US Healthcare Insurance Third-Party Administrator Market Size and Forecast 2021 - 2031, Country Share, Trend, and Growth Opportunity Analysis Report Coverage: By Type, Enterprise Size

Description

List of Tables

The US Healthcare Insurance Third-Party Administrator Market size was valued at US$ 64.92 billion in 2024 and is expected to reach US$ 144.86 billion by 2031. The market is estimated to record a CAGR of 12.1% from 2024 to 2031. The growth of the healthcare insurance third-party administrator market in the US is driven by several key factors, including the rising healthcare costs, increasing adoption of self-funded insurance plans by employers seeking cost savings, the growing complexity of healthcare management and regulatory compliance, and the rising demand for specialized administrative services such as claims processing, analytics, and member support. Additionally, the expansion of telehealth services and employer-sponsored health plans, the need for enhanced efficiency in claims adjudication, and the ability of third-party administrators to offer customized solutions for diverse healthcare needs further fuel the market. The shift toward AI-driven tools and automation in third-party administrators also contributes to the rising reliance on third-party administrators to streamline operations and reduce overall costs for insurers and employers.

According to the United States Census Bureau, in 2023, the majority of the US population, ~92.0% or 305.2 million people, had health insurance for at least part of the year. Private health insurance coverage remained the dominant form, covering 65.4% of individuals, while public coverage accounted for 36.3%. Employment-based insurance was the most widespread form, providing coverage for 53.7% of the population, followed by Medicaid and Medicare, both covering 18.9% of individuals. Other forms of coverage included direct-purchase insurance at 10.2%, TRICARE at 2.6%, and VA/CHAMPVA at 1.0%. This increasing prevalence of health insurance, particularly employer-sponsored plans, has fueled the growth of the healthcare insurance third-party administrator market in the US. As more employers offer self-funded health plans, the demand for third-party administrators to handle administrative tasks such as claims processing, compliance, and member services continues to rise.

Sedgwick; Crawford and Company; CorVel Corp; UnitedHealth Group Inc; Arthur J Gallagher & Co; Meritain Health; EDISON HEALTH SOLUTIONS; ESIS; Cannon Cochran Management Services, Inc.; and Heritage Health Solutions are among the key players profiled during this market study. The market players focus on new product launches, expansion and diversification, and acquisition strategies, which allow them to access prevailing business opportunities.

The overall US Healthcare Insurance Third-Party Administrator market analysis has been derived using both primary and secondary sources. To begin the US Healthcare Insurance Third-Party Administrator market research process, exhaustive secondary research has been conducted using internal and external sources to obtain qualitative and quantitative information related to the US Healthcare Insurance Third-Party Administrator market. The process also serves the purpose of obtaining an overview and market forecast for the US Healthcare Insurance Third-Party Administrator market growth with respect to all market segments. Also, multiple primary interviews have been conducted with industry participants and commentators to validate the data and gain more analytical insights about the topic. Participants of this process include industry experts such as VPs, business development managers, market intelligence managers, and national sales managers-along with external consultants such as valuation experts, research analysts, and key opinion leaders-specializing in the US Healthcare Insurance Third-Party Administrator market forecast.

Product Code: TIPRE00039852

1. Introduction

1.1 The Insight Partners Research Report Guidance
1.2 Market Segmentation

2. Executive Summary

2.1 Key Insights

3. Research Methodology

3.1 Secondary Research
3.2 Primary Research
- 3.2.1 Hypothesis formulation:
- 3.2.2 Macro-economic factor analysis:
- 3.2.3 Developing base number:
- 3.2.4 Data Triangulation:
- 3.2.5 Country level data:

4. U.S Healthcare Insurance Third-Party Administrator Market Landscape

4.1 Overview
4.2 PEST Analysis
4.3 Ecosystem Analysis
- 4.3.1 Healthcare Insurance Companies
- 4.3.2 Third-Party Administrators
- 4.3.3 Regulatory Bodies/Government Agencies
- 4.3.4 List of Vendors in the Value Chain

5. U.S Healthcare Insurance Third-Party Administrator Market - Key Market Dynamics

5.1 U.S Healthcare Insurance Third-Party Administrator Market - Key Market Dynamics
5.2 Market Drivers
- 5.2.1 Rising Healthcare Costs
- 5.2.2 Growing Employer-Sponsored Health Plans
5.3 Market Restraints
- 5.3.1 Data Privacy and Security Concerns
5.4 Market Opportunities
- 5.4.1 Expansion of Telehealth Services
5.5 Future Trends
- 5.5.1 AI-Driven Tools and Automation in Third-Party Administrators
5.6 Impact of Drivers and Restraints:

6. U.S Healthcare Insurance Third-Party Administrator Market Analysis

6.1 U.S Healthcare Insurance Third-Party Administrator Market Revenue (US$ Million), 2021-2031
6.2 U.S Healthcare Insurance Third-Party Administrator Market Forecast and Analysis

7. U.S Healthcare Insurance Third-Party Administrator Market Analysis - by Type

7.1 Health Insurance
- 7.1.1 Overview
- 7.1.2 Health Insurance: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
7.2 Disability Insurance
- 7.2.1 Overview
- 7.2.2 Disability Insurance: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
7.3 Workers Compensation Insurance
- 7.3.1 Overview
- 7.3.2 Workers Compensation Insurance: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
7.4 Others
- 7.4.1 Overview
- 7.4.2 Others: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)

8. U.S Healthcare Insurance Third-Party Administrator Market Analysis - by Enterprise Size

8.1 Large Enterprises
- 8.1.1 Overview
- 8.1.2 Large Enterprises: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
8.2 SMEs
- 8.2.1 Overview
- 8.2.2 SMEs: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)

9. Competitive Landscape

9.1 Company Heat Map Analysis
9.1 Company Positioning & Concentration Analysis

10. Industry Landscape

10.1 Overview
10.2 Market Initiative
10.2 New Product Development
10.3 Mergers & Acquisitions

11. Company Profiles

11.1 Sedgwick
- 11.1.1 Key Facts
- 11.1.2 Business Description
- 11.1.3 Products and Services
- 11.1.4 Financial Overview
- 11.1.5 SWOT Analysis
- 11.1.6 Key Developments
- 11.1.7 TPA Valuation
11.2 Crawford and Company
- 11.2.1 Key Facts
- 11.2.2 Business Description
- 11.2.3 Products and Services
- 11.2.4 Financial Overview
- 11.2.5 SWOT Analysis
- 11.2.6 Key Developments
- 11.2.7 TPA Valuation
11.3 CorVel Corp
- 11.3.1 Key Facts
- 11.3.2 Business Description
- 11.3.3 Products and Services
- 11.3.4 Financial Overview
- 11.3.5 SWOT Analysis
- 11.3.6 Key Developments
- 11.3.7 TPA Valuation
11.4 UnitedHealth Group Inc
- 11.4.1 Key Facts
- 11.4.2 Business Description
- 11.4.3 Products and Services
- 11.4.4 Financial Overview
- 11.4.5 SWOT Analysis
- 11.4.6 Key Developments
- 11.4.7 TPA Valuation
11.5 Arthur J Gallagher & Co
- 11.5.1 Key Facts
- 11.5.2 Business Description
- 11.5.3 Products and Services
- 11.5.4 Financial Overview
- 11.5.5 SWOT Analysis
- 11.5.6 Key Developments
- 11.5.7 TPA Valuation
11.6 Heritage Health Solutions, Inc.
- 11.6.1 Key Facts
- 11.6.2 Business Description
- 11.6.3 Products and Services
- 11.6.4 Financial Overview
- 11.6.5 SWOT Analysis
- 11.6.6 Key Developments
- 11.6.7 TPA Valuation
11.7 Edison Health Solutions
- 11.7.1 Key Facts
- 11.7.2 Business Description
- 11.7.3 Products and Services
- 11.7.4 Financial Overview
- 11.7.5 SWOT Analysis
- 11.7.6 Key Developments
- 11.7.7 TPA Valuation
11.8 Meritain Health
- 11.8.1 Key Facts
- 11.8.2 Business Description
- 11.8.3 Products and Services
- 11.8.4 Financial Overview
- 11.8.5 SWOT Analysis
- 11.8.6 Key Developments
- 11.8.7 TPA Valuation
11.9 Chubb Ltd
- 11.9.1 Key Facts
- 11.9.2 Business Description
- 11.9.3 Products and Services
- 11.9.4 Financial Overview
- 11.9.5 SWOT Analysis
- 11.9.6 Key Developments
- 11.9.7 TPA Valuation (ESIS)
11.10 Cannon Cochran Management Services Inc.
- 11.10.1 Key Facts
- 11.10.2 Business Description
- 11.10.3 Products and Services
- 11.10.4 Financial Overview
- 11.10.5 SWOT Analysis
- 11.10.6 Key Developments
- 11.10.7 TPA Valuation

12. Appendix

12.1 Abbreviations
12.2 About The Insight Partners