The background
Every time a member receives care, Medical Mutual generates an Explanation of Benefits (EOB) — the document that explains what was billed, what's covered, and what the member owes. It's one of the most frequently accessed, high-stakes touchpoints in the entire member experience. But for most people, it's also one of the most confusing: dense terminology, disconnected numbers, and little context for how a claim actually reached its outcome.
The challenge
Navigating the EOB and claims process was a persistent source of frustration for members. The existing experience lacked clarity, leaned on complex insurance language, and offered little context — leaving members unsure what was covered, what they owed, and why. The result: members felt blindsided by costs, had to "decode" their own paperwork, and frequently called support just to get answers that should have been self-evident.
The approach
How the research and design process unfolded, phase by phase.
Journey mapping & analytics
Built an assumptive member journey map to break the claims experience into distinct phases, then used analytics to pinpoint the moments causing the most friction — narrowing the focus to three: Receiving My EOB, Reviewing Claims Info, and Seeking Guidance.
Generative & evaluative research
Interviewed 24 members recruited against specific demographic, psychographic, and usage criteria to surface real pain points across the three critical moments.
Cross-functional ideation
Ran a 4-hour, in-person workshop with stakeholders, using How-Might-We statements to translate pain points into a broad range of solution concepts.
Prioritization
Evaluated and prioritized concepts against three criteria — user value, roadmap alignment, and technical feasibility — to focus design effort where it would have the greatest, most achievable impact.
The result
An experience that is less stressful and more intuitive — making it easier for members to understand their claims, find the right information quickly, and get support when they need it. Design recommendations addressed each moment directly: proactive claim status updates and scannable summaries for Receiving My EOB; plain-language cost breakdowns and clearer outcome explanations for Reviewing Claims Info; and tiered, self-service support with a streamlined appeals process for Seeking Guidance.
The impact
The redesign was built to directly target the root causes of confusion and support dependency uncovered in research — translating each pain point into a measurable design lever.
- ↓ Claim search time — By prioritizing scannable, identifiable claim details up front, the new design was engineered to cut the time members spend hunting through unrelated information to find the claim they came for.
- ↓ Support call volume — Itemized, plain-language coverage breakdowns were designed to help members self-diagnose discrepancies and form clear questions before calling, directly targeting the top drivers of repeat support contacts identified in research.
- ↑ Member peace of mind — Proactive claim status alerts replaced passive uncertainty with active visibility, giving members a low-effort way to stay ahead of their claims instead of chasing updates.
- ↓ Support burden and cost — Tiered, task-matched support pathways were designed to route members to self-service and the right expert on the first try, reducing avoidable escalations to live agents.
Each of these outcomes was directly informed by the friction points members described in research — turning specific complaints (delayed status visibility, undecodable jargon, support ping-pong between provider and insurer) into targeted, testable design solutions.