Insurance Settlements (Advisory Board Council)
Hospital billing department’s journey for evaluating how to dispute insurance claims.
Hospitals group similar underpaid claim together to track if the insurance companies pay the contracted amount.
Hospitals wanted to log “settlements” insurance companies paid instead of paying specific underpaid claims.
Problem
Hospitals found insurance companies underpaid on hundreds of claims. Instead of trying to collect on each claim, hospitals agreed to accept a lump sum of money as repayment. They had no way of tracking the money in their system or marking the claims as paid.
Solution
I designed a way to add a settlement to their system and mark in bulk the affected claims. Settlements would also show in the reporting and analysis.
Users said the solution was "slick."
Responsibilities
Conducted user interviews to understand how settlements were currently being tracked and what their unmet needs were
Created a user journey to best understand what the system was currently able to do and where we could enhance the capabilities
Designed the flows
Created the prototype to test
Tested and iterated on the design