The Moment of Truth: Building Customer Confidence in Health Claims

Building a health insurance claims experience using human-centred design and psychology principles

Starting with the customer at the heart

When our client engaged Axell to help reimagine a claims experience for their health insurance customers, we knew it must begin with research. Unlike home and car insurance, health insurance protects people and touches lives in a deeply personal way. Health insurance claims can be a moment of truth for the insurer to live up to their customer value proposition. It can also be a highly emotional time for customers facing financial outlay while recovering from an illness or injury.

The claims experience is a pivotal point in the customer journey where there’s a real risk of a bad experience causing serious harm to the relationship. On the other hand, it’s an opportunity to build a long-term relationship on a foundation of trust between the customer and insurer when the experience goes well. It was this opportunity that we began our research to see how our client can build trust and confidence with customers, while empowering them through the experience.

Listening to customer's voice

Call centre listening and 10 in-depth, qualitative customer interviews revealed pain points and roadblocks in the current process as well as motivations and drivers at claim time. We found that customers’ highly emotional state at claim time heightens their expectations and puts pressure on the insurer to deliver. The psychology of this emotionally-motivated state can cause people to perceive reality differently, react inconsistently, and affect decision making. Also, it can mean customers’ overlook details in the health claims process that can impact their experience. The strength of emotional drivers also changed throughout the process, which was an important insight to be able to meet the customers’ needs at every stage.

Building bridges instead of walls

So, we set out to design a process that addressed the customer needs throughout the health insurance claim journey while being sensitive to their emotional needs. For example, the research revealed when customers join a fund they need confidence in the insurer’s ability, while at claims they wanted a mutual relationship and responsibility in managing the process themselves.

Once we mapped out the current-state customer journey we could see not only their needs, but the complexity in the relationship between the customer and insurer. The map highlighted the touchpoints at each stage of the process with the communications channels used throughout the claim. By deeply understanding the customer, drivers, and pain points in the process, we could start to visualise a future state that was tailored to them.

Teach me how to fish

Empowerment – customers want the ability to self-manage their claim. This was a surprising learning from the research as the assumption had always been that customers want the claim handled entirely by the insurer. In practice, at many points in the process, the customer needs an experience of partnership – not being a passive bystander. They wanted recognition of the different responsibilities they and the insurer had in managing the claim.

To summarise, the research revealed 5 leading values that are important to the customer in building a strong foundation of trust:

Diving deeper to the core

The internal research we conducted into the insurer’s processes showed the limitations in the process that were resulting in a sub-optimal experience. These insights included:

  • Lack of transparency – customers calling to understand what their policy and covers and status of claim.
  • Information asymmetry – customers depend on the insurer to keep them updated on the claim’s status.
  • Manual process – claims were being managed offline which were complicated for team members to file.
  • Operational inefficiency – claims teams were managing hundreds of emails and multiple systems that caused delays in the process.

The result was contributing to customers feeling uncertain from lacking control in the process, which fostered mistrust.

Turns ideas into reality

Looking ahead, we’re embarking on the future-state journey design alongside our client where a new claims experience can satisfy customer and employee needs while delivering on business objectives. We’ve started to design a digital claims experience prototype to again test with real customers to ensure it meets their needs. Part two will share the next chapter in the journey with our client.

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