PROJECT OVERVIEW
The goal of this project was to improve the onboarding program for the member services team. Team leadership reported that new employees who finished training were not prepared to handle complex member calls, due to misunderstandings of cost sharing concepts like deductibles, copays, and coinsurance. A thorough needs analysis identified existing knowledge and performance gaps, leading to the development of targeted learning objectives. To address these learning objectives, I designed and developed a cost sharing role play scenario using Adobe XD and Articulate Storyline. In the scenario, trainees review relevant documents (member profiles and explanations of benefits) to answer fictional members' questions about coverage, costs, and plan details. The scenario allows learners the opportunity to practice applying their knowledge of cost sharing concepts in a realistic, low-stakes, and risk-free, setting. This scenario is intended to be used after learners have gone through initial formal training on cost sharing. The L&D team predicted the experience would promote learner engagement, reinforce knowledge of cost sharing terms, and lead to better on-the-job performance. Results indicated that, compared to earlier training cohorts who did not receive the practice, new hires had reduced escalation rates, improved customer satisfaction ratings, and higher rates of first-call resolution.
ID Approaches
Needs Analysis
Backward Design
Iterative Design & Development
SME Collaboration
Scenario-Based Learning
Tools
Adobe XD
Articulate Storyline
Generative AI
Google Docs
Problem
A needs analysis with stakeholders and subject matter experts revealed that member services employees had difficulty handling complex member questions about cost sharing, especially when those questions required them to interpret and explain information across multiple sources. While representatives could often answer basic benefit questions, they were less consistent when members called with confusion about how copays, deductibles, coinsurance, and out-of-pocket costs worked together in real claim situations.
This created a broader business problem: employees took longer to reach full competency and were more likely to escalate difficult calls rather than resolving them confidently during the first interaction. Stakeholders identified downstream effects such as inconsistent member explanations, reduced call efficiency, avoidable supervisor support, and a higher risk of member frustration when representatives could not clearly explain why a claim processed the way it did.
SMEs noted that one of the most important gaps was not simple policy recall, but the ability to apply plan knowledge to realistic member-facing scenarios. Representatives especially struggled when they needed to connect information from a member account screen with information from an Explanation of Benefits (EOB) and explain the relationship in plain language. As a result, the training need was defined not as more exposure to terminology alone, but as stronger practice in interpreting benefits and translating claim outcomes into accurate, member-friendly explanations.
Challenges
The needs analysis also uncovered several specific performance challenges that made this task difficult for learners. First, stakeholders and SMEs reported that employees often had trouble interpreting EOBs accurately, particularly when distinguishing among billed amounts, allowed amounts, insurance-paid amounts, and member responsibility. Representatives sometimes understood each term in isolation, but struggled to explain how those values worked together in a real claim.
Second, employees had difficulty connecting EOB details to member plan information shown elsewhere in the system. For example, they might recognize that a member had an office visit copay or remaining deductible balance, but still be unsure how to use that information to explain why a service was paid as a copay, applied to deductible, or subject to coinsurance. This made multi-step questions especially challenging.
Third, SMEs described a communication gap between knowing the answer internally and explaining it clearly to members in a high-pressure call environment. Even when representatives could partly interpret the information, they were not always able to deliver a concise, confident explanation that reduced confusion and prevented escalation.
Together, these findings pointed to a need for training that would go beyond static content review. Learners needed realistic, guided practice with the same kinds of scenarios they would face on the job: interpreting claims, comparing multiple artifacts, identifying the true source of member cost, and communicating the explanation in a way members could understand.
dESIGN REFINEMENT - SCENARIO QUESTION INTERACTION
INITIAL MOCKUP
I started by designing an initial mockup that included all of the essential elements for the question interaction: 1) Insurance documents displayed on dual computer screens (clicking on either shows the artifact full screen), 2) question stem, and 3) response options.
ITERATED IN ADOBE XD
I created Initial design and evolving mockups using Adobe XP. The learning and development team provided feedback on aesthetics and user experience through a series of slide mockups. This process led to significant improvements in slide designs to be used in Articulate Storyline.
FINAL MOCKUP
FINAL MOCKUP
The final mockup included important modifications: 1) the monitor displays look much more realistic after including overlay, 2) the caller avatar is more prominent in the interface, and 3) the question is more legible on the lighter background and with bolded text.