Carelon Global Solutions

What Carelon Global Solutions does

Carelon Global Solutions is a US-headquartered, India- and Philippines-delivered business process outsourcing and digital transformation provider focused exclusively on US health plan operations. Founded in 2017 and headquartered in Indianapolis, the company operates as a wholly owned subsidiary of Carelon and was spun out of what its materials describe as 'one of the largest health insurance providers'. It serves health plans across five integrated service lines: Provider Network Solutions (enrollment, onboarding, roster, and data management), Claims Management Solutions (full claims lifecycle modernization using intelligent automation and analytics), Customer Experience Solutions (multi-channel member engagement), Risk Adjustment and Quality Performance Solutions (care gap closure and risk score optimization through coding experts), and Clinical Operations Solutions (clinical appropriateness review and case management staffed by registered nurses with specialized training).

The underlying technology stack is described as a platform-agnostic, intelligent automation and advanced analytics layer applied across healthcare operations, with HITRUST certification and NCQA accreditation providing healthcare-specific compliance scaffolding. The company reports operational metrics of 98.7% provider data accuracy, 99.4% audited claims accuracy, and 97.5% medical coding accuracy. Delivery is supported by more than 29,000 associates, with recognized operations in the Philippines (Best Workplace 2026, HIMAP Awards 2025) and India, consistent with a right-shore model that pairs US client relationships with lower-cost clinical and operational talent pools.

Commercially, Carelon Global Solutions sells through a consultative enterprise sales motion directly to health plans under long-term managed-services arrangements that bundle operations, technology enablement, and continuous innovation. Pricing is not publicly disclosed and is negotiated per scope and volume. The company earns third-party validation through its Leader designation in Everest Group's Utilization Management Operations assessment and pursues thought leadership on healthcare cost trends and digital claims operations to support top-of-funnel demand generation. No revenue, M&A, or funding figures are publicly disclosed.

Name

Carelon Global Solutions

Legal name

Carelon

Website

https://carelonglobal.com

Company type

Private

Founded year

2017

Operating status

Operating

Headcount range

5,001–10,000 employees

Short description

Carelon Global Solutions is a US-based, India- and Philippines-delivered healthcare BPO and digital transformation provider serving health plans across provider network, claims, customer experience, risk adjustment, and clinical operations under HITRUST and NCQA frameworks.

Ownership category

akta.pro rank

Product category

Healthcare Operations and BPO Services

NAICS

Management Consulting Services (54161), Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518), Other Management Consulting Services (541618)

SIC

Services-Health Services (8000), Services-Management Services (8741), Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro primary industry

Care Management & Coordination Platforms (case/disease management workflows) (HLACAHAD)

akta.pro secondary industry

Helpdesk & End-User Support Services (BPAEABAB)

Keywords

• Healthcare operations services
• Claims management solutions
• Provider network management
• Clinical operations support
• Healthcare digital transformation

Headquarters

HQ city

Indianapolis

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales

Revenue model

1. Healthcare Operations and BPO Services: Carelon Global Solutions generates revenue through providing comprehensive healthcare operations management and business process outsourcing services to health plans. The company delivers end-to-end operations solutions including provider network management, claims management, customer experience, risk adjustment, and clinical operations. Revenue is derived from long-term partnerships with health plans requiring ongoing operational support and digital transformation services.

Go-to-market motion1 record

Distribution channels1 record

Marketing channels1 record

Core offering

Carelon Global Solutions delivers end-to-end healthcare operations and business process outsourcing services to health plans, including provider network management, full lifecycle claims management, customer experience operations, risk adjustment and quality performance, and clinical operations. Its offerings are powered by intelligent automation, advanced analytics, and a 29,000+ associate workforce operating under HITRUST-certified and NCQA-accredited standards dedicated exclusively to healthcare.

Product overview

Carelon Global Solutions offers a unified platform of healthcare operations and digital transformation services for health plans. The portfolio comprises five integrated service offerings: Provider Network Solutions (for enrollment, onboarding, roster and data management), Claims Management Solutions (full claims lifecycle modernization using intelligent automation and analytics), Customer Experience Solutions (high-tech, high-touch engagement across channels), Risk Adjustment and Quality Performance Solutions (care gap closure and risk score optimization), and Clinical Operations Solutions (clinical review and case management with specialized nursing staff). These solutions are powered by scalable operations, intelligent automation, and modern technology enablement, all delivered under a HITRUST-certified and NCQA-accredited framework wholly dedicated to healthcare.

Differentiator

Problem solved

Functional benefit

Products and services

• Provider Network Solutions

Quantifiable outcome

• 98.7% provider data accuracy
• +2 more outcomes

Named customers1 record

Segments2 records

Ideal customer profiles1 record

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability2 records

Feature5 records

Scale indicators6 records

Recent moves4 records

Expansion highlights4 records

Direct peers

• Infosys BPM: Infosys BPM is the business process management arm of Infosys, with a sizable healthcare payer practice covering claims, provider network operations, and member services — competing head-to-head on offshore-led health plan BPO.
• EXL Service: EXL is a publicly listed operations management and analytics company with a strong healthcare payer practice covering claims, care management, and risk adjustment — a near-comparable in scale and service mix.
• Accenture: Accenture Health operates a large-scale healthcare operations and consulting practice serving payers with claims, member services, and care management transformation — a global incumbent competing for the same enterprise BPO deals.
• Cognizant: Cognizant's Healthcare Business Operations practice delivers BPO, claims, provider data, and digital transformation services to US health plans, directly competing for the same buyer and many of the same workflows.
• Concentrix: Concentrix provides customer experience and BPO services at very large scale with a dedicated healthcare vertical, overlapping with Carelon Global Solutions' Customer Experience Solutions and member engagement workflows.
• Optum: Optum is UnitedHealth Group's health services arm, providing healthcare operations, claims, clinical, and technology services to health plans — almost a direct functional twin to Carelon Global Solutions within a different large US health insurer parent.
• HCL Technologies: HCLTech's Healthcare and Life Sciences practice delivers IT and BPO services to US health plans, including claims, provider network, and digital transformation — comparable delivery scale and buyer segment.
• Wipro: Wipro's Healthcare and Life Sciences business provides BPO, claims processing, provider data management, and member engagement services to US health plans, with comparable offshore delivery scale.
• Conduent: Conduent is a pure-play business process services provider with a large healthcare payer business spanning claims administration, member management, and provider data operations — directly comparable to Carelon Global Solutions' core offerings.

Regional players

• Parallon: Parallon, a subsidiary of HCA Healthcare, provides healthcare operations services including revenue cycle, credentialing, and provider data management — adjacent overlap with Carelon Global Solutions' provider network and claims operations, though anchored in provider-side rather than payer-side delivery.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks7 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/carelon-global-solutions-in
• Facebookfacebook.com/carelonglobalsolutionsIN

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Subsidiaries1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Carelon Global Solutions