Optimizing internal claim processing experience

Sunday is a fully-integrated sales and services insurtech company that uses AI and digital platforms to offer personalised insurance products and services that suits all types of individual and business risks. The project was initiated due to the inefficiency of the existing insurance claim process that used multiple spreadsheets and documents to assess incoming claims, track claims processing status, and delegate claim assignments. These issues resulted in longer claim processing times and lower claim processing rates for the claims team.

Design process

Problem statement

Sunday's existing claim management system relies on inefficient manual processes, such as spreadsheets and documents. This has led to slow claim processing times, negatively impacting customer satisfaction and operational efficiency.

Key pain points

Prior to the kickoff, we had discussions with the head of claims team and development director to discuss the plan of improving the existing claim process to be more efficient. After discussions with the team, we concluded that the most efficient way to improve the process would be to create a centralized platform, namely claim middleware. We highlighted key pain points of the existing claim process based on the focus group discussions with the claims team.

Key pain points of the existing claim process:

Lack of transparency and visibility makes it difficult to monitor claim statuses and identify potential bottlenecks
Low claim processing rates stem from inefficiencies that hinder the team's ability to process claims quickly and accurately
Long claim processing times result from manual data entry and document transfers
Increased risks of errors from manual processes lead to inaccuracies and delays in claim settlements

Defining goal

Our goal was to develop an MVP claim management platform for Sunday Insurance Indonesia. This platform will provide Sunday claims team with easy access to assess incoming claims, track claims processing status, and delegate claim assignments.

Solution

Three distinct user roles will use this platform: claim admins, claim assessors, and heads of claims. Each role will have varying levels of access to platform features with heads of claims possessing full access, while admins and assessors are given limited access, primarily for reviewing and processing claims. The majority of claims come from the after-sales service app, known as Jolly super app, while a smaller portion are received via emails and WhatsApp messages to customer service.

During the project, I was responsible for designing the end-to-end claim processing workflows from pre-assessment, assessment, to assessment results. Furthermore, I facilitated team understanding of these complex workflows by providing and organizing detailed annotations using charts and diagrams.

Research methods used during the collaboration included journey mapping, usability testing, and user interviews.

Claim list page, from where the claims team can view the list of submitted claims, add new claims, and adjust claim settings Claim middleware claim details page

Claim details page, which allows the claims team to review claim information and process the claim Claim middleware client configuration page

Client configuration, from where clients can be categorized as type 1 (can be processed directly) or 2 (need AdMedika review) Claim middleware claim delegation page

Claim delegation, which was one of the most requested features during the pilot phase Claim middleware create claim page

Creating claim, which allows the claims team to create a new claim for instances where claims are submitted outside of Jolly super app Jolly user flow

User flow for claim submission via Jolly super app, from submitting a claim to viewing claim history and status

Outcomes

Impact

MVP version has been successfully released and used by the claims team since early January 2025
-70% decrease in average claim processing time from 10 minutes to 3 minutes per claim
+150% increase in average claim processing rates from 350 claims to 875 claims per day

Learning

Regularly reviewing and receiving feedback from stakeholders throughout the product development process was essential for understanding their needs and pain points, while also ensuring alignment between teams.
Although most meetings were conducted online due to differences in office locations, occasional offline meetings provided valuable opportunities to gain deeper insights into their product feedback and observe non-verbal cues.

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