Making Claims management system human-centered

Designing a paperless claims management system to reduce efforts and speed-up Claims approvals.

Challenge and Problem statement

No one plans to get sick or hurt, but most people need medical care at some point. Health insurance covers these costs and offers many other important benefits.

Hospitals need a software that provides an effective way of claims processing and enables the elimination of inconvenient and error-prone paper and email-based operations taking all communications, data, and processes into a unified working environment.

User Journey

To approve a claim, the Recipient hands the patient ( The policy holder ) a form to fill, The hospital records all the medical services and the costs offered to the policyholder. This record is known as the medical claim. Hospital receptionists, Senior nurses, and doctors are responsible for creating this record and sending the claims out to the policyholder’s insurance company, which has three options. It can:

-Accept all expenditures and pay the bill in full

-Deny the claim on account of a billing error (like incorrect patient information). The bill is then returned to the healthcare provider to be corrected.

-Reject the claim outright, usually on account of the services not being covered within the health plan. The policyholder then pays for the service out of pocket

My Role

On this project, I served as a UX researcher, UI designer, and front end developer. I collaborated with a team of UI designers and frontend developers. The productive collaboration between the team was the key ingredient for this successful product.

Key Deliverables
  • Stakeholder Interview Key Findings Summary Report
  • End User Interviews summary Report
  • User-centered design canvas
  • Persona design
  • User journey map
  • Paper wireframes for testing
  • Interactive Prototypes (hi-fi)

Research and Ideation

Stakeholder interview

Because of the projects’ complexity and specific target group, it was crucial to understand the whole concept of the future portal. The first step was then a comprehensive stakeholder interview. After discussing projects’ objectives, we had a chance to learn more about hospitals, claims, and claim systems and as a consequence draw first conclusions about the target user characteristics.

User interviews ( ethnographic interview), Usability Tests and Competitive analysis.

To adjust the product to the target user, we had to learn as much as possible about their needs and expectations. we sat down with participants ( hospital receptionist, nurses, and doctors ) and ask them questions about their needs, goals, and motivations. We interviewed them inside the hospital to observe their natural behavior. We also conducted usability testing on competitors products. We asked participants to perform tasks like ( start a claim, save claim, how to send to nurse, how to send to the doctor , how to check status ) and observed where they ran into trouble or questions and asked follow-up questions to understand their thought process.

Interviews were very helpful in creating personas and Empathy-user-centered canvas.

It had become clear that the challenge implied more than updating the tool’s design by implementing the new visual style and common interaction patterns.

It meant a bigger effort with three focus areas:

1) Putting customers at the center by creating a service that would revolve around each of the target groups core tasks.

2) Updating front & backend structures.

3) Incorporating UX capabilities and using the Scrum development process in the organization.

Prototype and Testing

Wireframes and a basic prototype

I sketched two basic wireframes for the system, and while on a hangout the core team moved content around and talked about our messaging flows.

We had two different versions of the information architecture to be able to do A/B testing to make sure that information is clear to Users.

Interactive prototype

I used Invision to assemble the wireframes into a clickable prototype of which became the primary way we communicated about the project and was a huge asset to our  UI developer. Then we ran the A/B testing to know which design works best.

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Results

CMS has enhanced hospital reporting, increased efficiencies in claims handling, query management and e-submission at the hospital level.

Patients can electronically sign insurance forms via an iPad or tablet device.

Consultants can access an electronic secure list of their claims, and can electronically sign appropriate claims.