Claim Audit Platform (CAP)
Streamlining clinical claim auditing workflows through user-centered research and platform redesign.
$20M
Annual Savings
15 Sec
Saved Per Task
91.4
SUS Excellent Usability
+9.7
SUS Improvement
Project Overview
Clinical analysts relied on multiple applications, manual validation, and fragmented workflows to complete claim reviews. The CAP team aimed to reduce platform switching, improve analyst efficiency, and integrate critical Encoder Pro and CDF features into a more streamlined claim auditing experience.
Role: Lead UX Researcher
Methods: User Interviews, Field Observation, Usability Testing, Microsoft Desirability Test
Stakeholders: Payment Integrity, Product, Engineering, Design, Optum Insight
Product: Claim Audit Platform
Impact Area: Workflow Efficiency, Analyst Productivity, Decision Support, Average Handling Time
My Contributions
My Responsibilities
✓ Led user interviews, workflow observations, and contextual inquiry sessions
✓ Mapped end-to-end analyst workflows and technology touchpoints
✓ Planned and moderated usability testing
✓ Synthesized qualitative and quantitative findings into actionable insights
✓ Collaborated with six designers to inform product decisions
✓ Influenced feature prioritization and workflow redesign strategy
Why This Problem Mattered
$20M
Potential Annual Savings
Clinical analysts navigated multiple disconnected systems to complete claim reviews, creating workflow inefficiencies, context switching, and increased handling time.
PAIN POINT
Analysts relied on multiple disconnected systems, creating workflow inefficiencies and increased handling time.
OPPORTUNITY
Integrate critical claim review information into one streamlined auditing experience.
BUSINESS RISK
Workflow inefficiencies increased handling time and reduced analyst productivity.
Research Approach with AI-Enhanced Activities
User Interviews
Applied ChatGPT to generate a user interview guide to accelerate the documentation process. Through interviews to understand analyst workflows, feature needs, pain points, and decision-making requirements.
Field Observation
Observed how analysts navigated tools and reviewed claim information in real work contexts. Utilized Miro AI to assist with the sorting of qualitative data and the generation of themes.Utilized Miro AI to assist with the sorting of qualitative data and the generation of themes.
Usability Testing
Using an internal AI bot to gather essential product information for creating a usability testing guide. Observed MTAG team operations to understand real workflow constraints and recurring behaviors. Evaluated whether analysts could complete standardized claim review tasks using the CAP prototype.
Microsoft Desirability Test
Measured users' emotional responses and perceptions of the prototype experience.
Qualitative Synthesis
AI-assisted affinity clustering helped organize usability findings and identify recurring themes across analyst workflows.
Miro AI support organizing
Why This Synthesis Mattered
This synthesis helped surface patterns that informed workflow recommendations, usability improvements, and platform redesign priorities. To analyze feedback more efficiently, I used Miro AI to organize usability observations and identify recurring themes across analyst workflows.
• Frequently used reference materials were scattered across systems.
• Analysts relied heavily on decision-support content to validate claims.
• Navigation friction increased task completion time.
• Cross-system switching created unnecessary cognitive load.
Mapping a Day in the Life
A workflow model created from interviews and observation sessions to understand how analysts navigated multiple systems throughout claim review activities.
Workflow mapping revealed extensive context switching between PICTS, Encoder Pro, CAP, and supporting resources during a single claim investigation.
Analysts frequently moved between systems to locate supporting information.
Critical information was distributed across multiple platforms and documents.
Consolidate commonly used tools and decision-support content into a unified workflow.
Visualizing the Analyst Experience
A research-based video developed from interviews and observations to communicate analysts' daily challenges, workflow friction, and opportunities for platform consolidation.
Why This Artifact Mattered
The storyboard video translated research findings into a visual narrative, helping stakeholders quickly understand analysts' daily workflow pain points, system switching, and opportunities for platform consolidation.
• Communicated analyst pain points beyond a written report
• Made workflow friction visible to product and design partners
• Supported alignment around CAP redesign priorities
Key Research Insights
Analysts relied on multiple disconnected systems.
Clinical analysts frequently switched between tools to complete a single claim review, increasing workflow complexity and reducing efficiency.
Search was essential but unreliable.
Users depended heavily on search functionality, but inconsistent search behavior made it harder to locate critical information quickly.
Context mattered as much as data.
Analysts needed supporting context, not just extracted information, to validate findings and make confident audit decisions.
Cross-platform navigation created unnecessary friction.
Logging into external systems and manually validating information consumed valuable time during claim reviews.
From Fragmented Workflow to Unified Experience
Research revealed that analysts relied on multiple disconnected tools, manual validation processes, and dense reference systems. The redesigned CAP experience consolidated critical information into a more efficient and streamlined workflow.
Encoder Pro Legacy Experience
Analysts relied on a dense reference tool with multiple panels, external references, and high visual complexity.
Claim Audit Platform Integrated Design
Research findings informed a streamlined workflow that surfaced key information and reduced unnecessary navigation.
Research Impact
Reduced Information Overload
Prioritized critical claim review information and improved visual hierarchy.
Consolidated Reference Materials
Integrated commonly used Encoder Pro and CDF resources into the auditing workflow.
Improved Discoverability
Made essential information easier for analysts to locate and interpret.
Reduced Context Switching
Decreased reliance on multiple external systems during claim review.
Testing and Iteration
Step 1
MVP Usability Testing
Sample Size: 6 Participants · Testing Format: 1:1 moderated usability testing · Prototype Tool: Figma. This evaluation focuses on the MVP interface's UI/UX design, specifically examining how effectively analysts can complete claim review tasks using the integrated CAP prototype.
Step 2
Key Findings
Identified discoverability issues, unclear terminology, and missing decision-support information.
Step 3
Design Recommendations
Improved terminology, enhanced information visibility, and prioritized missing functionality.
Usability Testing Findings
Open Encoder Tab Was Hard to Find
Only one participant located the tab without assistance; others either missed it or needed additional time.
Terminology Was Unclear
Users found abbreviations such as "PX" and "Claim HX" confusing.
Missing Information Reduced Confidence
Users wanted additional decision-support content, including Crosswalk, Includes Codes, and a full list of primary procedure codes.
Streamlined Workflow Was Well Received
Participants described the prototype as satisfied, organized, effective, effortless, and easier to use than switching across tools.
Research Validation
Quantitative Results
91.4
SUS Score
A Grade Usability
+9.7 SUS Point Improvement
15 Seconds Saved Per Task
100% Success Rate for most critical workflows
Qualitative Feedback
• Satisfied
• Organized
• Effective
• Effortless
• Streamlined Workflow
Outcomes & Business Impact
$20M
Annual Savings
91.4
SUS Score
+9.7
SUS Improvement
15 Sec
Saved Per Task
Grade A
Excellent Usability
Reduced
Workflow Friction
Reflection
What Worked
Combining interviews, workflow observations, contextual inquiry, and usability testing helped connect analyst pain points directly to workflow and prototype decisions.
What I Learned
Enterprise workflow design requires understanding not only what information users need, but when, where, and why they need it during decision-making.
What I Would Improve
I would expand testing across more claim scenarios and track post-launch behavioral analytics to measure long-term workflow efficiency.