Medical Mutual
Redesigning the Medical Claims Experience
ROLE
UX Researcher + Designer
TIMELINE
3 months
TEAM
2x Researcher
1x Designer
1x Product Manager
CHALLENGE
Navigating the Explanation of Benefits (EOB) and claims process with Medical Mutual is often frustrating for members, as the current experience lacks clarity, uses complex language, and provides little context—making it difficult to understand what’s covered, what’s owed, and why.
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 needed.
IMPACT
The research and redesign of Medical Mutual’s mobile claims experience led to measurable improvements in user understanding, faster access to support, increased engagement with claim notifications, and reduced time spent searching for the right claim—helping reduce confusion, improve satisfaction, and lower support burden.
Member Claims Journey
I started the project by creating an assumptive member journey map to identify the different phases and narrow the scope of the study to prioritize and focus on areas that are significantly challenging based on analytics.
The research focused on Receiving EOB, Reviewing Claims Info and Seeking Guidance.
MOMENT 1
Receiving My EOB
Pain Points
When the claim information takes too long, members have no way to tell who is causing delays: the provider or insurance. This results in multiple calls for updates.
Information members look for to find claims quickly isn’t highlighted clearly- this is a challenge for those that receive multiple claims or EOBs.
Recommendation
Keep members updated on claims so they can identify follow-up requirements and feel prepared
Make claim summary information scannable for members to confidently find a specific claims
Help members understand claim status, what to expect and who to contact
MOMENT 2
Reviewing Claims Info
Pain Points
Initial research about costs sets certain expectations for members, and when those expectations aren’t met, they often feel blindsided. It’s frustrating not to know why something wasn’t covered or why they owe a specific amount.
The jargon and codes used in EOB make it difficult to reconcile information with other sources, especially since they don’t align with provider bills.
Members frequently have to “decode” these documents to understand what they actually owe, as the terminology is unfamiliar and unclear.
Important information is often buried beneath excessive detail, making it harder for members to get the answers.
Recommendation
Provide plan usage information to assist members in maximizing their coverage use
Provide members a concise cost breakdown with enough facts to identify challenges and make educated care decisions
Explain claim outcomes to help members plan future care and coverage decisions
MOMENT 3
Seeking Guidance
Pain Points
Finding the right channel and expert for the topic at hand can be difficult and time consuming
I don't like constantly having to coordinate calls between provider and insurance to get something fixed when they already have all the information I can offer.
Recommendation
Provide a variety of readily accessible support levels that match the tasks at hand
Create a foolproof self-service support and appeals process
Potential Impact
Reduce search time by prioritizing identifiable information
Help members identify the claim they need without combing through information that isn’t relevant.
Reduce call volumns by providing itemized coverage explanation
Help members identify potential errors and form well-informed inquiries.
Provide explanation regarding cost of care by offering coverage details.
Give peace of mind that claims are being handled
Surface alerts for members to easily navigate to view claims and provide proactive ways to stay
Reduce support cost by providing tailored support experience
Guide members to access specific types of support and help take actions.
Method and Approach
To uncover member’s claims journey and evaluate the current experience, I facilitated generative + evaluative research approach. Participants were recruited using a digital platform based on specific demographic, psychographic and usage criteria:
24 users were interviewed to collect detailed feedback.
Ideation Session
I set up an ideation session with stakeholders to encourage creative thinking and generate new ideas to solve pain points using HMW statements.
In a 4-hour in-person cross-functional workshop, we generated range of ideas using journey map and research insights.
Prioritization
Selected concepts were prioritized during an engaging workshop using three key criteria: value to users, alignment with current product roadmap, and technical feasibility.