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Optimizing claim processing experience

Shipped and in use since early January 2025, reducing claim processing time from 10 to 3 minutes, and increasing daily throughput from 350 to 875 claims

Role

Design Lead — defined the E2E claims workflow architecture, set the design direction, and led UI design for key pages

Team

2 Product Designers, 1 Product Owner, 3 Software Engineers, 1 QA Engineer

Claim Middleware is a claims management platform that streamlines the entire claim lifecycle for the Sunday claims team. This project aimed to resolve the inefficiencies of the existing manual insurance claim process. That process involved using multiple spreadsheets and documents to assess incoming claims, track their processing status, and delegate claim assignments. These inefficiencies resulted in longer claim processing times and lower claim processing rates for the team.

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Design process

Problem statement

Sunday's claims team assessed incoming claims, tracked their status, and assigned work across spreadsheets and separate documents. Limited visibility made it difficult to monitor claim progress and identify bottlenecks, while manual data entry and document transfers increased the risk of errors. Together, these challenges slowed down claim processing, negatively impacting operational efficiency and customer satisfaction.

Platform users

We identified 3 distinct user roles: Claim Admins, Claim Assessors, and Claim Manager. Each role has its own duties and different levels of access to features on the platform.

Claim middleware users

Understanding competitive landscape

We conducted a competitive analysis of leading claims management platforms to identify their strengths, weaknesses, and opportunities for innovation.

Claim middleware competitive analysis

Solution

Claim middleware new user interface overview Claim Middleware new user interface overview

A list the team works in

After conducting competitive analysis and mapping out the overall user journey, I wireframed the claim list and claim details with the existing design systems and UI components, so the new screens would stay consistent with the brand and be easier to update.

Kept

A claim list with sort and filter on each column, for both optical and non-optical claims. Claim type 1 is processed by Sunday’s claims team on this list. Claim type 2 is passed to AdMedika, a third-party administrator and digital healthcare provider in Indonesia.

Dropped

AdMedika’s screens as the place the Sunday team processes a type 1 claim.

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

Three jobs, not a suite

My task was to design the end-to-end claim processing workflows from pre-assessment, assessment, to assessment results from scratch. I also facilitated the team's understanding of these complex workflows by creating detailed, annotated flowcharts to map out the user journey.

Claim middleware flowchart

Kept

Admin pre-assesses. Assessor assesses after that. Manager assigns clients and sets leave access.

Dropped

Guidewire’s analytics layer and one role finishing the whole claim.

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

The assessor decides on one screen

Kept

After pre-assessment, the assessor works on one page. They mark each document as matching or not, see the benefit lines and the limit, and enter the approved amount and the rejected amount. They then choose reject (Tolak klaim), pending (Pending klaim), or approve (Setujui klaim). The pre-assessment note stays on the page.

Dropped

A recommended amount and finishing the assessment inside AdMedika. The assessor types both amounts. Type 2 claims are still handed to AdMedika. The decision is made on this screen.

Claim middleware claim assessment page Claim assessment page, which allows Claim Assessors to review claim information, assess claim amount, and decide claim status

One front door for messy claims

Kept

Manual create for email and WhatsApp. A short status email to the team and the client.

Dropped

Jolly, Sunday's employee benefit app, as the only way in and treating the status email as a feature of its own.

Outcomes

Impact

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

Learning

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