The US Payer’s Favourite Indian Appendix

Meet: The Company That Processes America’s Medical Claims. From Bangalore.

Incorporated in 2021, headquartered in Bangalore, owned briefly by PE, Sagility is in the business of doing things US healthcare companies don’t want to do themselves. That means: processing 105 million claims per year. Managing provider data. Conducting eligibility checks. Revenue cycle management for hospitals. Post-pay audits. Prior authorization. Member engagement. The entire unglamorous, high-volume, middle-office plumbing of American healthcare insurance.

The US healthcare outsourcing market is roughly $20 billion in revenue annually. Sagility captures 1.23% of it — not exactly market domination, but enough to work for five of the top 10 US health insurers: UnitedHealthcare, Elevance (formerly Anthem), Centene, CVS Health, and Cigna. Plus major hospitals like Johns Hopkins, Tenet, UCSF, and Cleveland Clinic.

The business model is delightfully simple: US healthcare generates $4.5 trillion of annual spend. Of that, administrators need to check if claims are real. Providers need to chase money. Payers need to prevent overpayments. Enter Sagility — a contractor who does this work for 60–70% less cost than hiring Americans. They have 48,522 employees across five countries (US, India, Colombia, Jamaica, Philippines). Revenue in FY25 was ₹5,570 crore. Revenue in 9M FY26 is ₹5,168 crore — implying a full-year run rate around ₹7,000+ crore if Q4 shows seasonal strength.

But here’s the plot twist: just when Sagility was cruising, EQT Private Capital Asia (its PE owner via Sagility B.V.) started diluting the stake. May 2025: -15%. December 2025: another -16.4%. Promoter stake went from 82% → 51% in seven months. Markets loved it (stock up 50% from IPO lows). Institutions bought up the float. And management kept saying “everything is fine, growth is accelerating, transformation is underway.”

How Do You Make ₹1,971 Crore From American Headaches?

Sagility operates two segments: Payers (88.5% of Q2 FY26 revenue) and Providers (11.5%). Payers = insurance companies. Providers = hospitals and clinics.

For Payers: Sagility processes claims adjudication. They check: Is this a real person? Is the procedure covered under this plan? Was this billed correctly? Should we pre-reject or post-pay-audit this claim? They process 105 million claims annually. They also manage provider networks (verify doctors are real, licensed, not fraudsters). They conduct payment integrity audits. They run member engagement operations. All at FTE rates far cheaper than US labour.

For Providers: Sagility manages the financial side of healthcare from patient pre-service eligibility verification through to post-service billing, follow-up, and collections. This is called Revenue Cycle Management (RCM). Hospitals hate this work. Sagility does it 24/7/365. They also provide patient engagement support and denials management.

Pricing model: Time-based (FTE rates, monthly fees). Transaction-based (per claim, per prior auth). And increasingly, outcome-based (we’ll manage your revenue cycle and share in the savings). The last model is the shiny new thing management keeps pushing because it requires less headcount and more technology — exactly what PE owners like.

The competitive moat? Scale (105 million claims/year experience). Client relationships (10+ year tenure with many). Regulatory compliance (healthcare is heavily regulated, switching costs are brutal). Global delivery footprint (pick your timezone, pick your cost). The headwind? Attrition (22.8% in Q3), wage inflation (ongoing), commoditization (every player is trying to move upmarket), and the small detail that the company processes **100% of its revenue from US healthcare**.

Q3 FY26: The Numbers Dance

Result type: Quarterly Results (Oct–Dec 2025)  |  Q3 EPS: ₹0.57  |  Annualised EPS (9M avg ×4/3): ₹1.80  |  9M FY26 EPS (Adjusted): ₹1.75

What’s This Healthcare BPO Actually Worth?