Third-Party Administrators & Insurance Claims Adjusters in the US - Market Research Report (2014-2029)
New York, United States
Last Updated: July 2024
NAICS 52429Revenue
$289.3bn
Past 5-Year Growth
Profit
$XX.Xbn
Employees
626k
Businesses
121k
Wages
$XX.Xbn
Third-Party Administrators & Insurance Claims Adjusters in the US industry analysis
Success in the industry is contingent on various factors, including professional experience, positive track record, cost-effectiveness and compliance. Since third-party administrators operate as an ancillary service to insurance providers, industry trends align with the broader finance and insurance sector. Third-party administrator revenue is expected to climb at a CAGR of 1.9% to $289.3 billion over the five years to 2024, with a boost of 0.6% in 2024 alone. While hikes in operational costs have dampened industry profit, substantial revenue over the same time has tempered these declines.
Trends and Insights
- Health and medical insurance are among the largest markets. As health and medical insurers face increased demand from more people, including those on Medicaid and Medicare plans, claims processing for these industries has similarly risen.
- Services consist of general back-office and administrative support, but they can also include plan processing and claims-related operations. In recent years, self-insurance activity decreased as more businesses use external insurance plans.
- The Southeast is the largest insurance market in the United States because it incurs a proportionately high share of insured losses due to its exposure to hurricanes and other inclement weather. Florida, the state with the industry's highest concentration of establishments, contributes to the region's prominence.
- There are no major companies that operate domestically. Most activity is from small-scale, nonemploying companies competing in regional and highly localized markets.
Industry Overview
Market size and recent performance (2014-2029)
Industry revenue has grown at a CAGR of 1.9 % over the past five years, to reach an estimated $289.3bn in 2024.
Trends and Insights
The lingering effects of the pandemic have mixed effects
- The initial unemployment surge during the pandemic decreased the amount of people on employer-backed insurance. Newly unemployed people sought public health insurance, like Medicaid and Medicare. As a result of increased health expenditures in recent years, the federal government accelerated spending on healthcare-related services.
- Additional trends and insights available with purchase
Source: IBISWorld
Industry outlook (2024-2029)
Market size is projected to grow over the next five years.
Trends and Insights
Growth encouraged by downstream demand
- Insurance policy volumes will likely rise, particularly among corporations, supporting demand for claims adjustment services. There's increasing economic uncertainty, so corporations will want to minimize their risks.
Biggest companies in the Third-Party Administrators & Insurance Claims Adjusters in the US
| Company | Market Share (%)
2024 | Revenue ($m)
2024 | Profit ($m)
2024 | Profit Margin (%)
2024 |
|---|---|---|---|---|
Capgemini Se | 7,687.9 | 1,042.1 | 13.6 | |
Infosys Limited | 6,492.8 | 1,150.9 | 17.7 | |
EmblemHealth Inc. | 6,006.8 | -42.1 | -0.7 |
To view the market share and analysis for all 8 top companies in this industry, view purchase options.
Products & Services Segmentation
Source: IBISWorld
Industry revenue is measured across several distinct product and services lines, including Third-party administration of health and welfare funds, Third-party administration of workers' compensation funds and Third-party administration of self-insurance funds. Third-party administration of health and welfare funds is the largest segment of the Third-Party Administrators & Insurance Claims Adjusters in the US.
Trends and Insights
Third-party administration of health and welfare funds is the most popular product
- Services relating to health and welfare funds include claims processing; coordination of contributions; administration of benefits for medical, dental or pharmacy benefits; case management services; claim recovery services; medical billing; prescription benefit management; wellness or other screen services; COBRA or other related service eligibility; and brokerage services.
- More insights available in the full report
Widen you competitive advantage with related industries
Competitors
- Insurance Brokers & Agencies in the US
- Retirement & Pension Plans in the US
- Workers' Compensation & Other Insurance Funds in the US
Complementors
- Portfolio Management in the US
- Health & Welfare Funds in the US
International industries
- Accounting Services in Australia
- Insurance Brokerage in Australia
- Accounting Services in New Zealand
- Insurance Brokerage in New Zealand
- Risk & Damage Evaluation in the UK
Table of Contents
About this industry
Industry definition
Operators in this industry investigate, appraise and settle insurance claims; provide third-party administration services of insurance and pension funds; and offer insurance advisory and rate-making services. This industry doesn't include companies that primarily provide portfolio management services, sell insurance policies or offer actuarial consulting services.
What's included in this industry?
Investigating, appraising and settling claimsThird-party claims processingThird-party insurance and pension fund administrationInsurance actuarial servicesInsurance advisory servicesInsurance exchangesInsurance loss prevention servicesInsurance rate-making servicesInsurance reporting servicesMedical cost evaluation servicesCompanies
Capgemini SeInfosys LimitedEmblemHealth Inc.Purchase this report to view all 8 major companies in this industry.
Related Terms
CLAIMS ADJUSTINGHARD MARKETSOFT MARKETINSURANCE SERVICE PROVIDERUNINSURED RATEIndustry Code
NAICS 52429 - Third-Party Administrators & Insurance Claims Adjusters in the US
Performance
Get an indication of the industry's health through historical, current and forward-looking trends in the performance indicators that make or break businesses.
Analyst insights
Health and medical insurance are among the largest markets. As health and medical insurers face increased demand from more people, including those on Medicaid and Medicare pl...
In this chapter (4)
- Current Performance
- Outlook
- Volatility
- Life Cycle
Key metrics
- Annual Revenue, Recent Growth, Forecast, Revenue Volatility
- Number of Employees, Recent Growth, Forecast, Employees per Business, Revenue per Employee
- Number of Businesses, Recent Growth, Forecast, Employees per Business, Revenue per Business
- Total Profit, Profit Margin, Profit per Business
Charts
- Revenue, including historical (2014-2023) and forecast (2024-2029)
- Employees, including historical (2014-2023) and forecast (2024-2029)
- Businesses, including historical (2014-2023) and forecast (2024-2029)
- Profit, including historical (2014-2024)
- Industry Volatility vs. Revenue Growth
- Industry Life Cycle
Detailed analysis
- Trends in supply, demand and current events that are driving current industry performance
- Expected trends, economic factors and ongoing events that drive the industry's outlook
- Key success factors for businesses to overcome volatility
- How contribution to GDP, industry saturation, innovation, consolidation, and technology and systems influence the industry's life cycle phase.
Products and Markets
Learn about an industry's products and services, markets and trends in international trade.
Analyst insight
Services consist of general back-office and administrative support, but they can also include plan processing and claims-related operations. In recent years, self-insurance a...
In this chapter
- Products & Services
- Major Markets
Key metrics
- Largest market segment and value in 2024
- Product innovation level
Charts
- Products & services segmentation in 2024
- Major market segmentation in 2024
Detailed analysis
- Trends impacting the recent performance of the industry's various segments
- Innovations in the industry's product or service offering, specialization or delivery method
- Key factors that successful businesses consider in their offerings
- Buying segments and key trends influencing demand for industry products and services
Geographic Breakdown
Discover where business activity is most concentrated in an industry and the factors driving these trends to find opportunities and conduct regional benchmarking.
Analyst insights
The Southeast is the largest insurance market in the United States because it incurs a proportionately high share of insured losses due to its exposure to hurricanes and other...
In this chapter (1)
- Business Locations
Charts
- Share of revenue, establishment, wages and employment in each state
- Share of population compared to establishments in each region in 2024
Tables
- Number and share of establishments in each state in 2024
- Number and share of revenue each state accounts for in 2024
- Number and share of wages each state accounts for in 2024
- Number and share of employees in each state in 2024
Detailed analysis
- Geographic spread of the industry across North America, and trends associated with changes in the business landscape
- Key success factors for businesses to use location to their advantage
Competitive Forces
Get data and insights on what's driving competition in an industry and the challenges industry operators and new entrants may face, with analysis built around Porter's Five Forces framework.
Analyst insights
There are no major companies that operate domestically. Most activity is from small-scale, nonemploying companies competing in regional and highly localized markets.
In this chapter (4)
- Concentration
- Barriers to Entry
- Substitutes
- Buyer & Supplier Analysis
Key metrics
- Industry concentration level
- Industry competition level and trend
- Barriers to entry level and trend
- Substitutes level and trend
- Buyer power level and trend
- Supplier power level and trend
Charts
- Market share concentration among the top 4 suppliers from 2019-2024
- Supply chain including upstream supplying industries and downstream buying industries, flow chart
Detailed analysis
- Factors impacting the industry’s level of concentration, such as business distribution, new entrants, or merger and acquisition activity.
- Key success factors for businesses to manage the competitive environment of the industry.
- Challenges that potential industry entrants face such as legal, start-up costs, differentiation, labor/capital intensity and capital expenses.
- Key success factors for potential entrants to overcome barriers to entry.
- Competitive threats from potential substitutes for the industry’s own products and services.
- Key success factors for how successful businesses can compete with substitutes.
- Advantages that buyers have to keep favorable purchasing conditions.
- Advantages that suppliers have to maintain favorable selling conditions.
- Key success factors for how businesses can navigate buyer and supplier power.
Companies
Learn about the performance of the top companies in the industry.
Analyst insights
There are no major companies in this industry. The fragmentation keeps the industry from creating players big enough to consolidate and gain significant market share.
In this chapter
- Market Share Concentration
- Companies
- Company Spotlights
Charts
- Industry market share by company in 2020 through 2024
- Major companies in the industry, including market share, revenue, profit and profit margin in 2024
- Overview of Capgemini Se's performance by revenue, market share and profit margin from 2018 through 2024
- Overview of Infosys Limited's performance by revenue, market share and profit margin from 2018 through 2024
- Overview of EmblemHealth Inc.'s performance by revenue, market share and profit margin from 2018 through 2024
- Overview of revenue, market share and profit margin trend for 5 additional companies
Detailed analysis
- Description and key data for Capgemini Se, and factors influencing its performance in the industry
- Description and key data for Infosys Limited, and factors influencing its performance in the industry
- Description and key data for EmblemHealth Inc., and factors influencing its performance in the industry
- Description, key data and performance trends for 5 additional companies
External Environment
Understand the demographic, economic and regulatory factors that shape how businesses in an industry perform.
Analyst insights
A new entrant must comply with stringent state and federal regulations. Compliance costs are more burdensome for smaller firms, as they must devote significant resources to s...
In this chapter
- External Drivers
- Regulation & Policy
- Assistance
Key metrics
- Regulation & policy level and trend
- Assistance level and trend
Charts
- Regulation & Policy historical data and forecast (2014-2029)
- Assistance historical data and forecast (2014-2029)
Detailed analysis
- Demographic and macroeconomic factors influencing the industry, including Regulation & Policy and Assistance
- Major types of regulations, regulatory bodies, industry standards or specific regulations impacting requirements for industry operators
- Key governmental and non-governmental groups or policies that may provide some relief for industry operators.
Financial Benchmarks
View average costs for industry operators and compare financial data against an industry's financial benchmarks over time.
Analyst insights
Profit differs significantly among operators depending upon the number of client engagements in a year, general claim volume, type of industries serviced and other operator-sp...
In this chapter
- Cost Structure
- Financial Ratios
- Key Ratios
Key metrics
- Profit margin, and how it compares to the sector-wide margin
- Average wages, and how it compares to the sector-wide average wage
- Largest cost component as a percentage of revenue
- Industry average ratios for days' receivables, industry coverage and debt-to-net-worth ratio
Charts
- Average industry operating costs as a share of revenue, including purchases, wages, depreciation, utilities, rent, other costs and profit in 2024
- Average sector operating costs as a share of revenue, including purchases, wages, depreciation, utilities, rent, other costs and profit in 2024
- Investment vs. share of economy
Data tables
- Industry Multiples (2017-2022)
- Industry Tax Structure (2017-2022)
- Income Statement (2017-2022)
- Balance Sheet (2017-2022)
- Liquidity Ratios (2017-2022)
- Coverage Ratios (2017-2022)
- Leverage Ratios (2017-2022)
- Operating Ratios (2017-2022)
- Cash Flow & Debt Service Ratios (2014-2029)
- Revenue per Employee (2014-2029)
- Revenue per Enterprise (2014-2029)
- Employees per Establishment (2014-2029)
- Employees per Enterprise (2014-2029)
- Average Wage (2014-2029)
- Wages/Revenue (2014-2029)
- Establishments per Enterprise (2014-2029)
- IVA/Revenue (2014-2029)
- Imports/Demand (2014-2029)
- Exports/Revenue (2014-2029)
Detailed analysis
- Trends in the cost component for industry operators and their impact on industry costs and profitability
Key Statistics
Industry Data
Data Tables
Including values and annual change:
- Revenue (2014-2029)
- IVA (2014-2029)
- Establishments (2014-2029)
- Enterprises (2014-2029)
- Employment (2014-2029)
- Exports (2014-2029)
- Imports (2014-2029)
- Wages (2014-2029)
Methodology
How are IBISWorld reports created?
IBISWorld has been a leading provider of trusted industry research for over 50 years to the most successful companies worldwide. With offices in Australia, the United States, the United Kingdom, Germany and China, we are proud to have local teams of analysts that conduct research, data analysis and forecasting to produce data-driven industry reports.
Our analysts start with official, verified and publicly available sources of data to build the most accurate picture of each industry. Analysts then leverage their expertise and knowledge of the local markets to synthesize trends into digestible content for IBISWorld readers. Finally, each report is reviewed by one of IBISWorld’s editors, who provide quality assurance to ensure accuracy and readability.
IBISWorld relies on human-verified data and human-written analysis to compile each standard industry report. We do not use generative AI tools to write insights, although members can choose to leverage AI-based tools within the platform to generate additional analysis formats.
What data sources do IBISWorld analysts use?
Each industry report incorporates data and research from government databases, industry-specific sources, industry contacts, and our own proprietary database of statistics and analysis to provide balanced, independent and accurate insights.
Key data sources in the US include:
- US Census Bureau
- US Bureau of Labor Statistics
- US International Trade Commission
Analysts also use industry specific sources to complement catch-all sources, although their perspective may focus on a particular organization or representative body, rather than a clear overview of all industry operations. However, when balanced against other perspectives, industry-specific sources provide insights into industry trends.
These sources include:
- Industry and trade associations
- Industry federations or regulators
- Major industry players annual or quarterly filings
Finally, IBISWorld’s global data scientists maintain a proprietary database of macroeconomic and demand drivers, which our analysts use to help inform industry data and trends. They also maintain a database of statistics and analysis on thousands of industries, which has been built over our more than 50-year history and offers comprehensive insights into long-term trends.
How does IBISWorld forecast its data?
IBISWorld’s analysts and data scientists use the sources above to create forecasts for our proprietary datasets and industry statistics. Depending on the dataset, they may use regression analysis, multivariate analysis, time-series analysis or exponential smoothing techniques to project future data for the industry or driver. Additionally, analysts will leverage their local knowledge of industry operating and regulatory conditions to impart their best judgment on the forecast model.
IBISWorld prides itself on being a trusted, independent source of data, with over 50 years of experience building and maintaining rich datasets and forecasting tools. We are proud to be the keystone source of industry information for thousands of companies across the world.
Learn more about our methodology and data sourcing on the Help Center.
Frequently Asked Questions
Unlock comprehensive answers and precise data upon purchase. View purchase options.
What is the market size of the Third-Party Administrators & Insurance Claims Adjusters in the US industry in United States in 2024?
The market size of the Third-Party Administrators & Insurance Claims Adjusters in the US industry in United States is $289.3bn in 2024.
How many businesses are there in the Third-Party Administrators & Insurance Claims Adjusters in the US industry in 2024?
There are 121k businesses in the Third-Party Administrators & Insurance Claims Adjusters in the US industry in United States, which has declined at a CAGR of 0.2 % between 2019 and 2024.
Has the Third-Party Administrators & Insurance Claims Adjusters in the US industry in United States grown or declined over the past 5 years?
The market size of the Third-Party Administrators & Insurance Claims Adjusters in the US industry in United States has been growing at a CAGR of 1.9 % between 2019 and 2024.
What is the forecast growth of the Third-Party Administrators & Insurance Claims Adjusters in the US industry in United States over the next 5 years?
Over the next five years, the Third-Party Administrators & Insurance Claims Adjusters in the US industry in United States is expected to grow.
What are the biggest companies in the Third-Party Administrators & Insurance Claims Adjusters in the US market in United States?
The biggest companies operating in the Third-Party Administrators & Insurance Claims Adjusters market in United States are Capgemini Se, Infosys Limited and EmblemHealth Inc.
What does the Third-Party Administrators & Insurance Claims Adjusters in the US in United States include?
Investigating, appraising and settling claims and Third-party claims processing are part of the Third-Party Administrators & Insurance Claims Adjusters in the US industry.
Which companies have the highest market share in the Third-Party Administrators & Insurance Claims Adjusters in the US in United States?
The company holding the most market share in United States is Capgemini Se.
How competitive is the Third-Party Administrators & Insurance Claims Adjusters in the US industry in United States?
The level of competition is high and increasing in the Third-Party Administrators & Insurance Claims Adjusters in the US industry in United States.
