Optimizing claim processing experience

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.

Design process

Problem statement

Sunday's existing claims 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.

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.

Key pain points

At the beginning of the project, we held discussions with the claims team and the Development Director to plan how to improve the existing claims process for greater efficiency. Through focus group discussions with the team, we identified key pain points in the current process.

Key pain points of the existing manual 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

Understanding competitive landscape

We conducted a competitive analysis of leading claims management platforms to identify their strengths, weaknesses, and opportunities for innovation. This benchmarking informed our design decisions and helped us identify established design patterns, interaction models, and features that are recognized as industry best practices.

Defining the goal

Our goal was to develop an MVP version of a claims 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 claim 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. I also facilitated the team's understanding of these complex workflows by creating detailed, annotated flowcharts to map out the user journey.

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
Claim Manager can assign Claim Admins and Claim Assessors to handle specific clients
Claim Manager can disable access and set active date for Claim Admins and Claim Assessors for leave situations
Creating new claim manually to accommodate claims submitted via email or WhatsApp messages
Email notifications to track claim status for claims team and clients

Claim Middleware new user interface overview 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 Claim middleware claim details page

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

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

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 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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