UNITED HEALTHCARE
Case Study—
Enhancing claim examiners workflow
Medicare and Retirement Insurance Solutions (AARP)
As a Senior UX/UI Designer at United Healthcare and UX Lead for the FOX claims processing application, Marlon’s chief priority was to streamline workflows and enhance the efficiency of claims processors handling fallout claims within AARP by addressing pain points, optimizing processes, and reducing friction in manual adjudication tasks.
This case study details the UX team’s efforts to transform the FOX application, a critical claims processing tool within United Healthcare. The focus was on addressing usability challenges that hindered productivity and caused user dissatisfaction, ensuring alignment with the highest standards of user-centred design and business objectives
(Roles)
UX Research
UX/UI Design
SME
UX Facilitator
(Method)
Surveys
1:1 User Interviews
(Tools)
Miro
Figma
Dovetail
Otter AI
Microsoft Forms
Rally
“I wish we could have a meeting to go over all the defects in FOX.”
-Shayna
— Shaya
“There are many barriers and things that SLOW US DOWN…Especially all the errors and slowness in-between screens.”
— Cheryl
“Fixing FOX would lessen anxieties for A LOT of people.”
— Natalia
What the claim examiners are saying…
The Problem
UHC's new insurance application, FOX, was created in 2021 to replace Fastrieve, an outdated insurance processing app. Persistent technical issues within the FOX application have led to ongoing productivity challenges, application bottlenecks, defects, and user dissatisfaction, raising concerns about the broader business impact, lost time on task, and employee morale.
Since its launch in the Summer of 2021, the FOX application has been plagued by ongoing issues that negatively impact productivity and user satisfaction. These issues are not isolated incidents but persistent problems requiring long-term solutions.
The Strategy
In response, the UX team, in collaboration with product management and key stakeholders, initiated a comprehensive improvement effort in Summer 2023. This initiative, known as the FOX Improvement Research Effort (FIRE), aimed to delve deeper into the unresolved issues by engaging with end-users and conducting thorough UX research. This research focused on identifying and categorizing problems, highlighting defects, and pinpointing areas for enhancements and opportunities.
Through a collaborative and investigative approach, the team effectively mapped these issues to the existing UI backlog, increasing visibility among product owners and paving the way for these insights to be integrated into development cycles. This approach, crucial in aligning UX enhancements with business goals, has led to refined user interfaces and improved operational workflows within FOX.
Objective: To enhance user satisfaction and productivity by profoundly understanding and resolving the underlying system issues affecting the FOX application.
Affected users
Primary: FOX Users (claims examiners, operational staff, the fallout/rework groups i.e. Complaints, Appeals and Checks)
Secondary: Customers, FOX Trainers, Claims Leadership, IT Support
FOX users reported persistent issues that hindered productivity and increased the claims backlog. Despite initial progress in resolving some functional defects, significant user dissatisfaction remained.
Problem Statement
How might we comprehensively understand and address the frustrations of FOX users, specifically claims examiners, to improve daily productivity and morale?
Research Effort Goals
Identify the challenges the claims examiner faces within the FOX application.
Understand, synthesize, and validate user feedback and provide recommendations and enhancements for the FOX experience.
Look for any opportunities for improvement.
Methodology
Query claim examiners' experience in the initial screener survey
Conduct 1:1 user interview selected from the screener survey
Consult with product management and business for feedback integration
Synthesize results for analysis
Identify patterns and key findings for actionable insights
Define if defect, bug, enhancement, or new feature, and map to the backlog
Map new opportunities
Final report
Research
Remote Observational Research: Otherwise known as Contextual or Ethnographic interviews, the UX team conducted an hour-long observational research study with four types of claim processors. These users were designated FOX trainers.
Like a fly on the wall, our team observed how the processors conducted their work, and we questioned them on specific workflows and processes. The trainers showed us how they worked, their shortcuts, what a happy path looked like, described limitations, and what problems they complained about.
Remote Observational Research: Shadowed 17 users to understand real-life interactions with FOX and COMPAS systems.
Surveys and Interviews:
Distributed a survey to 120 users (11 responses) to identify pain points.
Conducted one-on-one interviews with 4 users for deeper insights.
Task Analysis & Affinity Mapping: Identified patterns and clustered findings to prioritize solutions.
Proto-personas
Legacy proto-personas created by the prior UX team in 2021 help support our secondary research. However, the team wasn't sure if the personas were current since the product had recently been launched. Marlon began validating the proto-personas, re-crunching the data, and interviewing business and product managers. Since they were left incomplete, Marlon began developing the remaining personas.
In due time, the objective is to create true User Personas that reflect our current users.
User Surveys
Now that the UX Team is familiar with the FOX claim processing application, we created a list of survey questions, ranging from open-ended to closed-ended, qualitative to quantitative, to help validate our insights. Some questions were straightforward, some open-ended, and others tried to elicit an emotional response.
The 24-question survey questionnaire was emailed to 140-150 AARP Claims Distribution List users. Eleven participants responded (approx. 7.9% of the total pool), providing valuable feedback. We then selected a few key participants for an in-depth study, to gather more detailed user feedback.
1:1 User Interviews
During the deep dive phase of the project, we recruited three participants for further experience discovery. The UX team developed a script and questionnaire derived from the prior responses from the initial user survey. These interviews aimed to have the participant further explain unclear comments from the survey and leverage their willingness to engage. We gained permission to record the meetings with Dovetail to capture, analyze, and manage user feedback.
Once we scheduled the 30-minute slots with the three claim examiners over two weeks, Marlon conducted and moderated the user interviews, his colleague supported him with dev and accessibility expertise, and his UX manager supported him with business-level commentary if needed.
Using task analysis and affinity diagrams, Marlon and his team synthesized the findings and translated them into actionable insights to inform our hypotheses. Employing Marlon's AI Playbook to augment the research data helped enhance and expedite the findings and insights.
Findings
Key Findings: The research highlighted four major areas of concern:
System Reliability Issues: Frequent system timeouts and slow response times constituted about 70% of lost time; slowness was a major frustration, particularly with specific claim types triggering '500' errors. Specific claim tax like 'Hospitality Indemnity Plans' most frequently triggered the '500' errors. A workaround was clearing the cache within the browser for speed, which disrupts workflow.
Data Discrepancies: Users frequently encountered problems with data not saving correctly, leading to significant rework and frustration. An example is when the examiner goes back to a previous screen. A big complaint was with a third-party microservice app that regularly supplied incorrect or partially filled-in patient or healthcare provider information.
Function and Flow Issues: Difficulties navigating to previous screens and inefficient screen layouts reduced productivity, as users struggled with excessive scrolling and poorly organized information. Many users use the tab key instead of the mouse to process claims, and many complaints pointed to some tabbing functions as inconsistent and not working on particular form fields. Additionally, users requested copy-and-paste functionality, which would save them lots of time.
Communication and Training: There was a notable lack of ongoing support and communication regarding updates and issue resolutions.
Results—
KEY TAKEAWAYS
Productivity Gains: Reduced claims backlog and improved task completion times.
Enhanced User Satisfaction: Subsequent feedback indicated significant improvements in system usability and reduced frustration.
Operational Efficiency: Improved workflows, leading to better alignment with business goals.
Opportunities—
Broader UX Contributions
Advancing Organizational UX Maturity:
Introduced validated designs and strategies to reduce rework and streamline future projects.
Enhanced cross-team collaboration and alignment of UX with business priorities.
Demonstrated the strategic value of user-centered design to stakeholders, fostering a culture of continuous improvement.
Lessons Learned and Recommendations—
Responsive Design: Future projects should ensure fully responsive designs for seamless multi-device usability.
Dynamic Tables: Implement adaptable table designs to mitigate current inefficiencies in FOX and COMPAS.
User-Centered Validation: Continue engaging users to validate designs early, ensuring alignment with real-world needs.
Conclusion—
This case study shows how a structured UX approach can transform complex systems like FOX. By conducting rigorous research, collaborating across teams, and implementing targeted solutions, the UX team enhanced productivity and user satisfaction and contributed to broader business success. This effort highlights the importance of user-centered design in driving impactful, measurable outcomes at United Healthcare.