Centene Recovery Platform
Speeding up claim recovery at a Fortune 25
Leading a $40M initiative, enabling hospitals to more effectively communicate with insurance companies, challenge costs, and speed up claim processing.
- Strategy
- Facilitation
- Team Leadership
- Consultation
- Product Design
Impact
Two years in: claims processed 34% faster with 62% fewer errors
2 years later, the Centene Recovery Platform completed 149 business goals, 53 specific outcomes, and 182 hypotheses tested resulting in 31 published and tested iterations.
- Speed
- +34%Increase in claim processing speed
- Errors
- -62%Reduction in data errors
- Challenges
- -17%Reduction in reimbursement challenges
Leading a new team while writing the playbook
Our internal teams ran a decentralized team formation to product development. I worked as an embedded consultant, leading the design initiatives of multiple product teams simultaneously.
Building a foundation before anyone writes a line of code
Before the work could begin, the team needed a shared foundation. I introduced three frameworks to shape how we’d operate — Agile product design, Lean thinking, and a clear understanding of the end-to-end design process.
A Product Canvas workshop aligned the team on users, goals and problems
Every new product team starts with the same problem: team chaos. Where should we start? Who is doing what? What are we even building?
I facilitate a Product Canvas exercise as a method of gathering team alignment. This exercise allows the team to form a shared basis of understanding.
Moving forward, we can build momentum knowing we all agree on where we currently are and the fundamental problems we’re trying to solve.
The current process is costing us $38 million dollars annually.
Better quickly instead of perfect later
Fixing the insurance claim process could go many directions. Some of those directions are good, some not so good, and some completely unattainable. It’s more important to be better quickly than perfect later.
Focused effort
- Replacing Palantir
- Improving the current process
- Automating data flow
- Outdating the need for Excel
Parked, not abandoned
- Solving a larger healthcare problem
- Innovating the adjudication process
- Inventing a new claim adjustment flow
Increase claim validation speed, minimize errors, and simplify the recovery calculation process.
Dual-track Agile kept design one sprint ahead of development
To maximize momentum in an Agile framework, I introduced the team to Dual-Track Agile. This cadence enables the product team to know their involvement with the design process and when those involvements will occur.
This cadence cycles with each iteration, enabling the design momentum to stay ahead of development.
I further break down each sprint and introduce a design cadence. This enables the team to understand what is expected of them and when those expectations are required.
Turning Product Canvas findings into hypotheses, then ranking them by value and effort
With an Agile mindset and an objective of publishing quickly, the goal is to determine where we can provide the most value with the least amount of effort.
The Hypothesis Prioritization process from Lean UX builds team alignment while prioritizing momentum. We can use the data collected from our Product Canvas to quickly build hypotheses.
We will achieve
Increased claims processing speed
Hypotheses were presented to the greater team for prioritization. Product Owners can evaluate the value of each outcome while developers and analysts can evaluate the effort involved with building the feature.
Hypothesis Prioritization
Quick wins
High value · low effort
View an organized / grouped list of claims
through Claim Filtering
View claims organized by priority
through a timeliness indicator
Take action on a claim
through ‘Approve’, ‘Pend’, and ‘Deny’ actionables on every claim
View an organized / grouped list of claims
through Claim Sorting
View the edit history of a claim
through a ‘View history’ screen that displays historical data
Strategic bets
High value · high effort
Filter quickly
through applying multiple saved filters simultaneously
Measure denials
through specifying why a denial occurred via a dropdown of generic reasons
View specific and customized claim details
through customized dashboard layouts
Fill-ins
Low value · low effort
PI Analyst
Export a list of claims
through CSV exporting
Prioritize which claims to view
through applying multiple sorts simultaneously
Later
Low value · high effort
Find claims quickly
through error prevention via form validation
Healthplan Analyst
Communicate claim actionability to the PI team
through the ability to write comments on claims
See relevant claims quickly
through saving specific filter criteria
Compare claims to contra claims
through a comparison table that flags differing fields
Use subtractive filtering
through ‘or’ filtering
View more information about a claim quickly
through expanding and collapsing rows with user-created notes
Find claims more easily
through conditional filtering (contains, between, more than)
PrimeReact gave us a data-heavy design system that fit our tech and legal limits
The team chose PrimeReact, an open-sourced, federated design system to meet our constraints with tech stack, legal, and maintenance requirements. This system excels at presenting and manipulating data — a mechanic paramount to our users’ workflows.
Skipping wireframes and using Slicing to show each iteration’s scope
Based on our two-week sprint cycles and values of a lean, Agile workflow, we spent our effort on quick, high-fidelity mockups over wireframes.
To communicate iterations and effort, we use a process called Slicing.
Demos with users after every iteration turned feedback into new hypotheses
To validate the momentum of this iteration, I demo with various stakeholders and users to challenge if the output drives toward the intended outcome. Feedback was gathered enabling us to build new hypotheses as we begin tackling the next iteration of outcomes.
Outcome and feature roadmaps kept stakeholders up to date on each iteration
To maintain communication with the broader stakeholder team, momentum is captured through Outcome Prioritization and Feature Rollouts.
Tracking outcomes across iterations
Enables any stakeholder to view a team’s discovery effort and areas of focus.
Output momentum across iterations
Enables all stakeholders to view the output momentum of the application within each iteration.
From a Palantir replacement to a full recovery platform across 31 iterations
What started as a replacement for Palantir became a full-scale recovery platform handling everything from claim validation to vendor management.
Below: a short tour through four notable views, pulled directly from the working Figma file and annotated using the documentation that shipped with each slice. Together they trace how the analyst’s view evolved across 31 tested iterations.
The dashboard
The analyst's home. A left-rail navigator across all six recovery-platform surfaces, a persistent claims toolbar (batch actions, filter, settings, search), and a sortable table that doubles as the link out to a single claim view. Every claim arrives here after the exclusions process.
Anatomy of a claim
A single claim's full story on one scannable page. The header carries at-a-glance status, audit-log access, and a lookback timer; below it, the Healthplan Manager's verdict, prior adjustment comments, and the full structured property set.
The Audit Log
The Audit Log modal opens over the claim view so the analyst doesn't lose their place in the queue. Every action on the claim, indexed and searchable — the team's answer to "how did this claim get into this state?"
Saved filter Setups
By the latest 🟢 Advanced Filter slice, the right-rail filter rolls up into named Setups — analysts can save the exact configuration they use on a Tuesday morning, then reload it on Wednesday without rebuilding it field-by-field.
Component details
The small craft — modals, controls, and brand moments that make the platform feel like a single, considered system.
Measuring the team, not just the product
While not as paramount as measuring impact, these softer metrics assist in validating application and process momentum. Less about user outcomes and more about team health.
