Reducing customer service costs with claims automation

Project:

Reducing customer service costs with claims automation.

This feasibility study, a collaboration between UX, product, clinical, and development teams, evaluates the use of OCR technology to auto-capture receipt details, improve accuracy, reduce follow-up calls, and boost CSAT scores.

Mission objectives:

OCR digital claims transformation: Provide UX design support to lead developer to explore the feasibility of OCR healthcare claims automation.

Streamline processes: Optimise the claims journey to reduce 3,000+ monthly claim-related calls and address misunderstandings about underpaid claims while lowering error rates.

Research and journey mapping

Simplifying the process

The app's early version had a barrier with lengthy legal text and compliance details the user had to acknowledge to proceed.

Mapping out user flows + UI

Collaborating with product owners, developers, clinical and claims teams, I mapped user flows and iterated prototypes.

Cross functional alignment

Multiple claim form design variations had to be laid out to support based the type of treatment claim users were making.

Evolution of claims process to support digital transformation

User verification

The login screen was redesigned to enhance usability and align with the product’s clinical and minimalist aesthetic, creating a cleaner and more intuitive user experience.

Design evolution

This page serves as the gateway to the core features of the app. The design and flow have evolved alongside the product's growth, shaped by ongoing user insights.

Simplificiation

I challenged the existing flow by moving compliance criteria to the end, simplifying the over-engineered process, and reducing content with input from the clinical team.

Supporting digital transformation through automation

Checking entitlements

Users can review the remaining amounts that they have remaining for each treatment type before making a claim.

AI scans and extracts details

Users are invited to take a photo of their receipt following their healthcare treatment and the system quickly gets to work.

Checking claim details

AI recognises the details populating the claim form with relevant UI allowing users to adjust and validate details where appropriate.

Projected Results and impact of call reduction

Improved claims accuracy and reduced inbound customer calls.

‍Live BETA launch (initially sent to 10% of consumer plan policy holders):
Following successful testing and refinement, the AI driven claims experience was rolled out to 100% of customers.

This work formed part of a wider suite of initiatives supporting digital transformation of the business.

The new journey is projected to lead to a 35% reduction in claims-related support calls due to error prevention, rejected claims misunderstandings and allowance entitlement issues. This important work could equate to an estimated 1,050 fewer support calls per month. (Based on £12 per call).

97% (+3)

Improved CSAT score

£151,200

Projected annual savings

£12,600

Projected monthly savings

35%

Projected reduction in claims related support calls

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