Improving the Prior Authorization Experience in Insurance
Aligning cross-functional teams to reduce friction across a complex authorization ecosystem
Area
Health Insurance Operations
Scope
Member, Provider, and Internal Workflows
Duration
Multi-month engagement
Role
Service Designer
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
Mapped the end-to-end experience for members, providers, and internal teams, and facilitated cross-functional alignment that turned findings into prioritized improvements grounded in user and business impact.
Impact
Delivered 10 prioritized solutions for roadmapping from a shared, end-to-end view of the prior authorization experience, and reused the blueprints to lead a separate initiative in the PBM line of business.
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 ask was to understand the prior authorization experience end-to-end, from initiation through decision, to identify near-term improvements and shape a long-term future state, balancing 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.
Approach
Rather than addressing isolated touchpoints, I focused on identifying structural drivers of friction. I started with existing research and conducted 25 SME sessions, then modeled the end-to-end experience with a stakeholder ecosystem map, personas, and service blueprint to clarify interdependencies across member, provider, and operational workflows. This included mapping a multi-request member experience, an MRI through surgery, across vendor-managed and internally managed requests.
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 shifted the focus from reactive fixes to coordinated structural change.
From there, I led workshops and prioritization sessions with cross-functional teams to develop a future state journey map. We started with 75 ideas from “How might we” sessions, evaluated 24 on user value and business value, and prioritized 10 solutions for roadmapping.
My Role
I partnered with business, product, technology, and operations teams to:
Lead discovery and align teams on a shared view of the current state using personas and service blueprints
Facilitate root cause analysis and ideation workshops across functions
Turn opportunity areas into solutions and evaluate them on user value and business value
Support the handoff of prioritized solutions to teams for roadmapping
Outcomes
The initiative resulted in:
A future state vision and 10 prioritized solutions 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 improvements and longer-term transformation
Long-Term Enablement
Beyond immediate prioritization, this work:
Established a shared system-level understanding of the experience across stakeholders
Reused the blueprints to lead a separate PBM prior authorization initiative, mapping the entire member care journey and identifying shared pain points and in-flight capabilities
Additional details can be discussed in conversation using anonymized examples.