Regional Pharmacy Chain

Streamline the process of insurance claims submission.

The Challenge

The process for submitting claims to insurance providers and medicare requires detailed knowledge of various codes and required information for each claim. Claims processors have memorized much of the process and know which codes to use on a case by case basis, but still rely on manual entry into claims systems, costing valuable time and money and introducing the risk of human error.

What We Did

We conducted interviews with claims processors, and shadowed their workday to identify repetitive tasks, sources of knowledge, and document the processes for a wide variety of claims. Using this knowledge, we created User Task Outlines and a UX Flow for a new claims processing application. The result was a web application with a standardized and repeatable process that could automatically handle 95% of claims without human data-entry. Now claims processors could focus their time and attention on verifying and submitting claims instead of data-entry.

The Outcome

Claims processing time dropped significantly and the company was able to increase the number of successful claims, accelerate claims processing, and operate more efficiently.

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