Project Background
Many health benefits claims require a medical referral to be processed. However, users weren’t informed of this requirement before submitting their claims. They would only find out after their claims were declined for missing a referral.
Every year, around 8% of claims were declined because of missing medical referrals.
Workshop
Skills used
Design facilitation
Stakeholder management
Leadership
Collaboration
Communication
I started this project by facilitating a workshop with stakeholders, developers, the product owner, and the UX writer. I reviewed the business and user problems, outcomes, and potential risks. I captured everyone's input in the sticky notes.
Flow Map
Skills used
Flow mapping
Defining user scenarios
Collaboration
Communication
After analyzing everyone's input from the workshop, I created a flow map to define paths users would take depending on their scenario. I iterated the flow map with stakeholders to ensure all business requirements were captured.
Low-Fidelity Wireframes
Skills used
Wireframing
Mobile design
App design
UX design
Collaboration
After completing the flow map, I defined 3 main user scenarios. I then created low-fidelity wireframes, working with the UX Writer on the copy of the alert messages.
Scenario 1
The user doesn’t have a referral on file and they’re uploading a new one
Scenario 2
The referral that’s on file is about to expire. Proactively notify users so they can get a new referral ahead of time
Scenario 3
The referral that’s on file has expired
High-Fidelity Prototype
Skills used
Prototyping
Interaction design
Design systems
Mobile design
App design
UX Design
After iterating on the wireframes with the stakeholders, I created a high-fidelity prototype using Sun Life's design system.
One additional business requirement that came up when discussing with stakeholders was that users had to have the option to continue submitting their claim without a referral, even though this would result in their claim being declined.
I included a native alert that encouraged users to add a referral if they attempted to proceed without one:
User Testing
Skills used
User research
User testing
I then conducted unmoderated user testing with 15 participants.
User Testing Objectives
- Do users understand how to upload a referral?
- Do users know what to do when their referral has expired?
- Is it helpful to tell users their referral is about to expire soon?
- Is the alert effective in getting users to stop and upload a referral?
User Testing Findings
Around half the participants understood the alert messages and uploaded referrals. Most participants found it helpful to know if their referral was expiring soon.
The other half of the participants skimmed over the alerts that asked them to upload their referrals and continued without one. When they were prompted with the native alert, they only read the title “Continue without referral?” and clicked on “Continue.”
To solve this issue, I made changes to the text of the native alert:
Version 1
Version 2
Since participants were only reading the title of the alert, I changed it to “Your claim will be declined” to emphasize the consequence of not uploading a referral. The primary button on the right was changed to “Add referral” to further encourage this action.
2nd Round of User Testing
I tested the updated design to check if it solved the issue and got more users to upload a referral.
The changes were effective. If participants missed the initial alerts, they stopped when they read that their claim would be declined and went back to add their referral.
Project Impact (Oct 2023 - Jun 2024)
11,402 medical referrals have been required for health benefits claims:
- 60% of users uploaded a medical referral when prompted
This means that users are only submitting their claims once. They're not getting declined because of a missing referral, and they're getting paid for their claims faster
- 80% of users stopped and didn’t submit their claim because they didn’t have a referral
This results in reduced costs and processing time for the back office. Analysts don't have to review claims that are missing a referral
