Role: Project Lead & Design Strategist

Client: Top 10 U.S. Bank

Platform: Web portal integrating multiple external systems

Users: Relationship and Payment Managers

Project Description

This initiative focused on improving the healthcare payer enrollment process for a major U.S. banking client operating in the healthcare finance space. The goal was to modernize a fragmented system of tools and manual processes, enhancing efficiency and reducing reliance on third-party vendors.

Problem

The enrollment process was complex, involving multiple third-party tools and manual interventions. Key issues included:

• High dependency on external vendors

• Lack of automation in workflow and task management

• Disjointed user experience for internal teams handling payer and provider data

• Limited visibility and control over case status and progression

My Role

As the HCD Strategist and Project Lead, I guided the discovery, visioning, and solutioning phases. My responsibilities included:

• Facilitating contextual research and stakeholder workshops

• Mapping systems, workflows, and team needs

• Leading the design of future-state experiences and technical integration strategies

• Collaborating with platform teams (including PEGA stakeholders) to align with internal capabilities

Proposed Solution

We proposed a phased transformation roadmap centered around:

• Reducing external product dependency by consolidating functionality into existing internal platforms

• Introducing a case-based structure to manage enrollment tasks and workflows

• Enabling end-to-end automation and system-triggered task transitions

• Designing a unified experience that integrates data, actions, and case tracking for relationship and payment managers

How the Problem Was Solved

Through a series of discovery workshops and system mapping, we identified touchpoints, redundancies, and opportunities for streamlining. The final solution included:

• Replacing legacy tools with an internally managed case structure within PEGA

• Designing task triggers based on workflow progression and data completeness

• Introducing future-state API and architecture diagrams for integration planning

• Delivering actionable UX wireframes for phased rollout

• Prioritizing initiatives using a collaboratively developed matrix to balance business impact and implementation complexity

Key Deliverables

• Executive summary vision document

• Phased roadmap for solution implementation

• Future-state architecture and integration diagrams

• Enrollment process flowcharts

• UX wireframes for new task and case management modules

• Prioritization matrix for implementation initiatives

Challenges Faced

• Navigating competing priorities between business stakeholders and technical teams

• Harmonizing future-state vision with current PEGA capabilities and infrastructure limitations

• Ensuring minimal disruption to customer-facing processes during the transition

• Achieving alignment across internal product, IT, and business ops groups

Business Benefits

• Reduced Vendor Dependency: Streamlined tools and integrations eliminated the need for multiple third-party products.

• Increased Operational Efficiency: Automated workflows and reduced manual handoffs improved throughput and accuracy.

• Improved Internal Alignment: A unified case structure brought clarity and consistency to team processes.