CHA: Designing a service for insurance claims

Project with
Clearing House Apothekers
Amsterdam, NL – 2014

Clearing House Apothekers (CHA) is a company that handles insurance claims for pharmacies and insurance providers. They have more than 10 years experience in the business and were looking for a new design for their core offer: CHA Online. They partnered with User Intelligence to undertake the challenge and I was a part of the team as UX Consultant in the concept and initial development phases. 

By means of a “Vision” workshop with the company’s stakeholders, it became clear that the challenge implied more than updating the tool’s design by implementing the new visual style and common interaction patters. It meant a bigger effort with three focus areas: 1) Putting customers at the centre by creating a service that would revolve around each of the target groups core tasks. 2) Updating front & backend structures. 3) Incorporating UX capabilities and using Scrum development process in the organisation.


Tool for insurance declarations

To further understand the challenge we conducted interview sessions with the different target groups: individual pharmacies, pharmacy chains, insurance providers and internal CHA users. This enabled us to define each group in terms of main goals, priority tasks & overall motivations. For example: for pharmacies is about how much money they can claim back each month while for insurers it is about how much they need to pay. Another seemingly small but highly impactful finding was the variations in jargon across target groups; for instance pharmacies refer to people that come for a medicament as patients while insurers call them clients.

The differences and similarities across groups resulted in creating a modular concept where each target could be provided with the core functionalities that would serve their main tasks and align with the user’s motivations. Moving to a modular, focused concept was a decision supported by quantitative data from the current site’s usage statistics, where it was visible which functionalities were used by each target audience.

This implied a significant effort in terms of interface and backend structures since at that point, every customer could access every functionality, regardless of which entitlement contract or purpose they had the service for. On the other hand, having a modular solution would enable CHA to introduce the new platform one customer group at a time. It was also a good concept for a first-time Scrum team, as scoping per target group and functionality meant a starting point for prioritising User Stories.

Both detail concept design and development took place in parallel. We organised two main teams seating by each other: one with a focus on design (including Front End) and one focused on Backend development.  Because users were a priority, each sprint included a round of research at the end, these sessions varied from paper prototype concept validations to usability testing using the clickable product. Moreover, internal actors participated in several feedback sessions in order to provide further feedback and increase internal acceptance of the new service with its radical changes.

The approach in images:

Through the concept and initial development stages the teams were composed by CHA employees together with UX Consultants from User Intelligence.  However, it was a main goal to advocate for incorporating UX and Front-end capabilities within Clearing House in order to transition and further develop the platform with an internal team.

The project was further developed and the first user groups are already using the tool. The concept and approach helped overcoming the key challenges presented at the beginning of the project. By further understanding customers and creating a modular solution CHA now delivers a service that provides each user group with a set of functionalities that align with their goals and tasks. On the other hand, CHA undertook a significant effort to renew backend infrastructure while investing in new methods and capabilities that will enable faster implementation of new services in the future.

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