Reducing manual work for claims adjudicators
I led the end-to-end UX design of a centralized intake workflow for claims received outside the online submission system, enabling administrative staff to import, prepare and route claims before adjudication.
Mapping how incoming claims moved and where the process broke down
I led discovery workshops with three insurance clients, mapped their journeys and framed the recurring workflow challenges that mattered across different operating models.
Key pain points were identified
While each insurance client had its own processes, several common challenges emerged that helped define where improvements were needed:
Paper claims were difficult to track and locate, and plan members couldn't confirm receipt or check their status online.
Handling and processing claims received outside the system took significant adjudicator time.
The system lacked an efficient way to assign and distribute incoming claims across teams.
Paper claims were difficult to share across locations, particularly with geographically dispersed adjudication teams.
Turning discovery findings into possible directions
I facilitated brainstorming sessions with clients and the product team, using problem statements and “How Might We” prompts to generate potential solutions. I then created wireframes exploring different approaches to document intake, claim preparation, assignment and adjudication.
Explored concept
I designed an integrated workspace that allowed administrative staff to browse and drag documents directly into the claim intake screen. I felt this offered a more seamless experience for administrative staff by reducing the need to move between separate workflows.
Chosen concept
The chosen direction used a dedicated batch-upload screen followed by a separate claim intake list where staff could access and prepare documents before sending them to claims adjudication.
Why we chose the 2 step approach
The integrated concept offered a more unified experience,
but feasibility, timeline and budget considerations
influenced the decision to pursue a simpler approach
with separate document uploading and claim preparation workflows.
Other explored concepts
Designed a concept to let members track claims submitted outside the online application. Deferred to prioritize the core intake workflow and evaluate client adoption before expanding functionality.
Discussed using OCR to extract information from scanned documents and pre-populate claim fields. Not pursued further due to budget constraints.
Connecting claim intake and adjudication
I designed a centralized workflow that allowed administrative staff to prepare incoming claims before routing them to adjudicators, while supporting document review, workload management and corrections along the way.
Batch upload
Administrative staff could upload multiple claim documents and access them from a centralized intake list.
Claim preparation
Administrative staff would select andcould enter claim information and route them into adjudication.
Claim processing
Prepared claims appeared in the adjudicators' processing list, where they could be assigned, reassigned and opened for adjudication.
A more connected workflow for claim intake and adjudication
The solution introduced a centralized intake process that allowed administrative staff to prepare and route incoming claims before adjudication. It was designed to:
- Reduce manual preparation work for adjudicators
- Improve visibility and control over incoming claims
- Allow adjudicators to focus on adjudication
Client feedback
The design received positive feedback from insurance clients during pre-delivery reviews. Post-launch metrics weren't available to quantify the impact.
Reflection
One of my biggest takeaways was learning how to balance the needs of different clients without overcomplicating the experience. Each had its own way of working, and this project challenged me to look beyond individual requests and focus on the problems they had in common.
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