Designing an automated solution for claims adjusters to request medical records from vet clinics, and for clinics to respond to requests.
Timeline
May 2023 - Sep 2023
Company
Pumpkin
Platform
Web
“This new format makes record uploads very quick and simple. Appreciate that our time is taken into account. Most insurance companies are not as considerate.”
– Receptionist at Vet Clinic
Pumpkin faced an inefficient process for collecting medical records that are required for adjudicating claims. This system caused frustration for claims adjusters, veterinary clinics, and pet parents alike. Adjusters were bogged down by a manual process of contacting clinics and tracking requests through spreadsheets or Slack, without considering the preferred methods of clinics for sharing records. This inefficiency led to delays in claims processing, leaving pet parents in the dark about the status of their claims.
Aiming to streamline this process, I embarked on a discovery phase to understand the challenges from all perspectives. Through interviews with claims adjusters, veterinary staff, and pet parents, I uncovered several key issues:
How might we design a solution that makes it easier for our adjusters to request records, and easier for clinics to understand and quickly fulfill a request?
Insights from research guided the design of low-fidelity concepts for a more streamlined, future state process. My focus was on creating a user-friendly design that addressed the needs and pain points identified. I gathered feedback on these low-fidelity concepts from stakeholders and vet users.
Request Email (Entry Point)
Concept A: Simple Record Upload
Concept B: Claim Overview Page
We tested two versions of an experience with vets. In Concept A, after getting an email requesting records, they go to a page primarily focused on uploading the provided records. In Concept B, they are given an overview of the entire claim, along with the ability to upload records in the context of the current step. Vets highly preferred Concept A, as it allowed them to easily complete the required task without overloading them with information that wasn't relevant to them. (Note that the "pizza tracker" that appeared in Concept A, while received positively by vets, ultimately was not in scope for this project.)
One exciting aspect of this project was creating a scrappy pilot version of the tool to validate our approach—and make sure that vets would use our upload page. To do this, I stretched my skillset by building a system for sending record requests using Google Sheets, App Scripts (Javascript), and a form builder called HeyFlow. The pilot was a resounding success. Vets were sending us records more quickly & accurately, giving us the green light to move forward with the development of the full solution.
I used Google Sheets & App Scripts to create a pilot tool so we could validate our approach.
As we were getting results from testing, I worked to design the full automated record request system. This project was unique in that it sat across multiple platforms:
Pumpkin Admin: Where adjusters request records, and view requests that have been fulfilled
Email: For communicating record requests to vets (and, in some cases, customers).
Web: A landing page where records are uploaded.
I created a diagram to visually represent the system I designed.
An adjuster can view a table of in-progress and completed requests, and also start a new request.
The view when an adjuster has started a new request
Confirmation screen before an adjuster sends their request, showing a preview of the email message they're sending
When an adjuster clicks "View Details," they can review the request and see an audit log of events related to it.
“Love love love the drag-and-drop for the files, along with knowing it will be connected to the right patient and claim!”
– Receptionist at Vet Clinic
“I LOVE how absolutely easy and FAST it is to upload rather than email the records!”
– Receptionist at Vet Clinic
“EVERY INSURANCE COMPANY SHOULD OFFER THIS, MAKES MY LIFE SO MUCH EASIER!”
– Receptionist at Vet Clinic
In addition to receiving great feedback from vet users surveyed after using our tool, the redesign had a clear, direct impact on the business:
15% reduction in processing time across all claims
40% decrease in retrieval time (request sent to records received)
$200k YoY cost savings
As designed, the MR request system can unlock further opportunities to speed up claim submissions that we will tackle in the future:
While this feature currently lives outside PawPortal so that we can request records from clinics who do not yet have an account, my vision is for this feature to be integrated into PawPortal in the future, solidifying it as the destination for vet clinics to communicate with Pumpkin.