Insurance Claims Automation Platform

A startup founder asked us to define the workflows for a new tool to be used by physicians to submit patient care claims to insurance carriers.

The Challenge

The existing process for submitting patient care claims and appeals is heavily manual and relies on someone to do research across multiple data sources by hand to find information that supports the claim. The founder wanted to simplify the process using AI to perform research and offer suggestions automatically based on input from the physician.

What We Did

Detailed interviews with the founder, multiple physicians, and insurance carrier representatives to understand the problems with current solutions, and determine the information required by insurance carriers. We then created detailed User Task Outlines, a UX Flow, and wireframes to define how the application should work. Once validated with the founder and a group of physicians, we created a robust clickable prototype used to demonstrate the application to investors.

The Outcome

The founder successfully raised over $500,000 in grants and seed-stage investment to build the application.