UNITED HEALTHCARE

Case Study—

Optimizing Claims Workflows: Minimizing Scroll Fatigue & UI Inconsistencies

As Senior UX/UI Designer at UnitedHealthcare and UX Lead for the FOX claims processing application, Marlon focused on streamlining workflows and improving the efficiency of internal claims processors handling fallout claims that are out of auto-adjudication within AARP. By addressing pain points, optimizing processes, and reducing friction in manual adjudication tasks, he helped enhance productivity and user satisfaction and achieve the stakeholder’s goals.

This case study highlights the UX team’s efforts to transform FOX, a critical claims processing tool. The team’s deep dive UX research initiative addressed usability challenges that impacted efficiency and user satisfaction, aligning with user-centered design principles and business objectives.

Marlon’s Key Contributions

As a Senior UX/UI Designer and UX Lead for a claim processing app (FOX), I led transformative efforts to enhance the FOX claims processing application at UnitedHealthcare, delivering measurable results for both users and the business:

  • Streamlined Workflows: Improved navigation and consistency, reduced unnecessary white space, which caused too much scrolling, and optimized layouts to boost productivity and ease cognitive load for claims examiners.

  • Enhanced System Performance: Brought to attention critical errors, reduced load times, and implemented responsive table designs for improved usability and efficiency.

  • User-Centered Redesign: Developed and tested prototypes with claims processors, ensuring impactful, user-focused solutions.

  • Collaborative Leadership: Partnered with stakeholders to align UX improvements with business priorities, integrating seamlessly into Agile workflows.

Impact

  • Increased Efficiency: Reduced claims backlogs and expedited processing speeds, driving faster resolutions.

  • Elevated User Satisfaction: Enhanced usability and reduced frustrations, as reflected in continued user feedback.

  • Strategic Value: Positioned UX as a key driver of operational success and innovation, fostering a culture of continuous improvement. The conversation of UX Maturity begins.

(Roles)

  • UX Research

  • UX/UI Design

  • UX Facilitator

(Method)

  • User Surveys

  • 1:1 User Interviews

  • Thematic Analysis

  • Sentiment Analysis

  • Affinity Mapping

(Collaboration and Design Tools)

  • Miro

  • Figma

  • Microsoft Forms

  • UXPressia

(NPL Tools)

  • Dovetail

  • Otter AI

  • ChatGPT 4o

  • Perplexity AI

  • Claude AI

  • Speechify

  • Grammarly

The Problem

In 2021, UnitedHealthcare launched FOX to replace Fastrieve, an outdated insurance processing app. However, persistent technical issues in FOX have caused productivity challenges, application bottlenecks, defects, and user dissatisfaction. These ongoing problems have raised concerns about broader business impacts, lost time on tasks, and declining employee morale.

Since its launch, FOX has faced recurring issues that affect productivity and user satisfaction, necessitating long-term solutions rather than temporary fixes.

Strategy

To address these challenges, the UX team, in collaboration with product management and key stakeholders, initiated the FOX Improvement Research Effort (FIRE) in Summer 2023.

This initiative focused on:

  • Conducting comprehensive UX research to engage directly with end-users and gather actionable insights.

  • Identifying and categorizing persistent issues.

  • Highlighting defects and pinpointing key areas for targeted improvement.

Affected Users

  • Primary Users: Claims examiners, operational staff, fallout/rework groups (e.g., Complaints, Appeals, and Checks).

  • Secondary Users: Customers, FOX Trainers, Claims Leadership, and IT Support.

There are many barriers and things that SLOW US DOWN…Especially all the errors and slowness in-between screens.
— Cheryl Robertson, FOX Claims Examiner

Problem Statement

How might we comprehensively understand and address the frustrations of FOX users, specifically claims examiners, to improve daily productivity and morale?

UX Research Plan

Objective

To identify and address challenges faced by claims examiners within the FOX application, improving their workflow and overall user experience through a structured research and design process.

Research Goals

  1. Identify the specific challenges claims examiners face when using FOX.

  2. Understand, synthesize, and validate user feedback to ensure solutions address real user needs.

  3. Develop a collaborative process that aligns UX, product owners, business stakeholders, and technology teams.

  4. Provide actionable recommendations and enhancements for the FOX application.

  5. Identify opportunities for improvement beyond the current scope.

Research Methodology

1. Initial Screener Survey:

  • Query claims examiners to gather initial insights on their experience with FOX and to identify users for follow-up 1:1 interviews.

    • Method: Online Survey (Microsoft Forms)

    • Length of Survey: 25 questions (approx. 9 minutes)

2. User Interviews:

  • Conduct in-depth 1:1 interviews with selected claims examiners and Application Trainers to dive deeper into their workflows, pain points, and needs.

3. Stakeholder Consultation:

  • Collaborate with product management and business stakeholders to integrate their perspectives and priorities into the research.

4. Data Analysis:

  • Synthesize survey and interview results to identify patterns, pain points, and key findings.

  • Categorize and define issues as defects, bugs, enhancements, or new features.

  • Map findings to the development backlog for prioritization.

5. Opportunity Identification:

  • Highlight new opportunities for improvement beyond immediate fixes or enhancements.

  • Map opportunities for future exploration.

Deliverables

Actionable Insights:

  • Provide synthesized findings with clear recommendations for addressing user challenges.

  • Present enhancements as visual representations to improve claims examiners' workflows within FOX.

  • Final Reports; Executive and Team Summaries

These are examples of surveys, thematic clustering, affinity mapping exercises, and sentiment analysis.

Methodologies Used

  • 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.

  • 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.

  • Also referred to as contextual or ethnographic interviews, the UX team conducted hour-long observational studies with 17 users from various areas of the business to gain insights into real-life interactions with the FOX and COMPAS systems.

    Adopting a "fly on the wall" approach, we observed how claims processors performed their tasks, asking targeted questions about specific workflows and processes. Trainers shared their methods, shortcuts, and ideal "happy paths," while also highlighting limitations and common frustrations within the systems.

  • In-Depth User Interviews

    During the deep dive phase of the project, we conducted interviews with three participants to further explore and clarify their experiences. The UX team crafted a script and questionnaire based on insights from the initial user survey, focusing on ambiguous feedback and leveraging the participants' willingness to engage. With their consent, we recorded the sessions using Dovetail, enabling effective capture, analysis, and management of user feedback.

    The 30-minute interviews, conducted over two weeks, involved a collaborative team approach:

    • Marlon moderated the interviews, steering discussions to uncover valuable insights.

    • A UX colleague provided support with development and accessibility expertise.

    • The UX manager contributed business-level perspectives to ensure alignment with organizational objectives.

    To synthesize the findings, Marlon's team utilized task analysis, thematic analysis, sentiment analysis, and affinity diagrams, transforming raw data into actionable insights to inform strategic hypotheses. Leveraging Marlon's AI Playbook further augmented the research, expediting and enhancing the depth of the findings to ensure meaningful outcomes.

  • To derive meaningful insights from qualitative data, I employed a multifaceted approach to uncover patterns, themes, and sentiments that represent the core experiences of claim examiners.

    1. Task Analysis:

      • Examined the detailed steps claim examiners take to complete workflows, identifying inefficiencies and pain points that disrupt productivity.

      • Highlighted recurring friction points, such as inconsistent tabbing functionality and redundant processes, directly impacting their ability to meet quotas.

    2. Thematic Analysis:

      • Extracted overarching themes from user feedback to uncover the root causes of frustrations, such as system reliability issues, cognitive overload from poorly structured layouts, and data discrepancies.

      • Identified opportunities for improvement that align with user needs and business priorities, such as enhancing screen navigation and addressing UI inconsistencies.

    3. Sentiment Analysis:

      • Assessed the emotional tone of user feedback to gauge levels of frustration, satisfaction, and urgency.

      • Revealed heightened anxiety over system errors and a desire for smoother workflows, emphasizing the human impact of technical issues.

    4. Affinity Mapping:

      • Clustered findings into logical categories to visually represent patterns and relationships between recurring themes.

      • Prioritized issues based on frequency and severity, enabling the team to tackle the most pressing problems first.

    This comprehensive analytical process transformed qualitative feedback into actionable insights, allowing us to prioritize solutions that addressed both functional and emotional user needs. By combining advanced methods like thematic and sentiment analysis with task-focused approaches, I ensured that the design recommendations were deeply rooted in user experiences and aligned with strategic goals.

Findings

Using a collaborative and investigative approach, the team mapped identified issues to the UI backlog, increasing visibility for product owners and ensuring insights were integrated into development cycles. This alignment of UX enhancements with business goals has already led to refined user interfaces and improved operational workflows in FOX.

The research highlighted four major areas of concern:

  1. 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.

  2. 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.

  3. 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.

  4. Communication and Training: There was a notable lack of ongoing support and communication regarding updates and issue resolutions.

Solutions Implemented

  • System Optimization: Enhanced load times, reduced error rates, and optimized data flows.

  • UI/UX Redesign: Streamlined and improved the claim examiners’ flow by ensuring consistent CTA shortcuts, tab navigation (more than half of users use tab navigation exclusively), employed responsive design instead of fixed table width to regain screen visual real estate thereby reducing horizontal scrolling, improved contrast ratio and font size for text,

  • Feedback Integration: Incorporated user and stakeholder feedback into design iterations, with high-fidelity mockups guiding development and refinement.

  • Improved Training & Communication: Implemented regular update sessions and enhanced training materials to keep users informed and prepared.

Impact Results—

  • 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.

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.

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