Improving the Prior Authorization Experience in Insurance
Aligning cross-functional stakeholders to reduce friction across a complex authorization ecosystem
Area
Health Insurance Operations
Scope
Member, Provider, and Internal Workflows
Duration
Multi-month strategic engagement
Role
Experience & Transformation Strategy
Collaboration
Business, Product, Operations, and Technology Partners
Details have been generalized to protect confidential information.
Problem
Authorization creates friction across member, provider, and operational workflows due to fragmentation and limited transparency.
Contribution
Clarified structural drivers of friction and facilitated cross-functional alignment to prioritize high-value improvements grounded in user and business impact.
Impact
Defined a portfolio of high-impact improvements and strengthened alignment between experience strategy and operational performance.
Business Context
Authorization processes represent a high-friction intersection of member experience, provider workflow, and internal operations. Variability across channels, handoffs, and decision visibility creates dissatisfaction and operational strain.
The opportunity was to clarify the full ecosystem and identify improvements that balanced experience quality, operational feasibility, and business priorities.
System Complexity
The experience spanned:
Multiple stakeholder groups (members, providers, internal teams)
Cross-channel submission pathways
Interdependent operational workflows
Internal and vendor-managed processes
Fragmentation across these layers contributed to recurring breakdowns.
Strategic Problem Framing
Rather than addressing isolated touchpoints, I focused on identifying structural drivers of friction. Through structured discovery and cross-functional working sessions, I modeled the end-to-end experience using journey mapping, stakeholder ecosystem mapping, and representative personas to clarify interdependencies across member, provider, and operational workflows.
This work surfaced:
Where workflow inconsistency introduced delays
Where transparency gaps created dissatisfaction
Where data accessibility constraints slowed review and decision-making
Root cause analysis reframed the challenge from symptom mitigation to systemic improvement, shifting the focus from reactive fixes to coordinated structural change.
My Role
I partnered with business, product, and operations stakeholders to:
Align teams on a shared view of the current state
Facilitate root cause analysis across functions
Translate opportunity areas into prioritized solution directions
Evaluate improvements through a dual lens of user value and business value
Outcomes
The initiative resulted in:
Prioritized portfolio of high-impact improvements grounded in user and operational value
Cross-functional alignment around objectives focused on workflow efficiency, turnaround time, transparency, and data accessibility
Clear direction for near-term execution and longer-term transformation
Long-Term Enablement
Beyond immediate prioritization, this work:
Established a shared system-level understanding across stakeholders
Strengthened alignment between experience improvements and operational performance
Positioned authorization as a transformation opportunity rather than a discrete process fix
Additional details can be discussed in conversation using anonymized examples.