Bajaj Finserv Health, a top health services provider in India, supports clients like Nvidia, LinkedIn, and Credit Suisse, processing over 1,00,000 claims monthly. Its offerings include health insurance, telemedicine, and wellness programs.
Doctor Consultation
Claim
Doctor Consultation Details
Doctor Details
Clinic Details
Invoice Details
Doctor Consultation Details
Invoice Number
Invoice amount
Lab Visit
Claim
Labs Visit Details
Lab Details
Invoice Details
Uplaods Documents
Prescription
Lab Reports
Lab Invoice
Pharmacy
Claim
Pharmacy Details
Pharmacy Details
Invoice Details
Uploads Documents
Prescription
Pharmacy Invoice
Takes too long
Low success rate
No error checks
Missing documents
Feels repetitive
No real guidance
Too many steps
Hard to understand
CLAIM TIMELINE
USER VALIDATION
Confirming the issues
I interviewed 30 users representing key personas, senior management, corporate customers, and senior citizens, who navigated our product's claims process. Their feedback revealed unexpected challenges, which we categorised to guide our product improvements.
Scroll
Issues with claim filling journey
Issues with uploading documents
Claim Deficiency
Business Problems
INSIGHTS
Extensive research revealed key problems, which I grouped into four categories to guide strategic solutions. All findings focus on the consumer journey only; no agent workflows were studied or redesigned.
Hover over cards to see details
The claims journey revamp focused on improving efficiency, ensuring 'first-time right' resolutions, and boosting user satisfaction while reducing support load.
Increase accuracy and efficiency
Increase first time right metrics rates
Increase satisfaction rates
🛠️ Enhancing claim processing efficiency
Focus on reducing customer support needs.
Aim to increase the first-time successful claim rate.
Implement a guided journey to reduce deficiency rates.
Automate processes to reduce manual data entry for agents.
Decrease agent cost per claim processing.
🤝 Improving user experience
Provide instant help and support for quick issue resolution.
Ensure the journey involves minimal user effort.
Offer the easiest solution for reimbursements.
Make the end-to-end journey more efficient and effective.
Prioritise getting reimbursements to users promptly.
Our Road to 5x vision focuses on creating an intuitive, automated user journey that maximises efficiency and exceeds expectations through smart workflows and predictive tools.
FROM INSIGHTS
Addressing each of the four major challenges separately was the most effective approach, allowing me to concentrate on each issue individually and find tailored solutions. This method enabled me to achieve the best possible outcomes for each problem.
Hover over cards to see details
Conceptualization
We reimagined the claim journey to prioritise clarity, speed, and success. Using whiteboard flows and user patterns, we redesigned around real bottlenecks, balancing user ease with backend feasibility, while keeping the system scalable and intuitive.
Concept 1 - Reimburse AI
Rejected - Most seamless UX, but required full backend transformation.
Users just had to upload all their documents once, the system handled the rest. It matched files, filled details, and prepared the claim automatically, making the process almost effortless. But needed major backend changes to support it.
Concept 2 - Flexiclaim
Feasible, but UX not optimal
Users could upload documents at their own pace during the illness, and submit the claim for approval once everything was ready.
It offered flexibility, but ended up making the process too long and scattered.
Concept 3 - Conversational AI
Rejected - Didn’t build trust for this use case
The entire claim process was designed as a guided conversation, helping users step-by-step, but users didn’t trust a chatbot interface.
Concept 4 - Guided claims flow
Chosen – Scalable, user-first, dev-light
Users were guided step-by-step based on their illness, helping them upload the right documents without confusion or rework.
This approach struck the right balance, easy for users, low on tech effort, and scalable across different claim types.
Other enhancements - Smart entry points
To ensure users never feel lost, we introduced smart entry points and support touchpoints across the journey, helping them discover the claim feature naturally and get guidance whenever needed.
What we detected |
|---|
What users saw |
|---|
Patient name missing |
|---|
Prompt to upload a valid document with name |
|---|
|
|---|
Alert to check for doctor’s sign and stamp |
|---|
|
|---|
Message to upload complete prescription |
|---|
No cost breakup in invoice |
|---|
Prompt to upload an itemised bill |
|---|
Same document uploaded twice |
|---|
Alert to remove duplicate and upload a new file |
|---|
Wrong document type uploaded |
|---|
Wrong document type uploaded |
|---|
What we extracted |
|---|
How it helped |
|---|
Patient name |
|---|
Auto-filled claim form fields |
|---|
|
|---|
Pre-filled timeline for faster completion |
|---|
|
|---|
Reduced manual input and errors |
|---|
Doctor’s name & registration no. |
|---|
Used to verify prescription validity |
|---|
Bill amount |
|---|
Pre-filled expense summary section |
|---|
Document issue date |
|---|
Checked for outdated or invalid documents |
|---|
The Final Journey – Scalable, Guided, and User-Centric
View PDF
This journey view shows the final validated concept that streamlined claim submission end-to-end — from intent to payout. It reflects real user pain points, product constraints, and thoughtful orchestration across multiple modules, while keeping the agent system untouched.
Scroll
The ideation process was the most challenging part to navigate. With complex flows like document management, OCR, and error handling, I went through multiple iterations, learned from failures, and kept refining until the experience felt right.
Had a 'FINALLLLLLLLLLLLLL' moment 🤪
Choose who’s filing the claim
Let users select the member from their policy and get a quick view of eligible coverage. This step sets the foundation for a personalised, plan-aware claim journey.
1/7
Enter your treatment
Search for the illness or treatment name to continue. Smart suggestions reduce effort and help avoid duplicate or incorrect claims.
2/7
Add your bill amount
Select which benefits you’re claiming and enter the invoice amount. The available balance is shown upfront to avoid surprises. The header shows a persistent summary, treatment name, patient name, and navigation help, keeping users oriented throughout the process.
Only relevant benefits are shown to reduce clutter and guide users toward valid selections.
3/7
Upload your documents
Users are shown exactly what documents are needed for each selected benefit. Mandatory files are clearly marked to avoid confusion. The system checks for common issues—like missing amounts or blurry prescriptions and guides users to fix them before moving ahead.
Each document shows its current status, whether it's uploading, complete, or needs attention, so users always know what’s happening. The top summary keeps key details visible at all times, who the claim is for, illness, and total amount—so users never lose context.
4/7
Guided error handling
If a user tries to continue without uploading all required documents, a clear and focused prompt stops them. The popup highlights exactly what’s missing, so users can act quickly without guessing. This reduces drop-offs and ensures smoother, more accurate submissions.
Understand and fix document issues
When users open a folder, they can see all uploaded files and instantly spot any problems—whether it's upload failure or missing details. The system checks every document against key criteria. If something’s missing—like a patient name or doctor's stamp—it flags the issue.
Tapping on a flagged file opens a zoomed-in view with clear highlights and tips on how to fix the problem, reducing guesswork and delays. This helps users feel in control, even when things go wrong.
5/7
Verify extracted claim details
The system pulls key information like doctor’s name, date, and bill number from the uploaded documents.
Users can quickly verify or edit details directly with the help of side-by-side previews. This reduces manual entry while ensuring claims are complete and accurate.
6/7
Submit and stay informed
Users see a full claim summary before submitting, including document count, payment method, and total amount. Once submitted, a confirmation screen reassures them their claim is in process and offers a clear next step.
7/7
DIFFERENCE MAKER
File multiple claims with ease
You can now submit multiple claims under a single event without the hassle of duplicate document uploads.
For example, if you were treated for dengue and had multiple doctor visits, lab tests, and medications, all of these can be filed under the same event.
Plus, you can reuse previously uploaded documents if needed no need to upload the same prescription
or report again.
Doctor Consultation
Claim
Doctor Consultation Details
Doctor Details
Clinic Details
Invoice Details
Doctor Consultation Details
Invoice Number
Invoice amount
Lab Visit
Claim
Labs Visit Details
Lab Details
Invoice Details
Uplaods Documents
Prescription
Lab Reports
Lab Invoice
Pharmacy
Claim
Pharmacy Details
Pharmacy Details
Invoice Details
Uploads Documents
Prescription
Pharmacy Invoice
The impact of our redesign
40% fewer errors. 64% more completions. 0 changes to the backend.
What We Changed |
|---|
Why We Did It |
|---|
Smart Checklist |
|---|
Cut deficiency by 40% by guiding users up front |
|---|
|
|---|
Pre-filled timeline for faster completion |
|---|
|
|---|
Stopped bad submissions early → 88% first-time-right (FTR) success |
|---|
Human-Readable Status |
|---|
Dropped 22,000+ queries by replacing claim codes with simple status messages |
|---|
Document Reuse |
|---|
Solved repeat claims under same illness → reduced friction |
|---|
Guided > AI Flow |
|---|
Faster adoption, simpler onboarding, scalable without backend overhauls |
|---|
This project taught me that even small, thoughtful shifts, when rooted in the right insights, can flip critical journeys without changing a single line of backend code.
