Claim Submission Journey

BLUE CROSS BLUE SHIELDS MASSACHUSETTES is a state-licensed nonprofit private health insurance company under the Blue Cross Blue Shield Association with over 2.5 million policyholders.

The insurance company wants to understand where and what customers are having the most difficulty. Members need help submitting their claims; the company provides few details when denying their claims or helps them understand the details of their bills. The contact center is overwhelmed with calls, and Blue Cross would like to reduce these calls, enable a self-service site and improve customer experience.

  • Industry: Insurance
  • Website: www.bcbsma.com
  • Role: Sr Customer Experience Lead

Approach

  • Collect analytics and industry stats and gather stakeholder knowledge and goals.
  • Set up a design thinking workshop with the contact center.
  • Plan out the customer’s typical journey and document where the key complaints and pain points are.
  • Expose the channels and systems that may be contributing to the pain.
  • Recommend solutions.

Results

  • Departments working in silos are collaborating better.
  • Customer Experience focuses on journey mappings.
  • Little integration with Enterprise Technology.
  • The company better understands how to focus its efforts for maximum results.

Target Audience

Members Task Flow

Stages

Current Journey

Understand Claims – Customers’ Needs and Pains from Stage 3

“I want to understand my claims better, like how they were processed and how benefits were applied.”

“I want to be able to view/download my EOB/SHPP for more details or to share with third parties. “

“I want to understand why I owe what I owe.”

“I want to see how my claim aligns with my benefit information to understand how the claim was processed and how benefits were applied. “