Glycyrrhetic acid 3-O-mono-β-d-glucuronide (GAMG) is an important derivative of glycyrrhizin (GL) and has attracted considerable attention, especially in the food and pharmaceutical industries, due to its natural high sweetness and strong biological activities. The biotransformation process is becoming an efficient route for GAMG production with the advantages of mild reaction conditions, environmentally friendly process, and high production efficiency. Recent studies showed that several β-glucuronidases (β-GUS) are key GAMG-producing enzymes, displaying a high potential to convert GL directly into the more valuable GAMG and providing new insights into the generation of high-value compounds. This review provides details of the structural properties, health benefits, and potential applications of GAMG. The progress in the development of the biotransformation processes and fermentation strategies to improve the yield of GAMG is also discussed. This work further summarizes recent advances in the enzymatic synthesis of GAMG using β-GUS with emphasis on the physicochemical and biological properties, molecular modifications, and enzymatic strategies to improve β-GUS biocatalytic efficiencies. This information contributes to a better framework to explore production and application of bioactive GAMG.