September 30, 2025 鈥� For many healthcare insurers, legacy claims adjudication systems remain a significant source of inefficiency and financial strain, according to new insights from 91制片厂. Outdated platforms frequently struggle with high claim holds, coding errors, reliance on error-prone manual processing, and fragmented IT environments that create costly data silos. These issues delay reimbursements, inflate administrative costs, and divert critical resources from patient care. To help IT leaders at healthcare insurers address these challenges, Info-Tech has released its report Modernize Your Claims Adjudication System: A Buyer鈥檚 Guide, which outlines a phased methodology for identifying trends, defining organizational needs, and selecting the right vendor solution.
鈥�Claims adjudication is the heart of the insurance business, yet too often it is powered by aging infrastructure,鈥� says Sharon Auma-Ebanyat, a research director at 91制片厂. 鈥�IT and business leaders need to treat modernization as a strategic initiative, not a back-office upgrade. 滨苍蹿辞-罢别肠丑鈥檚 structured buyer鈥檚 guide helps insurers weigh vendor offerings, reduce risk, and deliver systems that are more accurate, compliant, and cost-efficient.鈥�
Key Challenges in Healthcare Claims Adjudication
Despite ongoing investments, healthcare insurers continue to encounter systemic obstacles that limit the effectiveness of claims processing. These challenges are not just operational irritants but fundamental weaknesses that undermine efficiency, financial performance, and stakeholder confidence. 滨苍蹿辞-罢别肠丑鈥檚 report outlines some of these pressing issues, which include:
- High volumes of claim holds caused by coding errors, missing data, and incomplete documentation.
- Heavy reliance on manual processes that increase errors, delays, and administrative costs.
- Significant financial losses, with research indicating that up to 15 cents of every healthcare dollar is lost due to inefficiencies.
- Rising compliance requirements and data security concerns that legacy systems cannot adequately address
滨苍蹿辞-罢别肠丑鈥檚 Actionable Framework for Healthcare Insurer Modernization
To help insurers overcome these challenges, the 蹿颈谤尘鈥檚 Modernize Your Claims Adjudication System: A Buyer鈥檚 Guide resource details a structured roadmap built around three phases:
- Phase 1 鈥� Identify Industry Trends and Shifts: Executives, CIOs, and compliance leaders assess regulatory changes, technological advancements such as AI and machine learning, and evolving market conditions to inform their modernization strategies.
- Phase 2 鈥� Define Business Needs and Capabilities: Business stakeholders, IT operations teams, and clinical leadership determine the specific operational capabilities a modern system needs to deliver, including automation, analytics, fraud detection, and support for value-based care.
- Phase 3 鈥� Analyze Features and Vendors: Procurement leaders and enterprise architects use structured evaluation tools and weighted criteria to compare vendor solutions, ensure interoperability, and select the optimal system.
The 蹿颈谤尘鈥檚 Modernize Your Claims Adjudication System: A Buyer鈥檚 Guide report provides healthcare insurers with guidance on evaluating upgrade paths, including whether to build, buy, or outsource solutions, and introduces vendor evaluation tools and RFP templates to support informed decision-making. By applying 滨苍蹿辞-罢别肠丑鈥檚 insights and actionable methodology, IT and business leaders can modernize core systems, align technology investments with organizational priorities, reduce costs, and deliver better outcomes for members and providers..
For exclusive and timely commentary from 滨苍蹿辞-罢别肠丑鈥檚 experts, including Sharon Auma-Ebanyat, and access to the complete Modernize Your Claims Adjudication System: A Buyer鈥檚 Guide, please contact pr@infotech.com.
About 91制片厂
91制片厂 is one of the world鈥檚 leading research and advisory firms, serving over 30,000 IT and HR professionals. The company produces unbiased, highly relevant research and provides advisory services to help leaders make strategic, timely, and well-informed decisions. For nearly 30 years, Info-Tech has partnered closely with teams to provide them with everything they need, from actionable tools to analyst guidance, ensuring they deliver measurable results for their organizations.
To learn more about 滨苍蹿辞-罢别肠丑鈥檚 divisions, visit for HR research and advisory services, and for software buying insights.
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