Availity, LLC

Smart Claims
UX Case Study

Product Overview

Smart Claim is an application on the Essentials platform that allows a person that is not familiar with healthcare administration to easily submit health care claims efficiently and accurately with as little information as possible.

Smart Claim steps users through creating a claim by asking questions in plain language. Often, the answers are already populated by leveraging data stored in the Essential's system. After a claim has been successfully submitted, that claim can then be used as a template for the future.

Project Duration

6 months

My Role

Senior UX Designer

Tools

qualtricsaxureinDesignhotjarmirofigma

My Process

Design Thinking


Empathize

Define

Ideate

Design

Test

Empathize

Problem Statement

There is a growing number of business owners that are performing services that can be reimbursed by submitting claims to health insurance companies. These businesses are known as "atypical" healthcare providers, because they have little to no knowledge of healthcare administration.

Businesses like ride-share companies, salons, carpentry companies and meal delivery services do not have the time or resources to dedicate themselves to learning the complexities of healthcare and to perform their services at the highest level. They simply want to get paid quickly for their hard work.

Objective & Goals

  • Create an intuitive way for business owners to get paid for healthcare related services
    Eliminate the frustration that comes with requiring so much information to submit claims by utilizing automation and AI.
  • Improve efficiency and reduce the time necessary to submit claims
    Ability to submit claims in bulk for multiple patients quickly
  • Reduce the number of rejected claims
    Workflow checks that run behind the scenes to make sure users have everything necessary to successfully submit claims

Target Audience

Businesses that regularly submit a small number of repeatable healthcare claims for the same or similar services: food delivery services, ride-share companies, taxi drivers, salons
target audience

Define

User Behavioral Analysis

I really wanted to know who was submitting claims from our target audience so that I could reach out to them, so I worked with our data and analytics team to identify businesses to contact.

Organization Type Breakdown Chart
Taxonomy Category Breakdown Chart
Transaction Volume by Taxonomy Category Chart

Quantitative & Qualitative Research

Survey results submitted by members of our target audience was the next thing I examined. After submitting claims, users have the option to leave feedback. This was one of the things I used during the definition phase.

Feedback

I'm happy with the experience: 2%

I'm not happy or unhappy with the experience: 5%

I'm unhappy with the experience: 93%

Suggestions

"My info as a provider should populate, I shouldn't have to enter it every time"

"..should not have to fill out claims filling out every detail that is on a claim form already! my time is valuable. more chance of errors. this is not new technology!"

"would love to be able to save and work on laterwhen we maybe need to find att hments or walk away for a second."

Feedback Survey

feedback survey

User Persona & Journey Map

After identifying businesses that met our target audience and learning more about their behavior, I reached out to several of them and set up a set of user interviews. From the information gathered in these interviews, I was able to create a persona and journey map.

journey map

Ideate

I then worked with a cross-functional team in a series of design workshops to come up with as many ideas as we could to address the major pain points for users. We then narrowed it down to a few different ideas we wanted to pursue into the design phase.

Flow Chart

flow chart

Empathy Map

empathy map

Design

During the design phase, I began with really low fidelity wireframes in order to make sure the flow was right and to quickly put the concept in front of users. Availity already had a robust style guide and component library to leverage in the higher fidelity mockups. From there, I moved into the interactive prototyping phase. I used Axure RP, because the team wanted to do moderated and unmoderated user testing to allow users to naturally interact with elements and to explore without having to be directed.

Low-Fidelity Wireframes

wireframes

Style Guide

typography
colors

Prototype

prototype

View the Axure RP Prototype

Test

After I created the interactive prototype, I participated as an observer in our moderated user research testing. I used Miro to record notes from our sessions.

Unmoderated UX Testing Miro Board

UX research testing miro board

Results & Take Aways

Smart Claim had a very slow and methodical launch. It was rolled out to specific organizations in key regions prior to being made generally available. At first, users were hesitant to try something new, but for those who gave it a try, over time, they came to like it. One of the users summed it up in this audio clip (audio transcript) when she simply stated that she loved the fact that we listened to her needs.

Lessons Learned

In learning more about the high stress process of getting reimbursed for healthcare services, I realized how desperate and how urgent solving problems and easing pain points is for those who need them the most. It directly affects business owners' bottomlines.

Some key takeaways from this project are:

  • Every little bit counts. We were looking for the gigantic transformational changes that would revolutionize the way that users work, but there were still small battles that we needed to win before we could get there. Users need to first understand what is required of them in simple terms.
  • Flexibility is key. Many different kinds of users want to work through their claims process in a way that makes sense to their business. Allowing for flexibility in the workflow and the ability to save and return was important.
  • Progress is more important than perfection. I went through many phases and iterations in the design process, because we were testing early and often. I had to take a step back from trying to make sure everything was pixel perfect and lean into making sure our ideas were clear and understandable.

Quick Links

Say hello.

teresawyattlopes@gmail.com
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