Are Liabilities Hiding in Your Claims and Absence Management Software Design?

Compliance is always top of mind when dealing with claims and absence management. This blog explores how the design of claims management systems and absence management software can impact compliance, and how to ensure your systems aren’t a liability.  

Earlier this year, one of the world’s largest financial institutions, Citibank, lost a lawsuit and $500 million all because of a confusing software design. Citibank was acting as an agent for Revlon to make creditor payments and was supposed to send out interest payments to these creditors. But, due to the confusing interface of the financial software used to make the payments, Citibank accidentally paid one creditor the entire loan principal balance at once. Most of the large balance wasn’t due for several more years and was subject to imminent refinancing 

The Citibank agent thought that by checking the “Principal” checkbox and entering the dollar amount in the software field, they were ensuring the principal payment would stay at Citibank. But this was very, very wrong. The opposite was true, and the misinterpretation of the payment submission screen caused Citibank to pay out the entire principal balance. To make matters worse, Citibank’s procedures require that three people sign off before making a transaction of this size. All three people signing off misunderstood the software screen and accidentally approved the transaction.   

Citibank tried to get the funds back, to no avail. They sued in court arguing the money was sent by mistakeBut due to 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. 

Why Insurance Software Design is so Important

This case demonstrates that the design of software tool, known as user experience (UX)can have drastic impact on any 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. 

How to Improve Your Software Design User Experience

There are many resources available to help refine designs to ensure they’re usability focusedThe Nielsen Norman Group’s “10 Usability Heuristics for User Interface Design” attempts to prevent usability problems from occurring in the first place 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 warn us with Are you sure you want to do this? messages and bright red icons which encourage us to pause and read terms and conditions before we proceed. These design patterns are specifically designed to minimize the risk of making consequential mistakes like Citibank’s 

Providing helpful context and documentation to accompany user flow in a software application or website is another key usability heuristicAgain, we find many familiar patterns which we all interact with daily. Info icons (the little “i”) that often accompany online forms and website FAQ sections are examples of such tools.  

For software applications, including in-application help text can not only minimize mistakes but reduce overall training costs. In Citibank’s case, the fact that three separate individuals all misunderstood the meaning of an input field suggests the application lacked effective guidance patterns for users.  

User Experience Matters for Claims Management and Absence Management Software

For claims and absence management software users who must complete their case administration under strict regulatory and contractual deadlines, the risk of ignoring error prevention or explanatory tools is high. Part of a claims examiner’s training should include the purpose of such UX tools and the risks around clicking too quickly through or outright ignoring alerts, flags, and information icons  

Compliance is achieved not only by following the regulatory rules, but also by having software designed to optimize user experience and prevent human error. Because of this, carriers need claims management solutions and absence management systems with solid UX designFINEOS Absence and FINEOS Claims offer configurable automation rules and modern, intuitively designed user interface to help carriers eliminate liabilities and remain in compliance 

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