Rethinking the Health Insurance Claim Experience
Note: This project is a case study I created on my own, not as part of a specific company.
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Context: Business Problem
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When you think about how clunky and complex the health insurance claims experience is compared to services like Amazon or Airbnb, there's a lot of room for improvement. Insurers have been searching for ways to meet consumers where they spend the most time: on their mobile device. Digitization of the healthcare industry can lead to member satisfaction and trust, increased revenue from digital branding and improved sales tools, and double-digit reductions in administrative costs.
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āFrom a customerās standpoint, few industries are as ripe for disruption as insuranceā [McKinsey]
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The Industry Is Changing
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"Most consumersā experience with their insurance company consists of buying a complicated policy in a vaguely unpleasant underwriting process, paying their annual premiums, and when something bad happens, filing a claim and hoping it gets paid. For customers with expectations increasingly formed by interactions with companies such as Amazon, Uber, and Facebook, this doesnāt quite cut it." [McKinsey]
Human-Centered Design Process
The human-centered design process is about building empathy with ourĀ users, honing in on the real problem, amplifying creative ideation, and conducting lean, iterative experimentation. It reduces risk,Ā lowers costs and creates better products.
Research
To get a better understanding of the customer perspective, I started by interviewing a neighbor about their recent health insurance experience. Had this been a real project, I would have also conducted qualitative research to empathize and build personas for other key stakeholders: Customer Service Representatives and Healthcare Practitioners.
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Takeaways
ā¢ Customers are confused and frustrated with the claim experience
ā¢ They value transparency and efficiency from big businesses like healthcare, something that is extremely important to them and their families
ā¢ Simplicity and friendly support = TRUST
A quick customer journey map sketch shows how and when the three personas interact, as well as the key pain points throughout the journey from a customer perspective. After targeting a few differentĀ opportunities, I reframedĀ them as āHow Might Weā questions.
Identify & Focus
I reviewed and synthesized the research. If we had quantitative data to help prioritize the pain points, I would add that in here to build a stronger picture. Clearly theĀ biggest areaĀ of opportunity emerging from the customer interviews: the complex and frustrating claim process. At this point in the journey, customers are unsure,Ā don't know what to expect and aren't familiar with the jargon. From a business perspective, call volume is also extremely high during the claim process. This is an opportunity to reduce costs for the healthcare company, as well as improve the claim experience for the customer.
How might we provide reassurance during the claim process and make it simple for customers at a difficult time?
Ideate & Prototype
With a clear opportunity statement, we can now begin solutioning. In a group project, I would typically lead an ideation workshop to generate as many ideas as possible using activities like Crazy 8s, Worst Possible Idea or Brainwriting.
I came up with these 8 different ideas in 8 minutesā¦
ā¢ Personalized mobile app for claims
ā¢ Email/text updates on status
ā¢ Chatbot to answer FAQs
ā¢ Real-time progress tracker for claims
ā¢ Claim concierge service to handle claims
ā¢ Friendly, approachable language
ā¢ Scan/photo to upload documents for claims
ā¢ Health isurance dictionary
After voting and consolidating the ideas that we feel will best solve our challenge, we can now start mocking up lo-fidelity prototypes.
For this challenge, I chose the personalized mobile app idea to make the claim process easier, but will also incorporate other ideas:
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Personalized Mobile App
ā¢ Real-time claim status tracker
ā¢ Approachable, friendly tone of voice
ā¢ Photo upload/scan feature
Ideate & Prototype
I began by creating the app architecture.
Then sketched out lo-fidelity wireframes. At this point, Iād like to do some quick paper prototype testing to see if weāre heading in the right direction. The earlier we identify problems the less expensive they are to fix.
Then moved on to medium-fidelity wireframes and tested again.
Test
Finally, I would test a high fidelity interactive prototype. Testing should also continue post launch to continue to improve the experience and add additional features.
Summary
We initially set out to improve a disjointed, complex health insurance experience and by providing a simple, more-unified mobile claims app solution. Through a human-centered approach, we learned that customers need transparency and friendly support during the claim process, which is a difficult time in their lives. We also learned that we could address business needs and lower call-volume costs at the same time. By understanding and anticipating user needs and behavior, we approached the challenge by providing reassurance during a confusing and complex claim process and making it simple for customers.
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ā¢ We were able to decrease the need to call customer service by reassuring customers through a real-time claim status.
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ā¢ We also created a more approachable, humanized claim process through a friendly tone of voice.
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ā¢ And finally, we were able make customers feel more empowered and confident, and were able to speed up the claim process by way of an in-app photo/scan feature.