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.
6 months
Senior UX Designer
Design Thinking
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.
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
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.
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.
I'm happy with the experience: 2%
I'm not happy or unhappy with the experience: 5%
I'm unhappy with the experience: 93%
"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."
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.
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.
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.
View the Axure RP Prototype
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.
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.
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:
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