Improving the Prior Authorization Experience in Insurance
Aligning members, providers, and operations across a complex approval experience
Area
Health Insurance
Duration
2023 (5 months)
Role
UX Strategist
Collaboration
Partnered with a fellow designer
This case study focuses on internal experience strategy work and uses representative, reconstructed examples.
Problem
Prior authorization is one of the most challenging points in the health insurance experience. Lengthy and often confusing processes, limited transparency around decisions, and misalignment between member expectations and provider recommendations can create friction and increase reliance on support channels, contributing to lower member satisfaction.
UX Strategy Contributions
Stakeholder facilitation and cross-functional alignment
Experience modeling through representative stakeholder maps, personas, journeys, and service blueprints
Opportunity framing and prioritization
Impact
Identified high-value experience opportunities addressing key member and provider needs
Surfaced opportunities to improve operational processes and reduce friction
Informed prioritization across near- and long-term business roadmaps
Outcome: Improved member satisfaction and reduced insurance-related call volume
Approach
Current-State Alignment
Using discovery insights, I developed representative member and provider personas and journey maps to clarify who the experience needed to support. These experience models created a shared understanding of the end-to-end journey, surfaced opportunity areas and root causes, and informed early problem framing and prioritization.
Future-State Alignment
I defined a future-state journey to articulate the desired experience and explore potential near- and long-term improvement opportunities. This work helped teams reason about experience implications and consider direction over time.
Prioritization
I facilitated value-based discussions to assess opportunities from both user and business perspectives, resulting in a prioritized set of experience improvements that informed future planning.
A deeper walkthrough is available via conversation, using anonymized and reconstructed examples.