Optimizing claim processing experience

Claim Middleware is a claim management platform that streamline the entire claims lifecycle for the Sunday claims team. 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 operational efficiency and customer satisfaction.

Key pain points

Prior to the kickoff, we had discussions with the claims team and development director to discuss the plan of improving the existing claim process to be more efficient. We highlighted key pain points of the existing claim process based on the focus group discussions with the 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

Platform users

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.

Defining goal

Our goal was to develop an MVP version of claim management platform for Sunday Insurance, namely Claim Middleware. This platform will streamline the entire claims lifecycle by enabling the Sunday claims team to seamlessly assess incoming claims, track claims processing status, and delegate claim assignments.

Solution

My task was to design the end-to-end claim processing workflows from pre-assessment, assessment, to assessment results from scratch. Furthermore, I facilitated team understanding of these complex workflows by providing detailed flows with annotations using charts and diagrams.

Proposed features:

Claim list with sort and filter capabilities for each column header
Comprehensive claim details information for non-optical and optical claims
Claim admins can conduct a pre-assessment process immediately after claims are submitted by clients
Claim assessors can conduct an assessment process after claims are reviewed by claim admins
Head of claims can assign claim admins and claim assessors to handle specific clients
Head of claims can disable access and set active date for claim admins and claim assessors for on leave situation
Creating new claim manually to accommodate claims submitted via email or WhatsApp message
Email notification to track claim status for claims team and clients.

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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