO). Inaugurated in 2015, Everest Group publishes this list every year. Why the Everest Group BPS Top 50™? The global third-party BPS industry is valued at more than US$250 billion. Over the years, this industry has evolved significantly, both in breadth and depth of services. What started as a cost optimization concept focusing on non-core and back-office business processes, today permeates the entire business process value chain, addressing a wide variety of business objectives. Naturally, the industry continues to attract many providers from a broad range of backgrounds and heritages. Today, Everest Group estimates there are more than 250 providers with more than US$50 million in revenues offering BPS services worldwide. Some are pure-play BPS providers, while others offer business services as part of a broader portfolio (IT services, consulting, technology products, etc.). Some are focused on a particular domain or geography, while others are broad-based. Some are listed, while others are privately held. This list helps enterprises in identifying scaled-up providers and evaluating their functional coverage. It also enables BPS providers to compare themselves with other industry participants. This list is not an analysis of provider capabilities but rather a factual representation of their business performance as measured by their revenues and growth in a particular year. (You can see the methodology on page 3.) Please refer to specific  Everest Group PEAK Matrix® reports for a detailed assessment of providers performance across various BPS segments. How is the BPS Top 50 determined? There are two distinct steps involved in determining the Top 50: (1) Qualification – Only the 50 largest providers, based on their BPS revenue, qualify for the BPS Top 50 assessment; (2) Rank determination – Providers are ranked on the basis of overall BPS revenue and year-on-year growth. Growth has two sub-parameters: absolute growth (measured as change in BPS revenue in US$ million) and percentage growth (measured as percentage change in BPS revenue).

What is the Everest Group BPS Top 50™? The Everest Group BPS Top 50™ is a global list of the 50 largest third-party providers, based on their Business Process Services (BPS) revenues and year-on-year growth. BPS is also referred to as Business Process Outsourcing (BPO). Inaugurated in 2015, Everest Group publishes this list every year. Why the Everest Group BPS Top 50™? The global third-party BPS industry is valued at more than US$225 billion. Over the years, this industry has evolved significantly, both in breadth and depth of services. What started as a cost optimization concept focusing on “non-core” and “back-office” business processes, today permeates the entire business process value chain, addressing a wide variety of business objectives. Naturally, the industry continues to attract many service providers from a broad range of backgrounds and heritages. Today, Everest Group estimates there are more than 250 service providers with more than US$50 million in revenues offering BPS services around the globe. Some are pure-play BPS providers, while others offer business services as part of a broader portfolio (IT services, consulting, technology products, etc.). Some are focused on a particular domain or geography, while others are broad-based. Some are listed, while others are privately held. This list helps enterprises to identify the scaled-up providers and their functional coverage. It also helps BPS service providers to compare themselves against others in the industry. This list is not an analysis of service provider capabilities but rather a factual representation of their business performance as measured by their revenues and growth in a particular year. (Please see the methodology on page 3.) Please refer to specific specific Everest Group PEAK Matrix reports for a detailed assessment of service providers performance across various BPS segments. How is the BPS Top 50 determined? There are two distinct steps involved in determining the Top 50: (1) Qualification – Only the 50 largest service providers, based on their BPS revenue, qualify for the BPS Top 50 assessment; (2) Rank determination – Service providers are ranked on the basis of overall BPS revenue and year-on-year growth. Growth has two sub-parameters: absolute growth (measured as change in BPS revenue in US$ million) and percentage growth (measured as percentage change in BPS revenue).

What is the Everest Group BPS Top 50™? The Everest Group BPS Top 50™ is a global list of the 50 largest third-party providers, based on their Business Process Services (BPS) revenues and year-on-year growth. BPS is also referred to as Business Process Outsourcing (BPO). Inaugurated in 2015, Everest Group publishes this list every year. Why the Everest Group BPS Top 50™? The global third-party BPS industry is valued at more than US$200 billion. Over the years, this industry has evolved significantly, both in breadth and depth of services. What started as a cost optimization concept focusing on “non-core” and “back-office” business processes, today permeates the entire business process value chain, addressing a wide variety of business objectives. Naturally, the industry has attracted many service providers from a broad range of backgrounds and heritages. Today, Everest Group estimates there are more than 250 service providers with more than US$50 million in revenues offering BPS services around the globe. Some are pure-play BPS providers, while others offer business services as part of a broader portfolio (IT services, consulting, technology products, etc.). Some are focused on a particular domain or geography, while others are broad-based. Some are listed, while others are privately held. This list helps enterprises to identify the scaled-up providers and their functional coverage. It also helps BPS service providers to compare themselves against others in the industry. This list is not an analysis of service provider capabilities but rather a factual representation of their business performance as measured by their revenues and growth in a particular year. (Please see the methodology on page 3.) Please refer to specific specific Everest Group PEAK Matrix reports for a detailed assessment of service providers performance across various BPS segments. How is the BPS Top 50 determined? There are two distinct steps involved in determining the Top 50: (1) Qualification – Only the 50 largest service providers, based on their BPS revenue, qualify for the BPS Top 50 assessment; (2) Rank determination – Service providers are ranked on the basis of overall BPS revenue and year-on-year growth. Growth has two sub-parameters: absolute growth (measured as change in BPS revenue in US$ million) and percentage growth (measured as percentage change in BPS revenue).

The US spends close to US$3.8 trillion on healthcare, which is almost twice as much as what any other major world economy spends, due to the complexities and inefficiencies within the US healthcare system. While inefficiencies plague the entire healthcare ecosystem, payers are the worst affected, with an average operating margin of 4.3%, much lower than a for-profit health system – 6.1%, or a pharma – 19.4%. This cost pressure, coupled with a fast-changing regulatory landscape and evolving member demands, adds to payers’ woes. With the traditional IT/BPO outsourcing model failing to address these concerns in an effective way, payers are turning their attention toward the innovative Business Process as a Services (BPaaS) outsourcing model, which offers them platform-based modernization. In fact, payers are increasingly realizing the benefits of a BPaaS model over traditional IT/BPO outsourcing models and have been quick to adopt it. This viewpoint studies the BPaaS model in detail, describes its benefits, and examines current and potential future adoption to achieve the healthcare industry’s objectives. Scope Industry: healthcare Geography: US Contents In this paper, we: Make a case for platform-based modernization and the adoption of BPaaS in the healthcare payer market Compare the different sourcing models, including shared services, traditional IT/BPO outsourcing, and BPaaS Describe the characteristics of a true BPaaS solution and its benefits Analyze BPaaS growth trends and adoption in the healthcare payer market Describe the best practices for a successful BPaaS deployment Membership (s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

The Everest Group BPS Top 50 is a global list of the 50 largest third-party providers, based on their Business Process Services (BPS) revenues (excluding public-sector services) and year-on-year growth. BPS is also referred to as Business Process Outsourcing (BPO). Inaugurated in 2015, Everest Group publishes this list every year. Why the BPS Top 50? The global third-party BPS industry is valued at more than US$200 billion. Over the years, this industry has evolved significantly, both in breadth and depth of services. What started as a cost optimization concept focusing on “non-core” and “back-office” business processes, today permeates the entire business process value chain addressing a wide variety of business objectives. Naturally, the industry has attracted many service providers from a broad range of backgrounds and heritages. Today, Everest Group estimates there are more than 200 service providers with more than US$50 million in revenues offering BPS services around the globe. Some are pure-play BPS providers, while others offer business services as part of a broader portfolio (IT services, consulting, technology products, etc.). Some are focused on a particular domain or geography, while others are broad-based. Some are listed, while others are privately held. This list helps enterprises to identify the scaled-up providers and their functional coverage. It also helps BPS service providers to compare themselves against others in the industry. How is the BPS Top 50 determined? There are two distinct steps involved in determining the Top 50: (1) Qualification – Only the 50 largest service providers, based on their BPS revenue, qualify for the BPS Top 50 assessment; (2) Rank determination – Service providers are ranked on the basis of overall BPS revenue and year-on-year growth. Growth has two sub-parameters: absolute growth (measured as change in BPS revenue in US$ million) and percentage growth (measured as percentage change in BPS revenue).