CASE STUDY
Discovery Workshop for Business Logic Rules Software
Extending Ability to Delete a Business Rule to Creators/Maintainers
The Background
Within the health insurance utilization review software, privileged admin users create and maintain business logic rules that automate authorization determinations to move them to claims payment. The rules are specific to state and federal regulations for covered care and health care services and vary by product: Medicaid, Medicare, or Marketplace.
The Problem
While it sounds fairly simple to allow the users who create and edit the business rules to also delete them, there are restrictions on what records can be removed from the system due to reporting needs: What was the rule that was in place while this authorization was in review?
What happens to an authorization currently in the system when the rule governing it is changed or removed?
My Approach
Key Contributions
To clearly define the problem, the lead UX designer (me) designed and facilitated several exercises in a discovery sprint in partnership with the core team (product owner, lead dev and BSA).
Research with end users: Moderated interviews with workflow related questions to understand gap in functionality and its connection in the larger rules maintenance workflow
Workshop with lead developer and PO to review environments, current workflow, and technical constraints
Design of Miro boards and facilitations of discussion for project direction and scope, documentation of decisions, review of questions/blockers
Process flow diagram for create, import, and edit rules.
Project scope definition and preliminary requirements.