UX Journey of an information Management System

Working at Carelon Global Service, i as a UX designer come across designing solutions for Anthem Insurance products. With multiple insurance products spanning across many states in US, they have to address changing regulations, meet business expectations, optimize their workflows and their claims processing. In order to consolidate Anthem's current distributed digital solutions and automate current claims adjudication pocess, a new proposal for a digital product was initated by Carelon and the UX team got involved.

When the Carelon business came with the requirement, the team had a sample prototype created and they wanted the UX team to create a detailed design. Our initial heuristics analysis and research found many pitfalls in suggested prototype. So the challenge was to understand the domain we are looking to solve, look at the business requirements, getting user access and then getting to know what they want and proposing a design plan.

But FIRST, we had to convince this to business on our efforts. Once that part is over, We can actually start designing.

I have documented the project's 1.5 year journey in steps below.

Project Initiation

Business vision was to digitize and optimize claims processing. The claims team approached the UX to build a customer centric application that digitize, modularize claims processing steps. the primary focus was on benefit booklet generation.

They envisioned to solve it by

Improving the quality of data used in booklet
Streamline manual process
Modernize adjudication systems

A Benefit Booklet is a written explanation of insurance coverages or benefits issued by an insurer. It is supplemental to and not a part of an insurance certificate or subscriber contract1. The benefits booklet is also called evidence of coverage (EOC) or certificate of coverage (COC)2. It is produced by the health plans to provide detailed information about plan benefits and what is and is not covered2. The benefits booklet is the primary source of coverage provisions offered under the plan2.
excerpt from https://www.hca.wa.gov/employee-retiree-benefits/retirees/benefits-and-coverage-plan

Our role as a UX team of 2 people is to streamline the booklet generation.

so, the first job was to identify the users and the context

To generate a booklet, there were 4 key players.

Client : A corporate who buys insurance from the company for their employees or retirees.
Consultant : Reviews requirements from clients, discuss new policy changes with them and communicates these changes to management.
Client Consultant : Notifies client about renewal of their policies. Receives updation requests from consultants and documents it in an intake form.
Operations team : Based on intake form, redline template for policies of current year and benefits data shared, they creates booklet drafts and reviews it with the client management.

Once all changes are confirmed and reviewed by both consultants and client, booklet will be published.

After identifying key users, We had to decide on a proof of concept that will kickstart the project. With stakeholder and product team discussions, he team mapped out the priorities of the MVP

An MVP was finalized on digitizing operation team key functions

creating the draft
Adding Benefit content
Generating the draft

The first steps

With the list of features for MVP, now it was time to understand our users and ideate.

Based on the initial research and select stakeholder interviews, we detailed out an initial draft. This gave confidence in our stakeholders and we were able to drive the project with UX processess.

Understanding users better

With our assumptions and initial sketches, we were able to detail out user goals and their frustrations with exploratory interviews focusing on their current workflows.

For our MVP, we put our focus towards 2 primary users

Client consultant who verifies the document
Operations team who focus on booklet generation

Mapping the workflow

Detailing out the workflow gave us more clarity on more user segments. Discussing it with product team, we refined to first MVP to focus on a single user archetype,

the operations team.

Scaffolding

The second iteration with fleshed out wireframes mapped the booklet creation workflow. These wireframes once finalized with stakeholders were then converted to high fidelity screens.

Visual Design

Following organization design system, the first iteration was converted to visual design. The screens followed the journey of operations team and was shared with them as a prototype to gather feedback.

Workflow Changes and refinements

Each iterations bought a common terminology to use within teams using the product. The 1 week processing time for first revision of a generated document was cut short into 20 minutes.

Now instead of waiting for review and changes, the users collaborate on a living document.

Ínsights from product team

By checking outlines, the product team found that 80% of the operations work involve renewals which will have fewer changes to last years document. They also found a sections which have frequent changes and the ones that never change

With this information, our team suggested introduction of an intermediate user archetype, we enabled reusable content blocks and templates to speed up the booklet creation process.

Once all users onboarded to platform in later MVP versions, Comments and review feature was introduced to communicate language changes, clause adjustments.

Feedback

With regular Usability feedback sessions after each major iteration, We received positive feedback as well as suggestions for new features.

The 1 .5 year worth of effort bought changes to the users

Booklet generation

The introduction of a step by step journey to kickstart booklet generation helped users onboard the platform with their previous knowledge.

Templates and reusable content blocks reduced the time spent on a single booklet

2. Communication

instead of waiting for mail to add feedback, users could quickly review changes and also add in comments for helping each other.

All changes and progress on a single booklet can tracked without any mail chain

3. Automated Archiving

The product handled archiving and version control removing the effort of keeping record of older files.

At the end of my journey, the app has successfully adopted by 3 businesses with positive reviews. 24 more businesses will be on-boarded in the following year.

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