Medical Mutual - Claims Experience

Overview

Conducted generative research to uncover member needs and priorities when filling claims, accessing old claims or managing ongoing claims. Identify different stages in their post-medical journey and identify barriers of engagement and provide comprehensive recommendations to meet member needs.

Timeline - 3 months

Research Activities

Project Scoping, Recruitment, User Interviews, Member Journey Map, In-Person Ideation Workshop, Prioritization and Roadmapping

Team

UX Researcher (Me)

Support Researcher

UX Designer

Brief

Objectives

  • Explore user needs and priorities in accessing claims information.

  • Assess current user experiences and interactions to identify gaps in comparison to their ideal claims experience.

  • Identify key stages in the user's medical journey that impact the claims process, aiming to uncover gaps and potential enhancements.

  • Investigate perceived barriers hindering user engagement and comprehension of claims and Explanation of Benefits (EOB) statements.

Key Insights

  • Improve status communication to help members feel confident and supported

  • Surface information that matters to find the right claim

  • Help members effortlessly track plan usage to make most of their plan

  • Help members leverage detailed cost information to find errors and plan efficiently

  • Explain coverage results to members can understand issues and assess plan success

  • Offer members different levels of support for unexpected next steps

Immersion

Immerse and understand the industry by familiarizing with products, terminology, and challenges. I approached this by conducting stakeholder interview, building user flows, having website walk-throughs to create an assumptive member journey map.

Methodology and Recruitment

To uncover member’s claims journey and evaluate the current experience, facilitating generative + evaluative research approach for a more structured study.

Participants were recruited using a digital platform based on criteria:

  • Must have had interactions with their insurance company’s app or website regarding claims within the past 6 months

  • Must have checked claims status, reviewed claims information and cost breakdown, and sought support from insurance company in the past 6 months

Research interviews included - 90 minute 1:1 session with 23 participants

Insights

Improve status communication to help members feel confident and supported

Surface information that matters to find the right claim

Help members effortlessly track plan usage to make most of their plan

Offer members different levels of support for unexpected next steps

Help members leverage detailed cost information to find errors and plan efficiently

Explain coverage results to members can understand issues and assess plan success

Ideation Session

An ideation session with stakeholders helped encourage creative thinking and generation of new ideas to solve existing pain points using HMW statements.

In a 4-hour cross-collaborative workshop, we generated range of ideas using journey map and research insights, which were translated into HMW statements.

Ideation activities included:

•Brain Writing: Goal was to create as many ideas as possible

•Idea Refinement: Share ideas in group and combine the best of each into a concept.

•Concept Poster: Create a pitch for the concepts and share with the team

•Voting for the best concept or parts of the concepts.

Prioritization

All concepts are prioritized in an engaging workshop on different scales:

  • Value to users

  • Business/ Product roadmap Alignment

  • Tech Feasibility

Key Takeaways

Aha Moments

  • Even when a claim appears unjustified to users, the complexity of the appeal process often leads members to pay the disputed amount instead of contesting it.

  • Some users still prefer using paper methods for making payments rather than adopting technology.

  • The lack of transparency in the claims process creates significant anxiety among members, with some waiting over a year to receive their claims.

Positives

  • Regular weekly check-ins and an engaging approach ensured team buy-in and active participation.

  • Collaboration with UX Designers ensured that research insights and recommendations were actionable and relevant.

Challenges

  • Misalignment within the team about the need to recruit more current users of Medical Mutual

  • Teams need constant education about each phase of the research process to ensure everyone understands the objectives and methodologies

Next

CFNA - Usability Testing