Reduced manual entry for adjudicators by centralizing and standardizing claim intake

Understanding the problem

Methods: Discovery workshops with representatives from 3 insurance companies and stakeholders

I led the full end-to-end research and discovery process:

• Stakeholder and client interviews to understand the existing manual workflows.

• Journey mapping workshops with claim intake clerks and adjudicators to visualize pain points and inefficiencies.

• Problem statement discovery based on the mapped journey.

• Validation sessions to confirm that the identified problems matched real operational challenges.

This collaborative discovery phase ensured alignment early and created shared understanding across teams.

Defining key design goals

From the research and journey mapping exercises, we established the following goals:

• Reduce manual data entry for adjudicators.

• Centralize and organize incoming claims (mail, scan, email) into a unified workflow.

• Enable intake clerks to quickly upload, prepare and categorize claims.

• Improve traceability and reduce errors before claims reach adjudicators.

• Provide a scalable and efficient foundation for future claims automation.

These goals helped frame the “How Might We” questions to guide the brainstorming sessions with clients and internal teams.

Ideation & exploration

I explored multiple ways to streamline intake workflows before committing to a direction:

• Created early concepts and wireframes depicting multiple intake flow options.

• Collaborated with clients to refine flows and gather operational feedback.

• Built iterative wireframes showcasing different import paths (scan, email, batch upload).

• Facilitated brainstorming sessions using the problem statements and “How Might We” to generate solutions.

This collaborative exploration helped validate the best direction before moving into detailed design.

Iterative design

Method: User testing and feedback sessions with the clients and our team stakeholders

Approach: Show → Discuss → Collect feedback → Refine

Once a direction was established, I created a mid-fidelity prototype to test and validate:

• Claim upload and import process

• Metadata entry and required fields

• Sorting, grouping and preparing claims

• Error handling, statuses and progress indicators

• Usability and workflow efficiency

Feedback from clerks and adjudicators helped refine detailed functionality and interactions before moving to high fidelity.

Final design solution

I delivered polished, developer-ready designs for all key flows, including

✓ Centralized inbox for scanned and emailed claims in a new claim intake section

✓ Batch import tools to quickly upload multiple documents

✓ Claim preparation workflows allowing clerks to categorize, verify and prepare files

✓ Clear statuses and indicators for in-progress, ready-for-review and flagged claims

✓ Seamless handoff to adjudicators, reducing manual data entry and improving throughput

This solution significantly reduced the adjudicators' workload and standardized the intake process across teams.

Outcome

The claim intake feature was designed as an optional add-on for clients still receiving claims through traditional channels like mail, email and fax.

Initially adopted by a small number of clients — primarily smaller organizations with more traditional submission workflows — the feature gave their clerks a structured digital process where none existed before.

Adjudicators reported meaningful time savings, no longer having to enter claims from scratch, and feedback on the streamlined workflow was consistently positive.

Reflection

This project reinforced how impactful thorough discovery with actual users can be. I really enjoyed leading the end-to-end research workshops, it allowed us to understand users deeply and design a solution that made a meaningful difference in their day-to-day work.