Carelon named a Leader in utilization management operations by Everest Group

Everest Group has recognized Carelon as a Leader in its 2025 Utilization Management (UM) Operations PEAK Matrix® Assessment. This independent, data-driven analysis evaluated 18 UM service providers based on the vision, capabilities, market impact, and value they deliver. Accessible infographic

Scatterplot graphic displaying where various competitors in the utilization management space rank in terms of both market impact and vision and capability. The chart groups companies into three main groups: aspirants, major contenders, and leaders.

Differentiators that matter to health plans


The report highlights several strengths that set Carelon apart, such as our:

  • Best-in-class, web-based provider portal that simplifies online submissions and increases efficiency.
  • Broad solution portfolio, which covers more than 12 clinical specialties and leverages advanced analytics and machine learning.
  • Strategically distributed, high-performing workforce.
  • Consistent, high-quality operational delivery.

“Carelon is uniquely positioned to meet enterprise demands with deep domain expertise and industry-specific solutions across 12+ therapeutic areas. Its automated provider portal solution, EMR integration capabilities, and decision support tool streamline UM workflows and enhances clinical decision-making,” said Everest Group Practice Director Lloyd Fernandes. “A strategically distributed workforce ensures operational reliability and flexibility, earning client praise for high-quality service.”

Best-in-class utilization management


Following an in-depth assessment — which included interviews with Carelon clients — Everest Group named Carelon a Leader, highlighting its ability to: 

  • Partner effectively with health plans by offering end-to-end solutions that balance cost and quality.
  • Invest in innovation to enhance decision-making, improve workflows, and meet rising demand for comprehensive outsourced services.
  • Prioritize risk-based delegated models that align with evolving payer needs.
  • Leverage technology to streamline operations and deliver measurable value.

Carelon earned the top position among Leaders in the Market Impact category, which considers client adoption, solution breadth, and the tangible value delivered.

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