Healthcare Portal –
Claims Process Redesign
This is an anonymized sample from client work at Fuzzy Math. It represents one focused area of a broader engagement – specifically the process documentation and UX design work I led for the claims process.
My Role
Process Documentation · Workflow Design · UX Design
Client
Anonymized healthcare portal provider
Context
Work sample – partial engagement scope
Platform
Cloud-based health plan & TPA portal
The Situation
A Hidden Feature Users Didn't Know Existed
The client managed and white-labeled cloud-based healthcare and administrative portals, working largely with health plans and third-party administrators to provide flexible, regulation-aligned programs.
The client was pursuing both tactical and strategic updates, seeking to provide an enhanced user experience that would allow them to compete in the larger healthcare market. A key discovery early in the engagement: users were largely unaware that they could file health insurance claims directly within the portal. The capability existed — but it was buried, fragmented, and cumbersome enough that even users who found it often abandoned the process.
My focus on this engagement was the claims process — specifically, documenting the current-state workflows in enough detail to identify decision points, surface friction, and inform a redesigned UI that would make the capability accessible and intuitive.
The Core Challenge
The claims process wasn't just a UI problem – it was a discoverability problem and a complexity problem simultaneously. Fixing the visual design without understanding the underlying workflow structure would have produced a prettier version of the same broken experience.
Process Documentation
Mapping the Claims Workflow End-to-End
Before designing a single screen, I documented the complete claims process across four interconnected workflow layers — each revealing distinct decision points, data requirements, and failure modes.
The goal of this documentation phase was to create a shared understanding of how the claims process actually worked — not how stakeholders assumed it worked. Each flow was built to surface decision points, identify required data inputs at each step, and flag dependencies between process stages that would affect UI design requirements downstream.
Flow 01
High-Level Claims Process
The end-to-end view of how a claim moves from initiation through resolution — establishing the overall structure and identifying the major stages a user navigates.
Flow 02
Claim Form Submission
A granular breakdown of the form submission process — documenting required data fields, validation logic, decision branches for different claim types, and error states.
Flow 03
Claim Management
Post-submission management — how users track, review, and interact with submitted claims. Documented decision points for claim status changes and user notification triggers.
Flow 04
Medical Claim Form Process
A specialized flow for medical claims — addressing the additional complexity and data requirements distinct from other claim types in the system.
Each flow was documented with a consistent tag legend to maintain clarity across all four process maps — distinguishing between user actions, system decisions, data inputs, and process endpoints. This standardization made the flows usable as both design references and stakeholder communication tools.
Why Process Documentation Came First
Thoroughly mapping processes upfront before redesigning experiences is foundational to good design practice. The four flows revealed that the fragmented UI experience wasn't arbitrary — it reflected a genuinely complex underlying process that needed to be understood before it could be simplified. The documentation phase directly informed which complexity could be hidden from users and which needed to be surfaced explicitly.
Design Translation
From Process Flows to Interface Design
The process flows weren't just documentation artifacts — they became the direct input for the wireframe design, ensuring every UI decision was grounded in the actual workflow structure.
I played a central role in translating the process flows into mid-fidelity wireframes with key UI design elements. The close alignment between documentation and design was intentional — maintaining consistency and clarity throughout the user journey rather than treating the two phases as separate activities. The alignment between process flows and UI design elements helped maintain consistency and clarity throughout the user journey, ultimately enhancing the overall user experience of the healthcare portal.
Design Process
Extract UI requirements from process flows
Each decision point translated directly into a UI requirement — a branching path, a validation state, a progressive disclosure pattern, or a confirmation step.
Map data inputs to form structure
The required data criteria identified in each flow informed the form field structure, grouping logic, and sequencing of the claim submission experience.
Design mid-fidelity wireframes with annotations
Mid-fi wireframes were annotated to communicate design intent and behavior — not just visual layout — ensuring engineering could accurately implement the intended experience.
Validate consistency between flows and UI
Each wireframe was cross-referenced against its corresponding process flow to ensure no decision points, error states, or required data inputs were lost in translation.
What the Wireframes Covered
Claim initiation and type selection
Step-by-step form submission with validation
Claim review and confirmation screens
Submitted claims management dashboard
Claim status tracking and notifications
Medical claim-specific form variations
Design Principles Applied
Progressive disclosure to reduce cognitive load
Consistent UI patterns across all claim types
Clear error prevention and recovery paths
Claims capability surfaced at portal navigation level
Aligned patterns with existing portal conventions
Refer to the Figma file here for annotated wireframes of the claims process.
Outcomes & Takeaways
Surfaced, Streamlined, and Accessible
Through the redesign efforts, the team successfully brought the previously obscured claims process functionality to the forefront, making it more accessible and user-friendly for portal users.
The redesigned process reduced friction, leading to smoother claim submissions and improved user engagement with the healthcare portal. By streamlining the claims process and eliminating pain points, the team achieved smoother claim submissions and increased user engagement — demonstrating that continuously identifying and addressing sources of friction within user journeys is crucial to the overall experience.
Key Takeaways
Process documentation before design is always worth the investment
Thoroughly mapping processes upfront to gain a comprehensive understanding before redesigning experiences proved highly valuable — surfacing pain points and informing design requirements.
Align process documentation with UI design to maintain coherence
By translating the process flows into mid-fidelity wireframes and ensuring consistency between the two, the team maintained clarity and coherence throughout the user journey.
Surface underutilized features strategically
Identifying buried features within existing products and strategically surfacing them demonstrates the value of understanding the full product landscape before adding new functionality.
Reducing friction drives adoption
Streamlining the claims process and eliminating abandonment points fostered better adoption and engagement — showing that friction removal is as valuable as feature addition.
What This WOrk Demonstrates
Process documentation as a prerequisite to design
Translating complex, multi-layer workflows into UI requirements
Identifying underutilized features and surfacing them strategically
Maintaining alignment between documentation and design artifacts
Connection to Broader Practice
The same process documentation methodology appears in the Nexus/Tempo case study
Available as a standalone service for teams needing workflow clarity before building
Healthcare domain familiarity — health plan structures, TPA relationships, claims logic
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