How Good UX Design Can Simplify Claims and Absence Management

Original article appeared in Benefits Pro June 2021

Megan Holstein, Esq., FINEOS, SVP Claims and Absence Product discusses the importance in considering user experience (UX) design when choosing claims and absence management solutions.

When selecting claims and absence management software, insurance carriers have a lot of factors to consider. At the top of the priority list are usually questions about how long the solution will take to implement, compliance rules, and what impact it will have on their organization’s customer service and overall revenue.

But one important factor often gets overlooked: user experience (UX) design. The UX design of claims and absence management systems can impact all of the factors above, plus create hidden liabilities for the carrier if not done well.

Good design, however, can simplify claims and absence management processes by making the software easier for the carrier’s employees to use and understand. Let’s take a look at a real-world example of what can happen when UX design misses the mark.

UX Design Gone Wrong

Citibank, one of the world’s largest financial institutions, recently lost a lawsuit and $500 million because of confusing UX design in their software. Acting as an agent for Revlon, Citibank was supposed to send out interest payments to Revlon’s creditors.

But, due to their financial software’s unclear user interface, Citibank accidentally paid one creditor the entire loan principal balance at once. The majority of the enormous balance wasn’t due for several more years. The Citibank agent thought that by checking the “principal” checkbox and entering the total dollar amount in the software field, they were ensuring the principal payment would stay at Citibank.

Unfortunately, the exact opposite was true. This misinterpretation of the payment submission screen caused Citibank to pay out the entire principal balance immediately. Citibank’s procedures even required that three employees sign off before making a transaction of this size, and all three people misunderstood the software screen and approved the transaction.

Citibank sued in court arguing the money was sent by mistake. But due to a specific creditor-debtor law, Citibank did not win. In fact, the court found it hard to believe that Citibank, “one of the most sophisticated financial institutions in the world,” could make such an expensive mistake.

The Impact of Well-Designed Insurance Software

The Citibank debacle demonstrates that the design of a software tool can have a drastic impact on any size or type of organization. Group disability benefits carriers who rely on insurance software every day to quote business, collect premiums, adjudicate claims, and send payments to claimants, employers, and taxing authorities should carefully review both internal and customer-facing software designs.

When it comes to disability and absence management in particular, given the highly regulated environment in which carriers are hyper-focused on compliance, user experience cannot be forgotten. One misinterpretation of an on-screen prompt could result in the carrier’s noncompliance and result in lost time and money to correct it. In more extreme cases, a carrier could even find themselves facing fees or legal action due to what was originally a simple mistake.

With well-designed UX, these types of mistakes can become virtually non-existent. Easy to read and understand prompts, clear workflows, and built-in warnings and fail-safes help to reduce or eliminate the chances of human error. This simplifies and expedites claims and absence management for users by making processes more clear and less risky.

How Carriers Can Improve Their Software UX Design

For carriers looking to refine their software designs, there are many resources available. The Nielsen Norman Group’s “10 Usability Heuristics for User Interface Design” attempts to prevent usability problems from occurring and provides guidelines such as emergency exits for users if mistakes are made.

Along with these heuristics, modern web design has many recognizable patterns used to mitigate user interface issues. We’ve all used software that warns us with pop-up messages and bright red icons which encourage us to pause and read more before we proceed. These design patterns are created to minimize the risk of making consequential mistakes like Citibank’s.

Including in-application help text also prevents errors. This can not only minimize mistakes but reduce overall training time and costs as well. In Citibank’s case, the fact that three separate individuals all misunderstood the meaning of an input field suggests the application lacked sufficient context to accompany the user flow.

User Experience Matters for Claims and Absence Management

For claims and absence management software users who must complete their case administration under strict regulatory and contractual deadlines, having effective UX design to guide their decision-making is critical. User error can impact both the carrier’s bottom line and reputation, so well-designed software which prevents these errors is certainly worth the investment.

Compliance is achieved not only by systematizing the regulatory rules, but also by having software designed to eliminate the small mistakes or misunderstandings that can turn into huge compliance issues. Carriers should look for software solutions which offer configurable automation rules and a modern, intuitively designed user interface to help carriers eliminate liabilities and remain in compliance.

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