Untangling insurance claims adjustments for Cigna members
As Senior Product Designer, I partnered with Product, Engineering, and Data teams at Cigna to redesign a fragmented claims adjustment experience into a centralized system that helped analysts confidently validate member balances and resolve discrepancies faster.
Company
Cigna
American Health-Insurance Company
My Role
Senior Product Designer
Duration
8 Weeks
The Problem
Cigna’s claims adjustment process depended on multiple fragmented backend systems that did not provide a consistent or trustworthy view of member balances, making it difficult for claims analysts to confidently determine what was owed and resolve adjustments accurately.
In practice, this meant the experience functioned more like a collection of disconnected data sources and manual reconciliation steps than a cohesive decision-making system—leading to slow resolution times, inconsistent outcomes across teams, increased rework, and reduced confidence in both analyst decisions and member billing accuracy.
How I Contributed
As Senior Product Designer, I worked across the full product lifecycle to improve Cigna’s claims adjustment experience, partnering closely with cross-functional teams to shape both the strategy and execution of the solution.
- Led discovery across fragmented claims workflows and systems
- Synthesized findings into key experience gaps and strategy
- Defined end-to-end experience strategy and core user flows
- Designed wireframes, interactions, and high-fidelity workflows
- Partnered with Product, Engineering, and Data through delivery and iteration
Who I worked With
Product
1 Product Manager
Software Development
10+ Engineers
Data Science
5+ Engineers
My Approach
Cross Functional Discovery
Facilitated alignment sessions with Product, Engineering, Data, and Operations to understand current workflows and system constraints.
User interviews
Conducted interviews with claims analysts across teams to understand real-world workflows, pain points, and decision-making challenges.
Workflow Mapping
Mapped end-to-end claims adjustment processes across teams to surface fragmentation, and inconsistencies.
System Audit
Reviewed existing claims platforms and data sources to understand gaps, overlaps, and lack of consistency across systems.
This work established a clear understanding of how claims data and decision-making were currently distributed across Cigna’s systems, where fragmentation was impacting accuracy and efficiency, and what opportunities existed to consolidate information into a more unified workflow. It also surfaced key needs from analysts around clarity, confidence, and speed in resolving claims, alongside how similar enterprise systems structure complex, high-stakes decision environments.
This foundation enabled us to move into the design phase with a clear direction for simplifying workflows and establishing a more cohesive claims adjustment experience.
What we learned
As we moved through research and concept testing, a few clear patterns emerged. These insights directly informed the direction of the experience.
Analysts often had to reconcile conflicting information before taking action
A significant part of the workflow was spent validating discrepancies between systems rather than actually resolving claims.
There was no consistent reference point for “correct” member balance
Information varied across tools, requiring analysts to manually determine which data was accurate in context.
Decision-making was slowed by verification, not complexity
The challenge wasn’t understanding what to do, but establishing trust in the underlying data before making adjustments.
Small data mismatches created outsized operational impact
Even minor inconsistencies between systems led to rework, delays, and repeated claim reviews.
Analysts needed certainty before speed
The most critical need was not faster workflows, but a reliable foundation that reduced ambiguity in financial decisions.
Turning Insights into Solutions
Each solution was designed to address key user needs and translate findings into more intentional product decisions.
Insights → Innovation
There was no clear reference point for accurate member balances
Designed a centralized view that established a more reliable, consolidated source of truth
We aligned key data points into a single experience so analysts could make decisions with greater confidence without cross-checking multiple systems.
Insights → Innovation
Analysts spent significant time resolving conflicting information before taking action
Introduced a discrepancy-focused workflow that surfaced conflicts early and guided resolution
Instead of requiring analysts to hunt for inconsistencies across systems, we brought discrepancies to the forefront and structured the experience around resolving them efficiently.
Insights → Innovation
Verification slowed down otherwise straightforward decisions
Streamlined workflows to reduce unnecessary steps and highlight only what was relevant
By removing redundant actions and focusing attention on critical information, we helped analysts move more quickly once confidence in the data was established.
Insights → Innovation
Analysts needed confidence to act, not just access to information
Designed for clarity and prioritization to support faster, more assured decision-making
The experience emphasized what mattered most in each moment, helping analysts quickly understand situations and take appropriate action without second-guessing.
Insights → Innovation
Inconsistent data led to inconsistent outcomes across teams
Standardized how information was structured and presented across workflows
We created a more uniform experience that reduced variability in how claims were interpreted and resolved, improving consistency at scale.
The Impact
While this work was delivered within complex system constraints and cross-team dependencies, it helped establish a more unified and reliable claims adjustment experience that better supported accurate and efficient decision-making. It also created a shared foundation for how claims data could be structured and interpreted more consistently across teams.
Impact & Adoption
Adopted across claims adjustment teams, supporting more consistent workflows and improving confidence in claim resolution.
Operational Efficiency
Reduced average adjustment time by 20% (from ~12 minutes to 9–10 minutes), enabling faster resolution and improved throughput.
Accuracy & Rework Reduction
Decreased rework by 25% and increased single-touch resolution rates from 60% to 80–85%, improving first-pass accuracy and reducing repeat handling.
Consistency & Scale
Standardized how claims information was surfaced and interpreted, leading to more consistent outcomes across teams and reduced variability in decision-making.