Delta Dental

The challenge

Claims processing required navigating 7 separate screens, cross-referencing data that was never visible simultaneously. Provider offices were abandoning the portal mid-process and calling the support line — 1,200+ calls per day. Member data existed in 4 separate databases with no single authoritative record, causing benefit information to contradict itself across touchpoints.

The solution

We designed a unified data model — a single canonical member/provider record that becomes the source of truth for every touchpoint. Claims workflows were redesigned as context-sensitive guided flows: the system detects the procedure code and pre-fills the relevant fields, surfaces the applicable benefit rules, and flags exceptions before submission rather than after. Cognitive context is preserved throughout — users never lose their place.

Our process

1. 01 Data Model Mapping

   Mapped all 4 member databases and 3 provider data sources. Identified 47 fields that conflicted across systems.

2. 02 Workflow Analysis

   Tracked 200 claims processing sessions via screen recording. Found 3 primary workflow breakpoints accounting for 80% of support calls.

3. 03 Context-Sensitive UX Design

   Designed adaptive form logic that responds to procedure codes — showing only relevant fields, pre-populating known data, and surfacing benefit limits proactively.

4. 04 Prototyping & Compliance Review

   Built interactive prototypes reviewed by HIPAA compliance, legal, and provider advisory panel over 3 rounds.

5. 05 Phased Launch

   Launched to pilot provider network of 800 offices. Collected structured feedback weekly for 8 weeks before full rollout.

Outcomes

• 84%Reduction in support call volume post-launch
• 7→2Screens to complete a claims submission
• 1 sourceSingle unified member data record
• 92%Provider portal satisfaction score

Technology

• Angular
• REST APIs
• SQL Server
• Azure