Client
Top National Bank*
Services
Research & Strategy
Wireframing
Year
Winter 2025
Role
Lead Designer
The Project
A Top National bank* engaged our Human Centered Design (HCD) team to develop a strategic vision and roadmap for its Healthcare Payer Enrollment Process.
*This project is protected by a Non-Disclosure Agreement (NDA)
Executive Summary
Executive Summary
To lay the foundation for a more efficient and risk-mitigated Payer Enrollment process, our team recommended utilizing PEGA to bring the end-to-end process in-house, eliminating reliance on a third-party vendor and increasing overall operational efficiency.
The Objective
The engagement aimed to reduce reliance on a third-party vendor, improve customer experience, and boost operational efficiency using existing platforms. The phased approach began with vendor replacement, then advanced to automating and scaling enrollment processes, streamlining workflows, and increasing flexibility. Early phases strengthened internal capabilities while minimizing customer impact by leveraging current tools. Later phases will introduce a self-service model to fully transform the experience for both customers and internal teams.
Current State Assessment
Current State Assessment
Our team employed HCD methodologies to understand the current state of the Payer Enrollment process. Applying a “human-centered design” framework, we analyzed our research findings to identify areas of impact, pain points, and opportunities.
The Approach
Through a series of discovery sessions, group interviews, and review workshops with subject matter experts, we identified key pain points, areas for improvement, and opportunities for transformation. We examined how various upstream processes influenced downstream workflows and mapped the entire enrollment journey from the perspectives of the Enrollers, Payer Relations team, and Project Managers.
To fully understand the current state, we utilized a mixed-method research approach to gain both qualitative and quantitative data. Our team explored user pain points and areas of impact by the third party vendor. Data backed findings were gathered to develop insights and informed recommendations for a phased approach. This allowed us to prioritize researched opportunities for changes in business, technology, and culture.
Transformative Vision
Transformative Vision
The proposed solution follows a phased approach to transition from the current state to the ideal future state. Phase 1 (MVP1) focuses on replacing the existing third-party vendor, establishing the foundational framework for the transition. Subsequent phases aim to fully realize the vision, incorporating automation and customization at scale to optimize efficiency, enhance flexibility, and streamline the enrollment process.
The Solution
PEGA case management was selected to streamline operations, integrate systems, and reduce reliance on external tools. The platform consolidates workflows, automates data handling, and minimizes manual work, improving efficiency and accuracy. Automated imports of provider data and payer documents accelerate enrollments, while centralized, role-based task management ensures proper access and workflow automation.
Document management integrates with the bank’s in-house storage, reducing external dependencies and improving control over enrollment packets. Real-time reporting delivers role-specific insights for better decision-making. The final deliverable outlined a roadmap for future optimizations, securing stakeholder buy-in and setting the stage for improvements in customer and employee satisfaction.
Projected Outcomes
The implementation of PEGA case management is expected to drive significant operational improvements and efficiencies:
Streamlined workflows automate previously manual tasks, reducing touchpoints and improving task completion times.
Consolidated systems eliminate reliance on multiple external platforms, simplifying data management.
Automated enrollment processes and document integration increase accuracy and speed while reducing errors.
Role-based access and task management enhance security and compliance.
Real-time reporting and dashboards improve data visibility and decision-making.
Wireframes
Wireframes
In addition to a detailed recommendations based on our findings and business needs, our team built PEGA concept screens that were sent to the the development team
