PGBA, LLC
- Company typePrivate
- Founded1981
- HeadquartersFlorence, United States
- Headcount1,001–5,000
- GTM typeB2B
- OfferingServices
PGBA, LLC firmographics
Firmographics- Name
- PGBA, LLC
- Legal name
- PGBA, LLC
- Website
- https://pgba.com
- Company type
- Private
- Founded year
- 1981
- Operating status
- Operating
- Headcount range
- 1,001–5,000 employees
- Ownership category
- akta.pro rank
PGBA, LLC industry classification
Industry- Product category
- Healthcare Administrative Services
- NAICS
- Health and Welfare Funds (525120), Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518)
- SIC
- Hospital & Medical Service Plans (6324), Services-Computer Programming, Data Processing, Etc. (7370)
- akta.pro primary industry
- Government Program Administrative Services (Medicare/Medicaid ASO/TPA) (HLAEALAO)
- akta.pro secondary industries
- Medicare Plan Administration & Third-Party Services (TPA/BPO, Enrollment, Billing) (FSAIAGAI), RCM Outsourcing & Managed Billing Services (HLACACAN)
Keywords
Where PGBA, LLC is headquartered
LocationHeadquarters
- HQ city
- Florence
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
PGBA, LLC business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales, Others
Revenue model
- Government Healthcare Administration Contracts: PGBA serves as prime contractor and subcontractor for government health plans, providing claims processing, customer service, fiscal administration, and data management services under long-term government contracts. Revenue is generated through contract awards from federal and state agencies including TRICARE, VA, Medicare, Medicaid, and correctional healthcare programs.
- Payment Processing Services: Processing over $14.1 billion in payments through tens of millions of transactions annually, working with government vouchering and approval processes as well as corporate clients.
- Fiscal Administration Services: Banking, reporting, and payment processing via end-to-end accounting services including collections with 96% collection rate, bank reconciliations, and 1099 processing.
Go-to-market motion1 record
Distribution channels4 records
Marketing channels3 records
PGBA, LLC product offering
Product offeringCore offering
PGBA provides outsourced healthcare administrative services to government agencies and private healthcare plans, delivering high-volume claims processing (65M+ claims/year at 99.8% accuracy), multi-channel customer contact center services, end-to-end fiscal administration ($14.1B in annual payment processing), data management, and web-based self-service portals for programs such as TRICARE, VA Community Care, and state Medicaid. The company operates as prime contractor and subcontractor, serving federal and state agencies plus large Medicare Advantage plans from its Florence, South Carolina headquarters.
Product overview
PGBA, LLC offers a unified platform of healthcare administrative services combining five core products: Claims Administration (65 million+ claims annually), Web Systems Integration (including myTRICARE® Web Portal and XPressClaim®), Multi-Channel Contact Center Services, Data Management, and Fiscal Administration (with Refund Monitoring and Management System). The company also provides Membership Enrollment and Billing Services as part of its integrated service model. These modular capabilities work together to provide end-to-end claims processing, customer support, and financial administration for government and industry healthcare programs.
Differentiator
Problem solved
Functional benefit
Brands
- XPressClaim: Fast, free Web-based healthcare claims submission of CMS 1500 and UB-04 claims with instant results.
Products and services
- Claims Administration High-volume healthcare claims processing for government and commercial healthcare programs, handling 65 million+ claims annually at 99.8% payment accuracy. Uses a HIPAA-compliant platform with embedded security that exceeds government requirements. For federal and state healthcare agencies (TRICARE, VA, FBOP, Medicaid) and large Medicare Advantage plans that need to outsource claims adjudication and payment.
- Web Systems Integration Multi-channel digital platform enabling customer-facing portals (including myTRICARE® and XPressClaim®) that integrate with partners' policy and claims administration systems for real-time claims access, eligibility checking, EOBs, remittances, and online authorizations. For government health programs and healthcare plans that require provider- and beneficiary-facing self-service.
- Data Management Data management platform providing monitoring, measurement, analysis, and reporting on key business metrics, with scalable processing for high volumes of transactions, enrollment, and claims data. For government and private healthcare organizations that need consolidated reporting and analytics across large claims and enrollment datasets.
- Multi-Channel Contact Center Services Contact center services with skills-based routing, live chat, secure portal self-service, Computer Telephony Integration, browser-based CRM, and automated document generation. Resolves 99%+ of full-service phone calls with the first touch and answers 98% of all calls in 30 seconds or less, handling 2.3 million customer inquiries and 3.1 million+ calls and contacts annually. For government health programs (TRICARE, VA, state public health) and private healthcare plans.
- Fiscal Administration End-to-end accounting services including payment processing of $14.1 billion in annual payments through tens of millions of transactions, financial reporting, collections with a 96% collection rate, bank reconciliations, and 1099 processing. Includes the Refund Monitoring and Management System (RMMS) for tracking recoupments, scheduled collection letters, and offsets of future payments. For government agencies and corporate clients requiring auditable fiscal administration.
- Membership Enrollment and Billing Services Services supporting membership enrollment and billing operations, integrated with claims administration to help customers meet strategic goals and objectives. For healthcare plans and government programs needing outsourced enrollment and billing workflows.
Quantifiable outcome
- 99.8% payment accuracy across all lines of business
- +7 more outcomes
Companies that use PGBA, LLC
Customer profileNamed customers9 records
Segments3 records
Ideal customer profiles3 records
PGBA, LLC technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature5 records
PGBA, LLC partnerships and signals
Strategic signalPartnerships
Nine partnerships are on record, tiered core and flagship.
- Health Net Federal ServicescorePGBA has served as contractor or subcontractor for TRICARE military health plan since 1981, processing claims for 50 million+ claims and responding to 3.1 million+ calls annually.
- Humana Government BusinesscorePGBA serves as contractor for TRICARE East Region under the TRICARE contract.
- TriWest Healthcare AlliancecorePGBA serves as contractor for TRICARE West Region and VA Community Care Network subcontractor, supporting veteran's health contracts with claims processing and customer service.
- UnitedHealthcare Military & VeteranscorePGBA has served as contractor or subcontractor for TRICARE military health plan since 1981.
- OptumServecorePGBA serves as subcontractor on VA Community Care Network supporting the U.S. Department of Veterans Affairs with claims processing, customer service, provider data management and fiscal administration.
- BlueCross BlueShield of South Carolina (Parent Company)flagshipPGBA is a Celerian Group Company. Parent company BlueCross BlueShield of South Carolina maintains continuing policy of nondiscrimination in employment and supports PGBA's operations.
- Federal Bureau of PrisonscorePGBA provides claims processing and support services for inmate healthcare including adjudication expertise to manage administrative process and control medical care costs.
- South Carolina Department of Public HealthcorePGBA provides comprehensive customer service support via Central Appointing System and CareLine program including management of inbound/outbound calls, voicemail, text communications, and live chat for health department appointments.
- South Carolina Center for MedicaidcoreState-level healthcare program administration support through customer service and claims processing services.
Scale indicators15 records
Recent moves6 records
Expansion highlights6 records
PGBA, LLC competitors and assessment
Company assessmentDirect peers
- Conduent: Conduent provides healthcare claims processing, utilization management, and constituent services for government payers, with significant Medicaid and commercial payer exposure. Comparable to PGBA in core claims administration and contact center capabilities, though larger and more diversified across other government verticals.
- Cognosante: Cognosante specializes in health IT and government healthcare services including MMIS, eligibility, and data integration for state Medicaid and federal programs. Directly comparable to PGBA in government healthcare focus, though it leans more toward systems integration and less toward high-volume claims processing.
- Health Net Federal Services: Health Net Federal Services is a TRICARE managed care contractor that has worked with PGBA as a prime/subcontractor. Comparable in TRICARE program knowledge and beneficiary services, though positioned as a prime rather than a subcontractor administrator like PGBA.
- Maximus: Maximus is a large publicly traded BPO that operates a federal health services segment providing claims processing, customer service, and eligibility support for Medicaid and other federal programs. Directly comparable to PGBA in scope, contract structure (prime/subcontractor to government payers), and customer mix.
- Gainwell Technologies: Gainwell Technologies (formed from HMS Holdings and DXC's state health business) is one of the largest government healthcare administrators in the U.S., focused on Medicaid Management Information Systems (MMIS), claims processing, and fiscal agent services for state Medicaid programs. Closest peer to PGBA in business model and government program mix.
- TriWest Healthcare Alliance: TriWest is a TRICARE and VA Community Care Network prime contractor that uses PGBA as a subcontractor for claims and customer service. Closely comparable in TRICARE and VA domain expertise, though TriWest is the prime contract holder rather than a back-office administrator.
Broad incumbents
- Optum (UnitedHealth Group): Optum's government health services arm provides claims administration, contact center, and care management for federal and state programs, including through UnitedHealthcare Military & Veterans (a TRICARE prime that works with PGBA). Overlapping capability set to PGBA at much larger scale.
- NTT DATA (Federal Healthcare): NTT DATA's federal healthcare practice delivers MMIS, claims, and contact center solutions for state Medicaid and federal agencies, including large procurements such as the CMS Federal Marketplace. Comparable to PGBA as a large-scale government health admin and IT services provider, with broader geographic and capability footprint.
Others
- Datavant (Ciox/Truveta ecosystem): Datavant provides health data exchange and de-identification services to government health programs and payers. Adjacent to PGBA's data management business capability, useful as a comparison for how PGBA could evolve its data management practice, but not a direct competitor in claims processing.
Emerging players
- ICF International: ICF provides federal health and human services consulting and digital modernization for CMS, HHS, and state agencies, including some program administration and analytics work. Comparable to PGBA in government health client base, though smaller in pure claims processing volume and more advisory in nature.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat6 records
Key risks6 records
Key highlights7 records
Customer concentration
PGBA, LLC social profiles
Digital presencePGBA, LLC compliance and trust
Trust signalCompliance12 records
PGBA, LLC financial estimates
Financial estimateRevenue estimate
Valuation estimate
PGBA, LLC leadership team
Management profileNumber of profiles
PGBA, LLC funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
PGBA, LLC M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about PGBA, LLC
What does PGBA, LLC do?
PGBA provides outsourced healthcare administrative services to government agencies and private healthcare plans, delivering high-volume claims processing (65M+ claims/year at 99.8% accuracy), multi-channel customer contact center services, end-to-end fiscal administration ($14.1B in annual payment processing), data management, and web-based self-service portals for programs such as TRICARE, VA Community Care, and state Medicaid. The company operates as prime contractor and subcontractor, serving federal and state agencies plus large Medicare Advantage plans from its Florence, South Carolina headquarters.
Is PGBA, LLC a public or private company?
PGBA, LLC is a private company. It is classified as corporate owned and is currently operating.
When was PGBA, LLC founded?
PGBA, LLC was founded in 1981. It employs 1,001 to 5,000 people.
Where is PGBA, LLC based?
PGBA, LLC is headquartered in Florence, United States, in the North America region.
How does PGBA, LLC make money?
Three revenue lines are on record. Government Healthcare Administration Contracts are the primary driver. The others are payment Processing Services and fiscal Administration Services.
Who are PGBA, LLC's main competitors?
Direct peers on record are Conduent, Cognosante, Health Net Federal Services, Maximus, Gainwell Technologies and TriWest Healthcare Alliance. Broad incumbents are Optum (UnitedHealth Group) and NTT DATA (Federal Healthcare). Datavant (Ciox/Truveta ecosystem) is listed as an others. ICF International is listed as an emerging player.
Does PGBA, LLC have an API?
No public API is recorded for PGBA, LLC.
What industry is PGBA, LLC in?
PGBA, LLC's product category is Healthcare Administrative Services. Its primary akta.pro industry code is HLAEALAO, Government Program Administrative Services (Medicare/Medicaid ASO/TPA), with a secondary code of FSAIAGAI, Medicare Plan Administration & Third-Party Services (TPA/BPO, Enrollment, Billing). Its NAICS code is 525120 and its SIC code is 6324.