A unified claims orchestration portal and design system for HR teams and TPAs, automating employee census onboarding and cashless hospital pre-authorizations.
Enterprise group health insurance management is notoriously fragmented. HR operations teams juggle disparate Third-Party Administrator (TPA) portals, disconnected employee census spreadsheets, and opaque cashless hospital authorization queues.
Manual census updates cause catastrophic delays: hospital pre-authorizations are rejected because employee activation data was stuck in CSV limbo during a medical emergency.
Legacy insurance portals suffer from brutal cognitive overload: dense unorganized tables, zero bulk action capabilities, and zero audit trails for disputed claims.
Designed a keyboard-friendly employee management table supporting instant multi-select, bulk activate/deactivate, and dry-run CSV validation that highlights syntax errors and schema mismatches before changes are committed.
Tradeoff: Prioritized information density over whitespace to ensure operations teams can audit 50 rows per viewport without horizontal scrolling.
Replaced cryptic tabular status codes with a visual stage-by-stage pipeline for cashless and reimbursement claims, tracking TPA reviews, queries, and MedPay settlements in real time.
Tradeoff: Dedicates vertical screen space to the pipeline, but drastically reduces customer support tickets and status confusion.
The redesigned claims portal eliminated CSV reconciliation backlog and provided enterprise benefits managers with live visibility into hospital authorizations.
"I would establish an automated bi-directional API sync with common enterprise HRMS tools (Darwinbox, Zoho People) earlier in the design phase to remove manual CSV uploads entirely."