Designing scalable member and servicing experiences during a large-scale healthcare transition.

Overview

A large healthcare organization was undergoing a multi-phase platform migration impacting claims, billing, payments, and member servicing. During the transition, historical and current information would temporarily exist across separate platforms, creating complexity for members and customer service teams.

I was brought in for a 6+ month engagement to identify experience gaps and help prioritize where the team should focus. Through workshops and discovery, payments, claims/EOBs, and member support emerged as the highest-priority areas.

I led design and research across those areas, focusing on payment strategy, claims access, and self-service improvements.

The Challenge

The transition could not happen all at once. Depending on the workflow, members and service teams could be routed between legacy and new experiences while functionality and data continued to move.

My challenge was to identify where that transition created the greatest risk or confusion and design experiences that could bridge those gaps while the new platform evolved.

The challenge became:

How might we reduce confusion and create clearer experiences while members and service teams move between legacy and new systems?

Finding the Highest-Impact Gaps

I began with cross-functional workshops to understand where the transition was creating the greatest member and operational risk.

We evaluated several areas, including login, provider search, payments, claims/EOBs, and member support. Payments, claims/EOBs, and support emerged as the highest priorities and became the focus of my work.

Defining the Future Payment Experience

I first focused on payments, where the team needed a clearer view of the current experience and how it would change during the transition.

I mapped the current and future payment journey to show how the member experience could evolve. I then developed a payment experience model that connected member feedback and pain points to recommendations, priorities, and future opportunities.

Current-to-future workflow: Mapped the member payment journey across current and future states.

Payment Experience Model: Connected member feedback and pain points to recommendations, priorities, and future opportunities.

Solving a Gap in Claims Search

During discovery with product and experience stakeholders, we identified a transition gap: claims processed around the migration period could exist in either the legacy or new experience.

I designed a temporary claims search experience that routed members to the correct platform based on backend rules defined with the product team.

This gave the team a practical bridge between platforms while claims data and functionality continued to migrate.

Claims transition handoff: Final workflow documenting routing logic, search behavior, edge cases, and mid-fidelity concepts for accessing current and historical claims.

Using Customer Data to Improve Self-Service

I analyzed Tableau call data alongside verbatim customer feedback to understand why members were contacting support and where the digital experience was falling short.

Matching call drivers with customer comments helped identify the highest-friction problems and informed self-service concepts aimed at reducing avoidable calls.

Usability & Rollout Readiness

I conducted prototype testing with customer service representatives to understand how prepared teams were to work within the new platform.

The research surfaced workflow and training gaps that were added to the team's roadmap.

I also mapped the team’s existing training and research workflows and recommended changes to improve how new platform guidance was organized and delivered.

Bringing the Future Experience Together

To bring the recommendations together, I created an interactive prototype showing how priority member workflows could work within a more unified experience.

I used an AI-assisted prototyping workflow to move quickly from concepts to an interactive experience that could be shared with stakeholders as part of the final handoff.

Outcomes & Impact

Although the broader transition was still in progress, the work produced several concrete outcomes:

• Established a future-state payment strategy and implementation workflow.
• Identified and designed a solution for a claims search gap between legacy and new experiences.
• Identified self-service and training priorities that informed the team's roadmap and final handoff.

Reflection

This project reinforced that successful migration design is not only about replacing interfaces. The larger challenge was identifying where fragmented systems created real member and operational problems, then giving teams practical ways to bridge those gaps while the platform continued to evolve.

Selected visuals and workflows have been simplified and anonymized due to NDA constraints.