2.4 million
claims processed every week
CASE STUDY · DELTA DENTAL
UX Research for
Provider
Tools
at Delta Dental
A usability research case study evaluating whether Provider Tools supports dentists and office administrators through the high-stakes claims submission workflow for patients’ coverage.
01 · BASELINE METRICS
UX research had to
protect patient
coverage
at enterprise scale.
Provider Tools supports offices submitting claims on behalf of patients. Without usability evidence, the team couldn’t know where workflows were breaking down or how denials might be prevented before patients absorbed unnecessary costs.
$18.7 billion
covered for enrollees in insurance groups
90%
of claim denials are preventable but still occur
02 · PROBLEM
The product had never
been evaluated
against real
claim-submission behavior.
The research examined whether the web portal fully supported 332,545 medical offices and whether providers could navigate patient insurance plans, medical records, attachments, and submission requirements without
avoidable confusion.
03 · OUR USERS
Research participants had
to mirror the people doing
claims work every day.
The study recruited dentists and office managers who represented the target Provider Tools personas. Recruiting was treated as a design decision: the right participants were essential for understanding high-pressure office workflows, claims follow-up, and insurance verification behavior.
10 moderated sessions
Participants completed Zoom-based tasks using realistic patient and procedure scenarios.
Dentist persona:
Dr. Ivan Diallo
A pediatric dentist focused on patient comfort, reimbursement friction, and reducing back-and-forth on unnecessarily denied claims.
Office manager persona:
Samantha Callahan
A multitasking office manager who double-checks benefits, batches claims, verifies procedure codes, and needs far less navigation inside practice software.
04 · USABILITY TESTING
Screening questions
qualified participants
before the claims scenario.
Participants needed experience with practice management software and the background characteristics of real Provider Tools customers. The discussion guide then framed a wisdom-tooth extraction claim with patient details, procedure codes, and attachment requirements.
Moderated Scenario: Submit a new claim after two wisdom-tooth extractions.
Participants received the enrollee name Rebecca February, date of birth, enrollee ID, oral surgery procedure category, extraction codes, tooth
numbers, and a prompt to attach an x-ray file. The study focused on whether users could translate this clinical scenario into a successful Provider Tools claim submission.
05 · USER INTERVIEWS
The moderated task
had to
feel like a real
office workflow,
not a
button-hunting exercise.
Participants were not simply told to click “Submit a Claim.” They had to start from an existing patient profile, interpret procedure information, add attachments, and recover when the page returned an insufficient-information state.
Step 1 • Find an existing patient
Users started in My Patients, entered Rebecca February’s enrollee ID, reviewed the returned patient list, and selected the correct patient before claim submission was available.
Step 2 • Input medical procedures
Once inside the claim page, users had to translate oral surgery category details, tooth numbers, and procedure codes into the correct claim fields.
Step 3 • Add electronic attachments
The scenario required an x-ray attachment, but the Attachment ID looked like plain text. Many users ignored this part of the workflow until the submission failed.
Step 4 • Submit claim and hit the error state
When procedure or attachment details were slightly off, the page returned an “insufficient information” pop-up without explaining what was missing or where to recover.
Step 5 • Observe recovery behavior
The most revealing moments came after failure: users scanned the page for missing requirements, overlooked transaction-type radio buttons, questioned whether attachments were required, and lost confidence that the claim would go through.
Step 6 • Chart the task path
During each test, notes captured the path taken, pass/fail status, behavioral cues, raw observations, and follow-up quotes so synthesis could separate what happened from what needed to change.
06 · RESEARCH SYNTHESIS
Raw observations
became a structured path
from data to decisions.
During testing, the discussion guide sheet charted each participant’s path, pass/fail status, behavioral cues, notes, and observations. The synthesis separated raw data, what the team learned, and what product changes needed to follow from the evidence.
07 · THEMATIC ANALYSIS
The key issue was missing
feedback when users
caused recoverable errors.
Participants did not know what information was missing after the insufficient-information pop-up. They missed transaction-type controls, questioned whether documents
were required, distrusted insurance workflows, and interpreted slow submission feedback as a broken page.
No missing-field guidance
The error message did not tell users what claim information was incomplete.
Attachment ambiguity
Users were unsure whether an x-ray attachment was required for the claim type.
Confidence collapsed at submit
Slow page feedback made participants wonder whether the submission was working.
08 · COMPETITOR ANALYSIS
Competitor patterns
helped
turn usability
problems into
solvable
feature requirements.
09 · FEATURE RECOMMENDATIONS
Recommendations
were tied directly to
observed behavior.
The recommendations focused on validating requirements before submission, clarifying attachment expectations, surfacing missing information, and adding stronger page feedback so users could recover without guessing.
Auto-fill and validate known patient context
Reduce manual re-entry once the user has selected the patient profile and procedure context.
Make attachment requirements visible before submit
Move x-ray and supporting document expectations into the claim flow instead of relying on hidden recovery.
Replace vague error states with guided recovery
Tell users exactly what field, attachment, or transaction type prevents successful submission.
10 · STAKEHOLDER BUY-IN
Findings were shared as
product evidence, not just
research documentation.
The research synthesis was presented to Design Operations, product design, and the research team so the claim-submission problems could become prioritized requirements for Provider Tools
improvements.
11 · CONCLUSION
The study created
a baseline for
safer, clearer
claims workflows.
By connecting claims data, usability testing, thematic analysis, competitor evidence, and stakeholder recommendations, the case study shows how research can reduce risk, reveal product opportunities, and protect patient coverage at scale.
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