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How Human-Centered Design Helps Adjusters Work Smarter, Not Harder

Portals designed with the user in mind can help claims professionals focus their time, attention and expertise on the cases that need it most, producing better outcomes for every stakeholder.
By: | July 19, 2021

Burnout is a top driver of turnover among workers’ comp claims adjusters, and it’s not just due to heavy caseloads. The volume of data to track keeps growing. While the wealth of information is meant to drive better decision making, it can have just the opposite effect when adjusters spend more time collecting and organizing data than analyzing and applying it.

“Adjusters are responsible for all areas of how a claim ultimately resolves. They have to keep track of the treatment plan, the medical expenses, the potential indemnity payments. They’re managing communication from multiple stakeholders. All while caseloads continue to grow,” said Jerry Kulig, Vice President Portfolio Leader, Casualty Claims Solutions at Conduent.

“Part of the problem is that not all of the information is useful. Some of it is actionable; some of it’s not. Adjusters need a way to handle information more efficiently — to cut through the noise and capture the data that matters.”

In many cases, that task is complicated by outdated legacy systems ill-equipped for fast, data-driven decision making,

“Many older systems have not been updated to use more contemporary design styles, techniques and tools that we’ve become accustomed to in other aspects of day-to-day life,” said Gail Koza, Director Business Product Management, Casualty Claims Solutions, Conduent.

The answer may lie in human-centered design.

Platforms and portals built on the tenets of this problem-solving framework can help adjusters capture and prioritize actionable data, leading to more effective claim management with positive outcomes for injured workers, workers’ comp payors and adjusters alike.

What Is Human-Centered Design?

Jerry Kulig, Vice President Portfolio Leader, Casualty Claims Solutions, Conduent

Simply put, human-centered design is exactly what it sounds like — a methodology for finding practical and applicable solutions for problems experienced by real people.

“The ‘human’ part of human-centered design is key. Without considering the people who are supposed to benefit from the solution, there’s a tendency to approach things from a systems perspective. You can end up developing a process that’s very efficient for the system but a pain point for the people using it,” Koza said.

Everyday examples include payment apps like Venmo. As people began carrying less cash and relying more on cards, splitting the bill at restaurants or paying back a friend became just a little more challenging and inconvenient.

App developers found a way to make the process simple and straightforward, without requiring people, banks or commercial establishments to change their habits or behaviors. It was a solution that made life easier for everyone.

Three Phases of Human-Centered Design

Gail Koza, Director Business Product Management, Casualty Claims Solutions, Conduent

The human-centered design process is well-suited to adjusters’ efficiency and productivity challenges. It is executed in three phases, with the end goal of creating a tool that helps adjusters manage their time more effectively.

Phase 1: Inspiration

“The human-centered design approach is based on developing empathy for your customers. You have to really understand them, their needs, their motivators, their process and their pain points,” Koza said.

“Only with that understanding can you build solutions users will actually embrace.”

This first phase, then, is all about getting to know the modern-day adjuster. This means discovering how expectations, priorities and business processes have changed for claims professionals with the advent of new technologies and the explosion of data.

“We conduct shadowing sessions, where we spend hours observing and talking with claims adjusters as they do their work in order to better understand how they organize their day, where they run into problems in their process flow, and how they overcome those challenges,” Koza said.

User focus groups and customer service inquiry data also present valuable opportunities to learn what’s most important to users and gather feedback on solution prototypes.

Phase 2: Ideation

The next phase involves taking all the information gathered in the inspiration phase and applying it.

Unlike other design methodologies, the target audience plays a central role in the creation and testing of potential solutions. By making user feedback the barometer of success, designers can create products specifically targeting their pain points.

“In the ideation phase, you build prototypes and take those prototypes back to your end users for feedback, then iterate based on that feedback. It could start with something as simple as a black-and-white wire frame model of a web app or PowerPoint slides that walk through the process,” Koza said.

“It avoids the problem of making assumptions about what people want, developing a product and delivering it only to learn that it wasn’t what they wanted to begin with,” Kulig added.

The ideation phase could take weeks or months, depending on the complexity of the problems being solved and the amount of time invested in the inspiration phase.

But it engineers out the wasted step of creating products that ultimately miss the mark, saving time, energy and money in the long run.

Phase 3: Implementation

“After you have gone through the prototyping, testing and feedback cycle sufficiently to get to the point where you have a highly usable, valuable product, you’re ready to start delivering it to a wider audience,” Koza said.

The implementation phase involves creating a marketing strategy that effectively communicates the advantages of a solution beyond the test group. Because no matter how a solution may improve an adjuster’s workflow, it is still a change — a disruption to their normal day-to-day that will take time to learn and adjust to.

“Historically, we’ve used traditional methods of communication including release notes, online help text and live demos, but it is a collaborative process with our customer contacts to figure out which approach will be most beneficial to them to help their audience understand the new capabilities,” Koza said.

Applying Human-Centered Design to Meet Adjusters’ Needs

Conduent applied human-centered design to the development of its new claims adjuster portal, Shield.

“In our industry, everyone has a desire to optimize productivity without sacrificing quality. Our goal with Shield was to help adjusters spend more time and energy on complicated cases — making the decisions that require experience and expertise — by streamlining or automating simpler tasks,” Kulig said.

That means leveraging data analytics to identify claims at risk for suboptimal outcomes using preset parameters such as medical expense thresholds, pharmacy involvement or presence of comorbid conditions. This helps adjusters prioritize cases demanding closer attention.

Shield’s dashboard-style design also collects all pertinent data in one place, so adjusters have the information they need to make timely and impactful decisions right at their fingertips. That includes nurse triage and injury reports, medical bill status, utilization reviews and other clinical data. It also prompts specific actions by generating alerts and notification of case updates.

“What really sets the portal apart, though, is that it is highly configurable. We have a very flexible administration module that allows our customers to tailor page contents and information access to specific users. Adjusters also have more control over how their pages are organized and can adapt their workflow to fit their unique process,” Koza said. “It’s very user-friendly, both at the individual and organizational levels.”

Future iterations could include advanced technologies like artificial intelligence and automation — which user focus groups will weigh in on.

“We’re spending time with customers, digging into their needs when it comes to smart systems and technology. We’re already in that iterative process of refining our ideas and soon will be working through prototyping and testing,” Kulig said.

“So far, though, users love how easy it is to use. Through human-centered design, we’re creating something that will make a difference in how claims professionals do their jobs, creating better outcomes for everyone in the insurance value chain.”

To learn more, visit https://www.conduent.com/workers-compensation-solutions/.



This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Conduent. The editorial staff of Risk & Insurance had no role in its preparation.

Conduent delivers mission-critical services and solutions on behalf of businesses and governments – creating exceptional outcomes for its clients and the millions of people who count on them. Through people, process and technology, Conduent solutions and services automate workflows, improve efficiencies, reduce costs and enable revenue growth. Conduent’s solutions deliver exceptional outcomes for its clients including $16 billion in savings from medical bill review for workers compensation claims.

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