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Centene Web Claims

Centene claims submitted through the web portal are time-consuming, error-prone, and lack controls, resulting in high-touch resolutions, inaccurate claim payments, interest and prompt pay penalties, and provider dissatisfaction. These issues directly impact administrative costs and revenue.

We conducted a current-state understanding of the process and technology within the web claim ecosystem. Reimagined the future of web claims processing by applying best practices, reinventing the user experience where appropriate, and used technology solutions to automate and optimize the process.

Challenge:

Redesign of a legacy provider portal to a new web claims portal tht enhances and completele changes the look and feel of the Claims portion of Health Plan's secure provider portal.
Web claims application allows providers to submit profesional and institutional claims, view status of claims, and enables quick access to claims information on the claims dashboard.
Access to individual claims, member details, services, and payment details.
Access to users up to 24 months of claims related history, as well as submit new claims, correct claims, upload EDI batch claims.

Solution:

Implemented web analytics which gives data on. the number of users accessing the application.
The AWS services being used are web claims backend, configured using AWS lambda functions.
Adobe analytics enterprise level global tags are enabled for tracking for web analytics.
Automation. suite developed in cypress, reviewed by client cypress expert.
Enterprise level global tags enabled for tracking.

Business Impact:

Increased in overall system performance. Code maintenance made much easier. Dependency in third party systems/APIs reduced.
The new web portal enables providers to find claims data more effectively by combining all the data in the database.
Improvised user experience without requiring a page refresh or reload, real-time notification of any changes in overall data.
Quick access to most relevant claim information on the claims dashboard.
Improved readability and length of stay on the website. Enabling the user to access the application via different devices.
Improved accessibility for users with disabilities.

Project Type: B2B Web application

Project Date: November 2021 - December 2022

Role: UX/UI Designer

As a UX/UI designer, I conducted user research using methods such as provider interviews, surveys, and workshop to gather insights into the user needs, behaviors, and pain points. Synthetized research findings to identify user personas, user journeys, and key pain points. Mapped out user flows to visualize the steps users take to achieve their goals within the application. I developed low fidelity wireframes and high-fidelity mockups as well as clickable prototypes to visualize the application functionality and the user experience. I used Figma to create the visually appealing and user-friendly interfaces ensuring the consistency in design elements, typography, colors and spacing across the application to maintain a cohesive visual identity and to comply with Fondue Design System. Created custom components based on application needs that were included in fondue. Gathered feedback on design concepts and prototypes from users and stakeholders to identify usability issues and areas for improvement. Refined and iterated on designs based on feedback to address identified issues and enhance user experience. Communicated design ideas and concepts effectively through presentations, prototypes, and design specifications. Shared with the development team design specifications and guidelines to ensure accurate implementation. Worked with stakeholders to define project scope, timelines, and deliverables. Prioritized design tasks. Throughout the entire design process, implemented accessibility best practices to ensure the product is usable by people with disabilities. Verified that the final product meets user needs and business objectives through feedback. In addition, guided junior designer during the wireframing process by providing feedback and support; encouraged a collaborative environment, promoting knowledge sharing and teamwork; and offered design direction to ensure consistency, quality, and innovation in the team’s work.