Healthcare BPO in India: Why US Hospitals Run Their Revenue Cycles From Here
SRF Capital Studio Research DeskFunding Intelligence, SRF Capital StudioIndia is one of the largest delivery bases for US hospitals' billing, coding and denial work. The industry is large, owned increasingly by global private equity, and about to be re-priced by AI.
Summary
- Indian healthcare BPO firms code charts, submit claims and fight denials for thousands of US hospitals and physician groups, with the largest operators employing ten to thirty thousand people each.
- Demand keeps rising because US claims keep getting harder to get paid: initial denial rates rose from about 10.2% in 2020 to 11.8% in 2024, and Medicare Advantage now covers over half of eligible Americans.
- The next phase will be decided by who can raise output per person with AI and move into documentation, analytics and outcome-priced work, rather than by who can hire fastest.
Ask most Indian founders to name a large healthcare export business and they will say pharmaceuticals or medical tourism. Very few will name the industry that processes a large share of American hospital paperwork from offices in Chennai, Navi Mumbai, Bengaluru, Hyderabad and Coimbatore.
That industry is healthcare business process outsourcing, and its core is revenue cycle management: the chain of work between a patient visit and the payment that eventually settles it. For a definition of every stage, see our sector report on revenue cycle management. This piece is about the export business India has built around it.
How big healthcare BPO in India is
No official body publishes a figure. The most recent estimate we found, from MarketsandMarkets, sizes India's healthcare BPO market at about USD 11.35 billion in 2025 and projects 13.8% annual growth to 2030. It should be read as a consultancy model, not a census, and it includes work beyond RCM such as payer claims processing and patient support.
The global market it serves is far larger. Precedence Research puts worldwide RCM spending at about USD 170 billion in 2025, the great majority of it in the United States. Indian firms compete for the outsourced slice of that spend, which is growing faster than the whole because US providers keep moving work out of expensive in-house teams.
A better sense of scale comes from the companies themselves:
Selected Indian-origin healthcare BPO and RCM operators
| Company | Reported headcount | Delivery footprint | Ownership in 2026 |
|---|---|---|---|
| Omega Healthcare | 30,000+ | 14 centres across US, India, Colombia, Philippines | Goldman Sachs Alternatives, Everstone, Ontario Teachers' |
| GeBBS Healthcare Solutions | About 13,000 | US, India, Dominican Republic, Philippines | EQT |
| AGS Health | 12,000+ | India, Philippines; US headquarters | Blackstone; IPO filed in India |
| Vee Healthtek | About 5,000 | India, US, Philippines | TA Associates (majority), founding family |
| Sagility | Not in sources used | India and overseas centres | Listed on NSE and BSE since Nov 2024 |
Behind these leaders sits a long tail of mid-size and small firms, many founder-owned, that serve physician practices, smaller hospitals and billing companies that subcontract work further.
Why the work comes to India
Cost is the reason usually given, and it is real: a trained coder or accounts receivable specialist in India costs a fraction of the US equivalent. It is not the whole story, and it is not the part that makes the position durable.
- Credentialed talent at volume. US coding credentials (AAPC's CPC, AHIMA's CCS and CDIP) can be earned in India, and large operators run their own training pipelines to produce certified coders every year.
- Clinical English. Coding and documentation review means reading doctors' notes and payer policies closely. Graduates in nursing, pharmacy and life sciences give Indian firms a supply of people who can do this.
- Overnight turnaround. Work received at the end of a US day can be coded, checked and returned before the next one begins.
- Twenty years of process. The largest firms have spent two decades building quality systems, US-grade security controls and client reporting that a new competitor cannot copy quickly.
The Philippines is the main alternative, and the table above shows that the Indian leaders hedge by running Philippine centres of their own. The competition between the two countries is increasingly between Indian firms' own delivery locations.
Why US demand keeps growing
The US system generates more revenue cycle work every year, even when patient volumes are flat, because getting paid keeps getting harder.
Kodiak Solutions, which benchmarks more than 2,100 US hospitals, found that 11.81% of claims were initially denied in 2024, against about 10.2% in 2020. Most of those claims are eventually paid; only 2.8% were finally written off. The gap between those two numbers is labour: someone has to read every denial, correct or appeal it and follow it until the money arrives.
Medicare Advantage adds to the load. KFF counts 34.1 million people, 54% of eligible Medicare beneficiaries, in private Medicare Advantage plans in 2025. These plans use prior authorisation and claim review more heavily than traditional Medicare, which pushes more work into the revenue cycle.
Every rise in the US denial rate is a rise in demand for someone in India to fight the denial.
What is changing
Three shifts will reshape healthcare BPO in India over the next five years, and none of them is about finding more people.
Ownership. Almost every large Indian-origin operator is now owned by a global private- firm or has listed. That brings capital for acquisitions and technology, and a hard focus on margin and revenue per employee. Our piece on RCM companies in India and the deals behind them sets out who bought what.
AI. Tools that suggest codes, draft appeals and read remittances are in live use. US clients know it and are asking for lower prices on routine work. Firms whose revenue is mostly routine outpatient coding priced per chart face the sharpest cuts.
Mix. The work that holds its price needs judgement: inpatient coding for complex cases, clinical documentation review, payer-specific denial appeals and analytics. Firms that move their revenue toward these services will hold margin. The case for doing so, and the myths that stop firms from trying, are in our piece on what the industry gets wrong.
Where we differ from the usual pitch
Industry presentations often claim India does 30 to 40% of the world's outsourced RCM work and captures under 10% of its value. We could not find a source for either figure and would not use them in an investment memo.
The more defensible point is narrower. Indian operators have built scale in services and are thin in software and payer analytics, which is where the highest valuations in US revenue cycle sit. Closing that gap is expensive, slow, and requires data rights that client contracts often restrict.
What this means for you
- Founders of mid-size healthcare BPO firms: your competitors are no longer other founder-run firms; they are private-equity platforms with acquisition budgets. Pick a specialty or a service line where you can be clearly better, and measure yourself on revenue per employee, not headcount. We lay out the options in our growth strategy piece.
- Investors: the leaders are expensive and owned. The opportunity is in specialists with long client contracts and a credible productivity story, and in the software and analytics layer around them. Treat any AI claim as a question about output per coder over three years.
- Domestic healthtech founders: the export industry has trained a generation of Indian coders, auditors and denial analysts. That talent pool is the raw material for domestic healthtech revenue cycle products, and it is available in the same cities.
Healthcare BPO in India is past its growth-by-hiring phase. The next decade rewards firms that sell outcomes and productivity, and it will be less kind to those that sell seats.
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SRF Capital Studio Research Desk
Funding Intelligence, SRF Capital Studio
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