ACE Claim Redesign

Redesigning How Medical Claims Display in a Salesforce Application

Don’t feel like reading through everything? Check out the Final Prototype!

Problem Statement & Background:

Claims are Blue Cross and Blue Shields highest call driver, and for good reason, they are difficult to understand and carry significant financial risks. To deal with claim related questions, customer advocates are trained to use the claim data found in an application called ACE (Advanced Customer Engagement). However, through conducting research, We learned most advocates are not using ACE to answer claim related questions, and instead are relying on significantly older systems. We approached the business with a plan to revamp the claims data found in ACE and improve the overall user experience to ensure advocates used it as their primary platform.

Investigating the Problem Using UX Research:

Contextual Inquiry


The goal of our contextual inquiry was to observe our Customer Advocates live as they answered phone calls from our members. We spent a total of 6 days across multiple locations to ensure we had a robust understanding of any potential problems we may encounter. In addition to observing, we also had an opportunity to interview and ask questions in-between calls to gain any additional clarification on anything we witnessed. To help document each call, we created a custom notes template to help categorize various interactions. Below are a sample of some photos from the sessions.

Contextual Inquiry Findings


The current layout and design of the claims page makes it difficult for users to find the information they are looking for

Claims in ACE lack dozens of necessary data fields which advocates rely on to answer a majority of questions

Customer Advocates are always swiveling out of ACE to use supporting applications in order to answer claim questions

Heuristic Review of Current Claims to Identify Design Opportunities


  1. Aesthetic Integrity: The current page layout has inconsistent spacing. Often leading to large chunks of whitespace which add unnecessary scrolling and eye movement as advocates scan the page for information

  2. Linguistic Clarity: Field names are often difficult to understand and contain large amounts of acronyms which require large amounts of training in order to learn

  3. Flexibility and Efficiency: The information presented cannot be searched or sorted using the ACE platform; this forces advocates to scroll through dozens of data fields which may be irrelevant in order to find what they are looking for

  4. No Logical Order to Fields: Claims contain dozens of data fields which advocates need to look at in order to resolve inquiries. The fields listed in the current page don’t have a simple logical order for an advocate to follow.

At this point, we knew the claim details page on ACE was failing in multiple aspects, so we wanted to perform a full review of the page to determine what actionable steps could be taken to help alleviate several of the pain points we had seen from our contextual inquiry sessions.

Claims Heuristic Violations:

Claims Sample Image

Designing A New Solution!

Re-Organizing Content & Adding Fields


The first step of our design process was to figure out how to best re-organize all the claims content on the page. We worked with Customer Advocates, Stakeholders, and Subject Matter Expert’s (SME’s) to comb through all of the current claims data, and then card sort them into new categories which made more sense. Re-organizing the content also led to another major design improvement; adding tabs. A tabbed approach makes it easier for our advocates to find the information they need by reducing the amount of potentially irrelevant information they need to scroll through.

Example of Reorganizing Fields

Creating Initial Wireframes


Once we organized all of the fields into the proper categories, we could start creating some initial designs for the claims page, using everything we’ve learned so far.

Goals for the Redesign:

  • Eliminate Excessive Whitespace & Scrolling

  • Introduce New Functionality to Make Finding Information Easier

  • Reorganize the content and add new fields

Initial Mockup Examples

New Page Layouts - Vertical

We changed the layout to be vertical instead of horizontal; while this makes the pages longer, it made it easier for our advocates to find what they needed and communicate more effectively with our members while on the phone. We also eliminated significant whitespace between fields.

New Features - Predictive Search Bar

We heard a lot of feedback from our contextual inquiry sessions that finding information was difficult, especially for newer advocates. To help alleviate that pain point, we added a search bar with predictive text to make finding the right information much easier

New Design Pattern for Expandable Tables

We completely revamped out design patterns for expandable tables; by re-organizing the content into a three column system and adding headings, we made the information easier to read and easier to locate for our advocates

Feedback and Final Design Updates


Once our initial designs were created, we needed to get feedback from both our stakeholders and users. We sent the wireframes to a variety of Customer Advocate Supervisors (CAS) and held demo sessions with stakeholders to go over the new designs in-depth and solicit feedback. Based on their feedback, we made a variety of changes to the wireframes.

Prototype Changes Based on Feedback

Refined Layout to Call Out Specific Information

We received several comments regarding the large amount of un-used space within each card; additionally, our Customer Advocates asked for Dates to be made more prominent on the page. To alleviate these, we changed to a three column layout which helped alleviate the extra space, while calling out dates more effectively

New Feature - Checking Medical Bits

Our customer advocates often need to look up medical information for specific procedures; this process used to be tedious and time consuming; but we streamlined the process to include this information on a members claim

Claim Redesign Reflections


This entire re-design took about 2 weeks from start to finish, which was a lot to get done. Engaging the stakeholders was particularly challenging because we had over 50 of them on each call; so it required a lot of probing and warming up in order to get folks to actually talk and make suggestions/decisions.

Our customer advocates were also very helpful during this entire process; I met with several of them regularly to show off updated design work, and they provided a lot of great feedback and critique. There are some additional flourishes I’d like to include into these designs in the future when we have additional budget, such as helpful information text to explain difficult to understand fields to advocates