The Role of Human Factors Design in Insurance Claims Management
The arrival of software platforms that can automate many of the elements of claims management is in the process of transforming the industry. Human factors design is a tool that can help optimize these platforms to be more effective, efficient, and intuitive for claimants and claims professionals.
Written By Sebastian Viasus, Product Design Lead at Gain Life | April 28, 2023
What is Human Factors Design?
Human factors is a discipline that studies how people use technology. It covers the interactions of human abilities, expectations, and limitations, with environments, technologies, and systems. It is an interdisciplinary field that integrates psychology, engineering, ergonomics, and physiology. Some common examples of human factors include attention span, physical ergonomics, sense of control, accessibility, familiarity, cognitive load, communication, demographics, and memory.
Human factors design is the application of human factors principles to the design of products and systems. It involves using the insights gained from human factors research to create designs that are optimized for human use, with a focus on making them more accessible, usable, and effective for people.
A real-world example of human factors design can be seen with the placement of navigation and frequently used applications on smartphones. These core features, like calling, texting, and internet access are placed exclusively at the bottom of all smartphone screens. This is because the design considered the physical ergonomics of the user so that the most frequently used features of the device would still be accessible even when using the phone with only one hand.
By creating more effective, efficient, and user-friendly products, human factors design is valuable to businesses because the products it delivers result in increased customer satisfaction and loyalty, it helps differentiate companies from competitors, it reduces cost on redesigns, and can allow businesses to easily tap into new markets and customer segments.
An example of a business benefiting from human factors design is Instagram. Originally launching in 2010, the company knew it had evolved from where it had started, and was looking to redesign in order to better match the user experience and offerings of contemporary applications. They began the process by looking at what currently existed with the application, the brand, and most importantly, the user interactions. Using a human factors approach, they conducted user research to understand what existing Instagram subscribers looked like, how they interacted with the application, and what role those interactions played in their lives outside of the application. Through this research, they were able to isolate core product values which included image sharing, commenting, and liking which led to a relaunch of a simplified version focused on these values. In less than two months, Instagram gained over two million followers and all without any strategic promotion of the product.
Why should we care about human factors in insurance claims management?
There are multiple lines of insurance covering every aspect of our lives, from workers’ compensation to property damage, to automobile insurance and many more. Each of these has a multitude of administrative and process elements that make up the management of a claim. Things like reporting of the initial event, getting authorization for medical forms or damage estimates, and collecting documents to name a few. Most of these activities require frequent communication between the claiming party (claimant) and the insurer or their administrator. How this communication happens and the speed and effectiveness of those communications are critical to a successful outcome for both parties.
Many of these different lines of insurance use legacy systems and antiquated methods for communicating with claimants and managing the various administrative and procedural requirements of a claim. This causes unnecessary delays, poor response times, poor outcomes and often promotes an attitude of distrust between the claimant and the insurance claims professional (often leading to expensive litigation). The arrival of software platforms that can automate many of the elements of claims management is in the process of transforming these systems to make them more effective and efficient, improving outcomes and the overall user experience.
Automating many of the activities that are necessary for managing claims brings with it the need for humans to interact with the software systems involved and the devices that they are performed on like smartphones and computers. Optimizing these interactions is the primary goal of human factors design.
We will use the workers’ compensation insurance business as an example to examine how human factors research and design are being used to transform the industry. The same principles would apply to designing applications that can help automate claims management for other lines of insurance as well.
Applying Human Factors Design to the Workers’ Compensation Insurance Industry
The workers’ compensation insurance industry is a 55 billion dollar a year industry with a landscape that is rapidly evolving as innovators seek to improve the experience of both injured workers and claims management professionals with new technologies and solutions. In workers’ compensation insurance, the main priority is to help injured workers recover and return to work as soon as possible while minimizing administrative delays and providing a positive experience, all while managing costs.
In the workers’ compensation insurance industry, injured workers and claims professionals share the same goal: fast recovery of the injured worker and a full return to work. Injured workers want to recover quickly so that they can return to work, regain full salaries to support themselves and their families, and get back to participating in daily life activities that their injury may have prevented or impacted. Claims professionals seek to ensure a quick recovery for the injured worker since the main contributor to claim costs is the length of the claim and because it is fulfilling for claims professionals to help people recover. In a research study conducted by the Gain Life team, 73% of claims professionals stated that “making a difference for injured workers” was the main reason they got satisfaction out of their jobs. However, there are two main types of problems that are prevalent in the industry that negatively impact this shared goal: poor communication and procedural inefficiencies.
Poor communication problems are issues that relate to the information pipeline between injured workers and claims professionals and can take the form of phone tag, language barriers, and confusing paperwork. Procedural inefficiencies, on the other hand, are problems inherent to the existing methodologies used to complete tasks. Things like long surface mail times, staying up to date with appointment information, and collecting signatures. The impacts of these various problems typically take the form of delays in the process, a lack of understanding for injured workers, overworked claims professionals, and an overall sense of antagonism between both parties.
It’s easy to envision how modern day technologies like websites, mobile apps, electronic signature services, and instant messaging might help address the issues present in workers’ compensation insurance. Each of these stand-alone technologies can help, but a human factors informed solution would seek to make use of all of these capabilities on one platform in a manner that is optimized for the individuals who will actually use it. Gain Life has created such a platform, called Jarvis, to help automate and manage the claims process for both injured workers and claims professionals.
We started by researching the pain points present in the industry for both injured workers and claims professionals, then looked at solutions that could resolve those problems. Through our research, we were also exposed to the many human factors related to those pain points, and related to using software and devices to solve those pain points. As we explored solutions, four human factors surfaced as key drivers that would help shape our product: accessibility, familiarity, emotional state, and sense of control.
Designing for Accessibility and Familiarity
Accessibility and familiarity are two key human factors that are pivotal when designing any piece of technology. Accessibility relates to how easy it is for a user to get to and use a tool. A hammer that’s stored on the roof of your house and with a handle so long that it requires two hands to use, is not an accessible hammer for hanging up picture frames. Familiarity is the idea that people will transfer expectations they have built around one familiar product to another that appears similar. This also relates to the human factors concept of mental models. Mental models are the expectations people have about systems and how something might work based on their previous experience. Mental models are often subconscious and automatic, and can have a powerful impact on behavior and decision-making. Ultimately, the takeaway from familiarity is that by leveraging existing mental models, efficient user experiences can be created in which users can focus on their tasks rather than learning how to use a new tool.
As we began designing Jarvis, we paid special attention to understanding accessibility and familiarity as they related to creating software to optimize our solution for injured workers and claims professionals. For example, trends in technology use show that people are moving away from computers and moving to smartphones for most electronic transactions seeking the mobility of the device as a factor that fits best with their lifestyle. This led us to design our injured worker platform around a smartphone application as an accessible user hub. User research with injured workers taught us that they didn’t want to download and install yet another application on their phone due to it taking up valuable device memory and extra time and effort. This led us to design a progressive web app that worked like a native app but did not need to be installed on their device. Given that individuals are used to completing complex tasks on their phones with native apps that they have downloaded, we designed for familiarity by incorporating the same mobile interactions and UI elements like sticky navigation, iconography, and notifications so that users would encounter a familiar experience and not have to learn anything new to interact with our product.
For claims professionals, onsite research informed us about existing workflows with claims management software and how claims professionals did not want to add extra or duplicative work when integrating a new tool into their workflow. This led us to design our claims professional platform that optimized integration with their claims management systems. For example, when an injured worker signs a document or updates an appointment in Jarvis, that information is automatically exported to the claims management system so that claims professionals can have instant access without ever having to log in to our platform.
Designing for Emotional State and Sense of Control
Emotional state is another important human factor key to the development of Jarvis. Emotional state speaks to the specific emotions that a user may be feeling at the time of interacting with a system or product. Through our research, we learned that injured workers are frequently anxious, sad, or angry as they make their way through the workers’ compensation process. These feelings may stem from not having the right information available when they need it or frustration because they are constantly playing phone tag with their adjuster. These unpleasant emotions can decrease a person's patience and increase their irritability. Considering these emotional factors, we designed Jarvis with on-demand FAQs and routine emotional check-in questions so that injured workers can have their questions answered any time of the day and feel like they are being cared for throughout the claims process. We also focused on using empathetic language throughout the platform to further ensure a caring atmosphere. Everything in the app is written at an 8th-grade reading level so that it can be easily understood by anyone using our platform, further reducing the risk of confusion and the need for injured workers to call their claims professional.
Sense of control is a human factor that considers how much awareness a user has about the existing status of a tool they are using and what abilities they have to adjust the experience to suit their needs. In a car, you have displays and warning lights showing you how much gas you have left so that you are aware of when the vehicle will stop working if you don’t fill up. You are also able to adjust your seat, steering wheel, and mirror position so that it is most comfortable for you. These features ultimately increase your sense of control of the vehicle and allow you to operate it most effectively. Through continuous effective operation of a product, a user also develops competence, which leads to trust in a product and comfort as a user doesn’t have to worry about their ability to use and interact with the product.
When designing Jarvis, we looked to maximize system feedback and personalization to provide the highest sense of control for both injured workers and claims professionals. For example, on the injured worker platform, we give clear system feedback in our document completion feature by providing a visual breakdown of each step of the process and clear labels indicating what action they need to take in order to proceed. We also make use of “info” icons next to key actions or information so that users can get a detailed description of specific features, functions, or content at any time. Both of our platforms can also be easily personalized. For injured workers, this means allowing them to control settings like whether they want to receive notifications via text or email so that the most user-friendly communication method is being used. Injured workers also can select a preferred language for communicating with their adjusters and Jarvis will then auto-translate messages in over 100 languages between the injured worker and the claims team. In addition to having control of notification types and frequency, claims professionals can customize their active work hours and create automated messages that will be sent to injured workers letting them know when the professional is available. This gives the claims professional some control of the process even when they aren’t at their desk.
The user-friendly interface and intuitive design have made it much easier for our injured employees to navigate and understand the claims process-"
Denise Evans StaffmarkThe Future of Human Factors Design
As technology quickly becomes more embedded in various aspects of our lives, human factors design is consistently gaining more traction as an effective tool to develop efficient products, systems, and environments. With the increased popularity of human factors design, we are also starting to see new methodologies develop for the ways that human factors research is conducted and how findings are then implemented into the product. Artificial Intelligence (AI) is playing a large role in these new methodologies as AI-powered systems like ChatGPT can be used to analyze vast amounts of data and user feedback, allowing designers to identify areas for improvement and optimize products more quickly than traditional methods. Another potential application of AI in human factors design is in the development of virtual and augmented reality systems, which can provide more immersive and realistic user experiences for testing products.
However, impactful as these AI applications may be, they only answer part of what human factors research and design seeks to achieve. Human factors research is often in search of the “why” behind human behavior with respect to people’s interactions with technology. Understanding why someone did what they did provides designers with a driver that they can then use to design an optimized solution. And deciphering the “why” is a process that will never be able to be replaced by AI as it requires human researchers, working in novel spaces, who can think outside of traditional conventions in order to ask the right questions to real, human users.