Submitting a Health Insurance Claim

Submitting a Health Insurance Claim

The Challenge

When a customer learns they need to submit a health insurance claim on their own, something usually their doctor, or health provider would do, it's not uncommon for them to experience a wave of dread.

I was part of an initiative to design an online process for users to submit an online claim, where they felt comfortable and confident from the first step.

A screen from prototype of member submitted claim filing experience.

The Approach

Insurance companies have lots of forms. The goal was to design a system that would accommodate different types of forms, which simplified the inputs into steps a user could easily process.

Goals

• Experience must be simple to follow for user.

• Integrate well with the data in their health plan.

• Reduce errors that result in denied claims. 

 

My Role

• Primary designer for web product.

• Identified business requirements and goals, with stakeholders and product manager.

• Conducted analysis and user research.

• Built user flows to illustrate scalability of design.

• Built a prototype in Axure.

• Conducted user testing and analysis. 

• Worked with developers to ensure project could be built within design and technology constraints.

Current Experience

User downloads a form, fills it out and re-uploads.  Many of the fields duplicate information already on file with the users account.  

Analysis and Research

Form Best Practices

• Researched and documented best practices in form design.

• Compiled best practices wizard / stepper design.

• Presented examples of form structure and grouping.

I cited this work from the Google Research Blog to help build a case for a vertical one column format. Eye tracking study shows less effort and time when users move down the one column format.

Business Requirements

• Built strong relationship with project manager and client liaison to identify all business requirements.

• Worked with claims business unit to determine how the experience would affect their operations.

User Behavior

• Looked at business data on the habits and timing of user submitted health claims.

• Examined causes of common errors or reasons for denials for submitted claims.

Insights

I created a journey map that looks at all the touch points a user may experience in submitting an online claim, using both a paper form and a digital experience.

Considerations

• Scalability of form structure. How do we handle claim types that need much more information than others?

• Responsive design.  If user needs to submit receipts, will they want to use this on a mobile device with a camera? 

• Multiple claims. How can user file multiple claims on one form?

• Error prevention.  What are key reasons a claim is denied, and can we build experience to prevent those errors?

• Order of the tasks. Which data needs to be validated before user advances far into the flow

• Coordination with other insurance coverage.  Is this a primary or secondary claim?

• Grouping of content. How can we group content in a way that makes most sense to user.

• Accessibility. 

Design Evolution

Design constraints called for following Bootstrap framework. Bootstrap doesn't have a stock wizard or stepper, so I built a case to develop this component.

Making a case for the wizard

The graphic shows the difference in the number of inputs for vision claim, the form that is prototyped in this case study, versus an international claim form.

Early in the design process I looked at a one page form.  This worked fine for a shorter form, although it was a lot of information for the user to look at all together.  When I looked at some of the longer forms, it was apparent that there would be a large amount of scrolling.  I could see where this could cause issues, with errors and uncertainty that steps early in the form were not validated.

Introduction of the wizard concept
• Breaks down the steps to make form look less intimidating.
• Gives form a more modern UI which is mobile and tablet friendly.

Exploration of progress bar instead of a wizard
• Goal is to maintain maximum simplicity.
• Progress Bar main function to give user system status as each step is processed. 

Combination properties of wizard and progress bar elements
• Adds visual triangle element to tie wizard step to form content.
• Adds animation to give sense of forward progress.

Incorporates icons and numbers in the wizard steps
• Wizard includes four states, disabled, enabled, selected and hover.
• Wizard shows all steps in process, where early version revealed them in the progression. 

Prototyping and Testing

I built a comprehensive prototype using Axure. Prototype was tested internally, and then externally with UserTesting.com.

Screen of prototype as tested for member submitted claim filing experience.

Testing Goals
• Assess effectiveness of the flow.
• Determine user's preferences around navigating with wizard or back/next buttons.
• Capture the perception of ease of use.
• Look for usability issues on each step.

Testing Scenario
Your daughter, Evelyn Jacobs, has gone for multiple exams at the eye doctor over the past several months. You need to submit the bills from the doctor to the insurance company. You are logged into your health insurance account as Edward Jacobs. You have navigated to an area where you can submit a claim.

Emerging Themes From Testing Results

Nav Bar
• Users unsure if nav-bar is clickable. 
• Once discovered, users were comfortable navigating backward using the task bar when updating an earlier section of the form. 
• 2 of 6 users said they preferred to see all the tasks written out in the progress bar even though they wouldn't be able to click on them.

Date Picker / Date Range
• All users understood they needed to answer that they had multiple dates.  They were all able to enter most recent and latest date of service.
• 5 of 6 users didn't read the additional explanation / instructions that open up below when they date picker changes to a range.

Overall design
• Users commented on overall simplicity and ease of use.
"Do you know this  is one of the easiest claim submittal forms and, and  things I have ever done on a website?" – SCasey4444,  Female, 63

Post Testing Changes

As tested

Updated

Change Summary
• Wizard incorporates icons and numbers in the wizard steps.
• Wizard includes four states, disabled, enabled, selected and hover.
• Wizard shows all steps in process.
• Content has updated language.
• CTA buttons aligned left.

MVP views for Desktop and Mobile

Mobile View
View shows how wizard collapses in mobile or tablet view.
This is an experience where a user would be uploading receipts or documentation to submit claim. Since it's easy to capture documents with device camera, a mobile device would be an easy way to do this.