Tibco Cloud Configuration
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BMI - Claims Auditing
Overview
BMI provide insurance claims auditing service for organizations. Their clients are large scale organizations across US amounting to 500,000+ claims being audited annually by BMI's auditors.
BMI wants to pivot their business by rebuilding as a SaaS auditing platform while retaining a white glove experience for their clients. Over the course of our engagement I designed an ecosystem of 3 interconnected products for different phases of claim auditing. Here I will showcase few solutions we built.
BMI wants to pivot their business by rebuilding as a SaaS auditing platform while retaining a white glove experience for their clients. Over the course of our engagement I designed an ecosystem of 3 interconnected products for different phases of claim auditing. Here I will showcase few solutions we built.
My Role
I owned the end-to-end design of the platform along with building it's supporting design system.
I also created product prototypes and defined success metrics for the validation tests.
I also created product prototypes and defined success metrics for the validation tests.
Duration
August 2021 - May 2022
(10 months)
(10 months)
Team
1 Product Designer (Me)
1 Product Manager
BMI
Director of Product
Lead Backend Developer
Frontend Developer
2 Internal Claim Auditors
1 Product Manager
BMI
Director of Product
Lead Backend Developer
Frontend Developer
2 Internal Claim Auditors
Tools
Figma
Whimsical
Dovetail
Whimsical
Dovetail
The Users
Internal Auditors & Clients
With the new SaaS model, BMI's internal single persona of auditor was discussed and expanded to a cohort of user personas on their team and client's side.
![Conversation scheduling with the most complex configuration possible](https://uploads-ssl.webflow.com/5c95a7e8bf3e254ba25a720d/629fb6efe433cc754a8bd1c8_BMI%20Users.png)
THE CHALLENGE
Multiple touchpoints, Single software
BMI created an internal tool used by their auditors, but the audit flow was fragmented with different users using different tools, causing redundant communication and important information being lost.
Difficult to filter & audit claims
Auditors complained that filtering to find suspicious cliams was tedious and often repetitive. Once found, all claim information was in long horizontal tables.
Lacking information about insurance members
Auditors wanted to see the context around a member to better understand their claim history to decide if one of their claims can be reported.
THE SOLUTION
Multi-user product ecosystem
We designed a Monitoring and Audit tool to better cater to the user's needs. These tools remove the need to other apps by incorporating vital features like building & collaborating on reports and sharing progress. It also allows BMI to market effectively to different segments of the domain in coming years.
Shareable filtered views
Auditors can now save their filter and search criteria into a 'Saved View'. This View can also be shared with other auditors working on different clients.
Insurance member details in context of the whole audit
Auditors and Third Party Auditors can now view member details. They can also look at their claims across different categories and use the 'Saved Views' feature to efficiently find claims.
Design System built for the product ecosystem
BMI is set up for success with a consistent and scalable design system, which includes common interaction patterns, design tokens and tone guidelines.
TESTING RESULTS
Internal validation tests showed approval by 6/6 participants
As BMI is gearing up to make this product a reality, we conducted validation tests with 4 internal auditors and 2 valued clients. They recommended feature tweaks and overall approve of the direction chosen for these product.
Due to restrictions I cant share design artefacts on the website. But, I would like to show them to you in person.
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BMI Audit
Defined product ecosystem and built product designs for an enterprise insurance audit service company.
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