Transforming the digital medical claims experience
Creating faster decisions, clearer guidance, and measurable efficiency gains
Overview
I led the end-to-end redesign of a digital medical claims and treatment authorisation journey within a large private health insurance organisation.
The goal was to reduce operational inefficiencies, simplify a complex customer journey, and create the foundation for future automation – all within a highly regulated and legacy-heavy environment.
My Role: Senior Product Designer (end-to-end ownership)
Team: Product Owner, Project Manager, Business Architect, Product Designer, Content Designer, User Researcher
The challenge
Digitally, customers waited days for eligibility decisions, while telephony customers often received answers immediately.
At the same time:
- Customers felt lost in the end-to-end healthcare journey
- Insurance terminology created confusion and anxiety
- Agents manually re-keyed unstructured data
- Expectations of “fast private care” often clashed with reality
As well as a speed issue, this was a clarity and confidence problem.
Research and discovery
We ran:
- Multiple rounds of qualitative interviews
- Quantitative journey testing
- Customer workshops
- Analytics deep dives
- Feedback programme analysis
Key insight
While stakeholders initially leaned toward richer visual design, research clearly showed customers wanted:
- Plain language
- Step-by-step guidance
- Status visibility
- Reassurance during vulnerable moments
When someone is unwell, clarity beats delight.
This insight reframed the entire direction of the product.
Defining the opportunity
Using recurring themes from the customer feedback programme, I helped define a focused strategy:
Design principles:
- Customer in control
- Proactive guidance
- Sensitivity to context
- Seamlessly connected systems
- Plain, human language
We aligned around measurable outcomes:
- Reduced eligibility turnaround times
- Improved satisfaction and experience metrics
- Operational efficiency gains
- Increased adoption of alternative care pathways
- Improved claims data visibility
Navigating constraints
This project operated within:
- Regulatory requirements
- Complex legacy systems
- Third-party integrations
- Tight delivery timelines
A turning point came when we mapped technical constraints early, allowing us to design phased, achievable improvements rather than idealised but unfeasible concepts.
From complexity to clarity
Early exploration included:
- Automated eligibility checks
- Condition-specific pathways
- Data integrations for capacity insights
To accelerate delivery, we reduced initial complexity and created a structured question-based flow that:
- Routed customers accurately
- Reduced ambiguity
- Laid groundwork for future automation
Edge cases were workshopped with subject matter experts to ensure safety and compliance.
I also contributed new components and behavioural rules to the design system to support scalability.
Collaboration and influence
- Brought the user voice into stakeholder rooms through interview playback videos
- Advocated for dedicated research time in roadmap planning
- Identified areas requiring clinical and specialist support early
- Helped split the initiative into two focused product areas to accelerate progress
- Influenced communication strategy and third-party collaboration practices
Prototyping became a key alignment tool, reducing ambiguity across engineering, architecture, and business teams.
Impact
The redesigned journey delivered:
- Operational savings equivalent to several full-time operational days per month
- Reduced average eligibility turnaround time
- More than doubled adoption of alternative care pathways
- Increased data structure and visibility
- Improved customer and agent satisfaction
More importantly, it established a scalable foundation for future automation.
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