Anthem is a Health insurance company and this project is for the Federal Health Products & Services (FHPS) which is part of the Anthem Federal Program. To manage the structure and process of care management and it's supporting systems for health insurance they are using an enterprise system called Streamline which is a multifaceted and multiyear project. Anthem envisioned to leverage advanced technology and transform the existing legacy system into a new system and named it "Fusion".
ANTHEM
UX/UI Design
Figma
May - July 2019
Complex and tedious insurance claims processing system. Anthem Claims processors were by using 20 years old legacy system with around 30 supporting application and with completely different interface and logins.
From the beginning to the end this project was designed with close feedback loop with the claims processors and business team. It helped me in gathering information and experiences they have with the existing system by using it from so many years. It was important to understand values and expectations of these people with the new system along with meeting the business need.
A total of 218 respondents shared their opinion about the Streamline system usability and their experiences.
The survey has two sections the first section has questions to know about the participant& their role and demographics. The second section has questions about the user experience of the participants on the Streamline system.
User research was imperative to fully grasp the requirements and grievances of the people who use existing system. It was of utmost importance that we understand context pertaining issues they faced over the years and the mindset of the users.I did 6 contextual interviewed with Claims Processors and Operation experts and 6 Interviews with Product Owners
These interviews were conducted in a semi-structured manner.
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To meet the performance target claims processors need to be fast in processing every single claims.
In streamline they can open multiple screens and compare and edit.
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Use of Keyboard is Faster
Use of keyboard is more efficient and helpful in fast processing as compared to mouse. The Claims processors prefer streamline over other GUI based apps because they feel use of mouse makes work very slow.
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High Cognitive load . Even older claims processors have lack of confidence about being sure of what need to be done because there are many different type of claims cases .
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Every Claims processor have a different styles of keeping track of their work and organising their requirements and deliverables.
After identifying the features required, we needed to bring them together in a cohesive manner. After rounds of iterations, we created a conclusive user flow which describes the overall journey.
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The claims processors need to use multiple application to get information to process a claim.
30 applications and 20 streamline screens are used by the claims processors to get the informations for different kind of claims. There was huge inconsistency in the look and feel and information styles in all the resources
To work on streamline users need to use commands to open various screens. They can either refer document or remember the commands.
The steps for processing claims may vary for different kind of claims, CPs generally look at the manuals and paper documentation to decide the steps to be taken. They need to memorise a lot of information
I break down the process in small task and list activities that user has to perform and evaluated the problems user face while performing those tasks. Through my research process I discovered that no single person had end-to-end complete process knowledge. Through the in-depth analysis of the process I found numerous redundancies and areas prone to error.
During the secondary user research it was found that their are many different kind of claims types which comes for settlement for the and each claim need a different treatment. It was imperative to divide these several claims types into categories based on what all steps the SPs need to take to settle that particular claim.
There were several claims that required simple matching of certain informations those can be easily automated to reduce the workload on CPS.
I made a list of all such claim types with the help of claims processors and operations experts
There were few types of claims which are more prone to error because of nature of verification it requires.
I made a list of all such claim types with the help of claims processors and operations experts.
Some of the claims needs a letter to be sent to the provider and pricing claims needed to be treated in a different manner
This page help the user see the number of claims need to be processed in a day.
Graphs for quick view of the pending claims
Graphs for quick view of the pending claims
The Claim Processors can customise the table as per their work style and preferences
Time is an important factor for claims processors, preview of claims helps them to decide what need to be done in a particular claim
Claim processing screen let user process the claim by clicking one of the claim. On click of a claim the system will open windows and menus based on the requirement of that claim. User can easily search and add other information if required. User can use short keys to open any information tab.
Dashboard help Claims processors to stay informed about their performance.
The claim processors are trained to use keyboard and prefer using keyboard over mouse as it speeds up their overall performance. The shortcuts on each action point are given to process faster.
The claim processors are trained to use keyboard and prefer using keyboard over mouse as it speeds up their overall performance. The shortcuts on each action point are given to process faster.
Claims processing screen has multiple windows with information needed for reviewed by the claims processor.
Discover In-Depth Insights into Product Usage & User Behavior to insure user view only required Information. When User click on a claim he will only see claim type specific informations. This was achieved by leveraging on the claims documentation about steps need to be taken for each type of claim.
To meet the need of different style of users the design has customization options in all the menu.
I created a design system to create consistency in our design. It was essential to have clear communication between the users and the system due to distinct input mechanisms in place.
Home Page
Claim Preview
Customizing table
Comparing Cliams
Processing Claim
Dashboard
This project was challenging many ways, first was to understand the insurance process and understanding Anthem's way of handling their claims.
I learnt ho splitting the big chunk into small and then woking on that is really helpful.
Another challenge was to make the keep a balance in the design to address emotions of the end users who are using the system from more than a decade and the business team.
Integrating ideas and forming a cohesive flow was a challenge. I would like to spend more time correcting the discrepancies of the user flow and design for edge cases to provide a more comprehensive solution.
