Strategic Platform Redesign Reduces Staffing Needs and Supports Millions of Members
FAST FACTS
Industry:
Health Insurance & Payer Operations
Specialty:
Individual and group plan administration, member experience, and regulatory compliance
Solution:
End-to-end platform build with strategic guidance on UX, CX, and technology design
Users:
Consumers, providers, service agents, product teams, and leadership
ABOUT THE PROJECT
A national health insurance provider serving both public and private markets was at a crossroads. Their technology stack was bloated, expensive, and inconsistent across touchpoints. Member experience was poor. Internal service reps had to jump between multiple systems. Leadership needed to scale—fast—but couldn't justify hiring hundreds more tech and support staff.
PROJECT IDEA
- Redesign the core platform with UI/UX/CX as a first-class priority—not a bolt-on.
- Enable end-to-end service flows that reduce cognitive load and support self-service..
- Eliminate system sprawl while preserving regulatory and operational complexity behind the scenes.
PROJECT CHALLENGES
- Fragmented Experience: Members, agents, and internal users all used different systems—creating friction and rework.
- High Staffing Dependency: Every task—from claims to ID cards—required human touch, driving up headcount and cost.
- Legacy Platform Debt: The company had multiple systems stitched together, each with its own UI and rules.
- Poor UX and CX Design: No team owned customer experience; workflows were driven by back-end constraints, not front-end value.
RESULTS
- Consolidated platform supports full lifecycle of member and provider interactions—seamlessly.
- Reduced tech staffing requirements by rearchitecting workflows and empowering business users.
- Increased platform adoption and satisfaction across all roles: members, agents, internal users.
- Enabled the company to confidently onboard millions of new customers without adding infrastructure or staff.
BUSINESS CHALLENGES
The insurer had ambitious growth plans. But its infrastructure couldn’t support them. Legacy systems drove high friction across every department. Onboarding took too long. Claim status visibility was inconsistent. Support teams were overwhelmed. And customer complaints were mounting.
Worse, the company had no holistic product or experience design team. Digital initiatives were owned by IT, siloed by function, and optimized for maintenance—not impact. While competitors embraced digital-first service, this insurer was falling behind—despite its size and market share. Cognativ’s engagement began with business and strategy review sessions, but quickly evolved into full architecture and platform design. The mission: deliver a scalable, modern experience for users—and relieve internal teams of manual, error-prone work.
WHY HEALTH INSURERS TRUST COGNATIV?
Cognativ helps payers rebuild smarter—aligning strategy, systems, and service. Our RAPID methodology identifies real bottlenecks, and our SmartSaaS architecture unlocks scale without hiring binges. Whether you’re modernizing member experience or rationalizing legacy platforms, we turn complexity into clarity—and help insurers serve millions with fewer moving parts.
FRAGMENTED EXPERIENCE
Members used one system. Providers another. Customer support used five. None spoke the same language.
HIGH STAFFING DEPENDENCY
Processes were designed for human intervention—not automation—forcing the company to scale headcount, not capability.
LEGACY PLATFORM DEBT
The insurer had accumulated multiple tools via acquisitions—none built for cohesive delivery.
POOR UX AND CX DESIGN
Interfaces were form-heavy, confusing, and inconsistent—hurting adoption and increasing call volume.
LACK OF ROADMAP GOVERNANCE
Departments launched features independently. There was no unifying experience or strategic vision.
SCALABILITY CEILING
The company had plans to onboard millions of members, but their systems couldn’t handle the load.
THE SOLUTION
Cognativ applied its RAPID framework to drive alignment, eliminate waste, and deliver a composable platform built around experience and scale.
- Phase 1: Led strategic planning sessions with the executive team to define platform goals: reduce friction, increase adoption, unify workflows, and support volume growth. Audited every interface, flow, and system across member, provider, and internal use cases.
- Phase 2: Designed a front-end experience layer powered by a composable SmartSaaS core. Consolidated workflows across eligibility, billing, claims, provider lookup, support, and plan selection. Integrated everything into a unified UX strategy across mobile, desktop, and internal tools.
- Architecture: Composable, API-driven, and modular. Role-based access and context-aware logic enabled a single interface to serve consumers, agents, and staff—dynamically adapting by use case. Back-end services were abstracted, reducing staff training time and system errors.
HOW RAPID WAS USED...
"“We helped this client replace 13 different experiences with one intelligent one. RAPID lets us align the roadmap, move fast, and keep everyone focused on outcomes, not just releases.” "
– Ali Davachi, Cognativ Founder
What is the RAPID Framework?
RAPID —Research, Analyze, Plan, Implement, Decide— is Cognativ’s structured delivery methodology, trusted by payers, platforms, and provider systems nationwide. Described in RAPID Transformation: An Outcomes-Based Approach to Drive Results, it keeps transformations on time, on value, and on point.
RESULTS OBTAINED
Cognativ was engaged as both strategic advisor and platform builder. Over a multi-year partnership, we helped reshape the company’s digital architecture and delivery model. Using the RAPID framework and SmartSaaS design principles, we delivered a unified, experience-driven platform that dramatically improved adoption, reduced tech staffing requirements, and positioned the company to serve millions of new members with minimal operational drag.
Tech Staffing Requirements
SmartSaaS reduced manual dependencies. Teams shifted from support to strategy.
Of New Members Supported
The platform now reliably serves millions of new and existing members without infrastructure sprawl.
Experience Layer
Consumers, providers, and agents all operate on a shared interface—tailored per role.
Adoption and Satisfaction
Digital NPS scores increased. Internal user complaints dropped. Platform loyalty grew.
IMMEDIATE BENEFITS
- Faster Member Service: Eligibility, ID card access, and claims status all available digitally.
- Lower Operational Drag: Staff can now manage high-volume workflows without manual handoffs.
- Consolidated Interfaces: One login, one UX—regardless of role.
- Improved Leadership Insight: Dashboards track adoption, usage, and friction in real time.
ONGOING BENEFITS
- The platform continues to evolve with modular rollouts—no massive code rewrites required.
- Cross-functional teams now share a single roadmap, enabling true digital transformation at scale.
- Staff onboarding time has decreased due to consistent, contextual workflows.
- The company has become a digital-first payer—competitive with much larger firms in experience and efficiency.