Manual Claim Adjustments
Alma needed to streamline and scale internal claim adjustments to clear the path for automating provider payouts.
Role
Senior Product Designer
Goal
Design a tool to automate provider payout adjustments, reducing the cost-per-claim
Timeframe
Feb – Apr 2024
Problem
$60k worth of claims were manually adjusted every week in a Google sheet.
Operations teams and Accounting had no way to access critical cash-flow information. Accounting frequently caught discrepancies and worried about incorrect data. Mistakes were frequent.
The CX burden was high.
Ticket resolution spanned over the course of multiple days. Providers grew more escalated and were ultimately dissatisfied with the resolution. Providers wanted to be aware about the why of a monetary adjustment, something which was difficult for CX to offer quickly.
Providers were in the dark.
Providers noticed differences between what the Alma portal said and the amount they actually received in their bank account. They had no way to understand why a change occurred.
Requirements Gathering
Information was scattered. To get up to speed, I scheduled shadowing sessions with Operations team members to understand their process and decision-making across 20 workflows.
The diagram below was used to relay to Engineering and find similarities in logic.
Internal Testing
I ran early designs and prototypes by Operations leads. For internal tools, an additional click in a workflow and mismatched mental models could compound over time.
Leads were hesitant on automating the process fully. We found a balance between manual work and automated tasks.
Providers, and by extension Customer Experience, were suffering from the product's lack of clarity. Though it was additional scope for the team to contend with on a tight timeline, it was important to give providers insight into what adjustments were occurring and which payouts they would hit.
Impact
Since June 2024, $3,500,000 has been automatically adjusted.
Workflow reduced from 3m30s to 40s, saving 15 hrs per day for the Operations team.
20 workflows are now unified into one tool.