EXL ranks leader in AI-enabled healthcare payer operations
NEW YORK, UNITED STATES — Everest Group has named EXL, a Leader in its Healthcare Payer Intelligent Operations PEAK Matrix Assessment 2026 — the first iteration of the report to explicitly evaluate AI-enabled capabilities across analytics, automation, and back-office operations for health plans, drawn from a field of 33 assessed providers.
According to a press release, the designation reflects growing demand from United States health plans for operations partners that can demonstrate measurable AI integration across high-volume payer functions — from prior authorization processing to population health management and claims adjudication.
Payer assessment expands to intelligent operations
The 2026 assessment marks a significant evolution from Everest Group‘s 2023 payer operations report, broadening its scope from traditional back-office delivery to “intelligent operations” — a framework that evaluates provider capabilities across AI, automation, analytics-driven workflows, and Business Process as a Service (BPaaS) delivery models.
EXL’s recognition specifically cited strengths in analytics and predictive modeling, solution flexibility, and the proprietary CareRadius platform — which combines utilization management, case management, and population health workflows with analytics-driven automation in a single integrated system.
“EXL is advancing its data and AI-led strategy through a mix of functional BPaaS, analytics, and platforms,” said Vivek Kumar, Practice Director at Everest Group.
CareRadius platform anchors EXL’s payer strategy
EXL reported double-digit growth in its health and life sciences business alongside the recognition, a trajectory the company attributes to rising demand from U.S. health plans for operations partners with integrated AI and analytics capabilities across the full payer value chain.
The company’s CareRadius platform reflects the direction of health plan operational modernization: connecting utilization review, population health, and case management within a single analytics-driven workflow.
“Data management, analytics and AI have become vital tools for health plans to improve operational efficiency,” said Vivek Jetley, President and Head of Insurance, Healthcare and Life Sciences at EXL.
Healthcare payer operations — including prior authorization, claims processing, utilization management, and population health management — represent one of the largest and fastest-growing segments of the healthcare business process outsourcing market, driven by mounting administrative complexity and regulatory pressure on health plans.
The industry shift toward AI-enabled BPaaS delivery models reflects growing demand for managed service arrangements that convert fixed back-office costs into variable, outcome-linked expenditure without requiring health plans to build and maintain underlying technology infrastructure.
Providers that can demonstrate measurable gains in claims accuracy, authorization turnaround, and compliance performance are positioned to capture long-term operational mandates from health plans under sustained financial pressure.
