Background
The Fraud and Abuse Report Form is a tool that allows policyholders, healthcare providers, and employees to report suspected fraud or misuse of health insurance benefits. It plays a crucial role in maintaining the integrity of the healthcare system by helping to identify fraudulent claims, billing errors, and other abuses that drive up costs and compromise care.
My Role
Sole UX Designer
My Team
1 Content Writer
2 Product Owner
Timeline & Status
3 months, Shipped
My Process
Discovery, Ideation, Design, Outcome
Overview
This project aimed to redesign the Fraud and Abuse Report Form by implementing a dynamic, guided experience using conditional logic.
The Goal
- Simplify the process
- Enhanced accessibility
- Optimized performance
- User-focused design
The Problem
Meet Lisa: A Policyholder Trying to Do the Right Thing
Lisa trusted her health insurance provider, but one day, she spotted a charge for a procedure she never had. After calling her doctor’s office, she realized someone might have fraudulently billed her insurance.
Determined to report it, Lisa found the Fraud and Abuse Report Form—but frustration quickly set in:
- Too complicated: The form asked for detailed information she didn’t have, like provider ID numbers and claim codes.
- One-size-fits-all: Whether reporting a billing error or fraud, she had to complete the same long, rigid form.
- Unclear instructions: She wasn’t sure what was required or if she could submit the form without certain details.
Frustrated, Lisa wondered, "Why is this so hard? Shouldn’t they want to make reporting fraud easy?"
The Solution
Our goal was clear, redesign the reporting experience to be user-friendly, efficient, and stress-free.
✅ A Guided, Personalized Experience: Instead of one long form, I designed a step-by-step process that adjusted based on the situation.
✅ Only Relevant Questions: Using conditional logic, the form asked only what was necessary, no more confusing, irrelevant fields.
✅ Clear, Simple Language: We replaced jargon with easy-to-understand explanations, so Lisa knew exactly what to enter.
✅ Flexible & Accessible: Lisa could now submit a report from any device, and choose to remain anonymous.
The UX Process
How I Solved It
Discovery
Stakeholder Interviews
I collaborated with stakeholders to define project goals, align business and user needs, and identify technical limitations. Through discussions, we addressed key questions such as “What are the form’s must-haves?” and “What pain points are we solving?” to ensure the redesign effectively streamlined the reporting experience.
Content Audit
I partnered with our content writer to analyze and refine the form’s content, identifying key information that needed to be prioritized, simplified, and reworded for clarity. Through iterative reviews and revisions, we streamlined the language, eliminating unnecessary text and reducing cognitive load. This process ultimately shortened the form’s length while ensuring users could easily understand and complete it.
Ideation
Identifying the Core Experience
The fraud reporting process included three sections:
- Fraud Details (Required) – Information about the fraudulent activity.
- Insurance Details (Optional) – Insured party information.
- Reporter Information (Optional) – Details of the person submitting the report.
The MVP was defined as:
A submission flow that allows users to report fraud using only the required fraud details.
Key Benefits
- Lower friction – Users can report fraud quickly.
- Increased accessibility – No need for insurance or personal details.
- Business alignment – Investigations can proceed with minimal input.
Future Enhancements
- Progressive disclosure for optional fields.
- Guidance text to clarify additional information.
- Confirmation for users providing contact details.
By focusing on essential functionality first, we ensured a simple yet effective fraud reporting experience.
Design
Iterations
During the design phase, I led multiple working sessions with stakeholders, content writer, and developers to refine the form and ensure it met business needs and technical requirements.
- Stakeholder Alignment: Identified pain points, prioritized needs, and addressed business constraints to enhance the form.
- Content & Flow Optimization: Simplified language, refined question sequencing, and removed unnecessary fields for a streamlined experience.
- Technical constraints: Ensured feasibility, refined interactions, and aligned with backend systems for seamless implementation.
- Final Approval: Resolved edge cases, clarified logic, and finalized the structure to secure stakeholder approval.
This process ensured the form was clear, efficient, and technically sound, making fraud reporting more intuitive while maintaining compliance and accuracy.
Challenges
Addressing cognitive overload
Restructuring the form into manageable steps without disrupting the flow or adding unnecessary complexity.
Solution
To address this, each step showed only the questions that mattered, and the form adjusted based on user answers to make it easier to use.
Visualizing complex screen flows
Prototyping different scenarios for the Fraud and Abuse Report Form was challenging due to its dynamic, conditional nature. It was essential to present the various screen transitions and logic paths clearly so that stakeholders and developers could understand how the form adapted based on user inputs.
Solution
I structured the Figma file with color coding, clear labels, and organized flows, making it easier for stakeholders and developers to understand screen transitions and conditional logic.
Prototype
To bring the redesigned Fraud and Abuse Report Form to life, I created an interactive Figma prototype that demonstrated the form’s step-by-step flow, conditional logic, and user interactions. Since the form dynamically adjusted based on user responses, it was essential to clearly visualize how different scenarios played out.To ensure clarity for stakeholders and developers, I:
- Mapped out all possible user paths, showing how the form adapted based on different responses.
- Created an interactive prototype that allowed stakeholders to experience the guided flow firsthand.
This prototype served as a blueprint for implementation, aligning teams on functionality and interaction behavior before development.
Key takeaways
The value of collaboration
Working closely with our content writer and stakeholders reinforced the importance of cross-functional teamwork in creating a user-centered design.
Balancing simplicity and functionality
Simplifying the form while maintaining its ability to capture detailed and accurate information was challenging but also a rewarding balancing act.
The power of iteration
Iterative design and feedback loops were essential to refining the form and ensuring it met both user and business needs effectively.
