Overview 

• Client: B2B & B2C - Centers for Medicare & Medicaid Services (CMS)

• My Role: Lead UX Researcher and UX Manager - I led the research project from start to finish

• Duration: April – May 2024

• Methodologies: Flow Visualization, Journey Map, User Interview, Usability Testing, SUS (System Usability Scale)

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Background

The Federal Independent Dispute Resolution (IDR) system facilitates payment dispute resolution under the No Surprises Act. Email was the only official communication method between the IDRE portal and users—initiating parties (IPs) and non-initiating parties (Non-IPs). However, feedback revealed critical communication breakdowns. I led a UX research initiative to understand and improve this experience.

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The Problem

Users were overwhelmed by a high volume of automated emails that lacked clarity, contextual relevance, or prioritization. There was no centralized way to view dispute status or past communication history, which led to delayed actions, operational inefficiencies, and missed deadlines.

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Approach

 

Before launching into research, I needed to clarify not just what users were struggling with, but how those struggles were connected to system design, policy constraints, and operational workflows. Rather than jumping straight into usability testing, I took a systems-level approach to understand the broader ecosystem users were operating within.

 

I began by aligning with CMS policy leads and dispute processing stakeholders to understand the intent behind the existing email communication strategy. While the team was aware of user complaints, such as email overload and unclear instructions, they lacked concrete data about where and why breakdowns were happening.

 

I framed the research around four guiding principles:

1. Context is critical: Users interact with CMS emails in the middle of high-stakes, high-volume dispute resolution. Every message must be actionable, scannable, and time-sensitive.
    

2. Email is not a workflow system: CMS was using email to approximate task management, status tracking, and dispute coordination—all without a centralized interface.
    

3. One-size communication doesn’t fit all — Initiating Parties and Non-Initiating Parties have different roles, pain points, and preferences. Our solution had to reflect those differences.
    

4. Policy must meet behavior — Any redesign needed to respect regulatory intent while adapting to real user behavior and operational needs.
    

Given these principles, I chose a qualitative-first research strategy to uncover not only how users interpret individual emails, but how email communication affects their overall workflow. I also proposed testing redesigned email mockups within the same sessions, so we could capture both diagnostic and solution-oriented insights in one study. This hybrid approach allowed me to surface not just what was broken, but what better could look like.

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Process

1. Planning & Preparation

• Defined research objectives and key questions in collaboration with CMS and IDR stakeholders

• Conducted early desk research to review known communication pain points

• Developed a flow visualization of all system-generated emails by process stage and user type

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• Created research protocols and semi-structured interview guides

• Designed visual stimuli for testing:

  • Real examples of current system-generated emails

  • Mockups of redesigned emails informed by prior research

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2. Recruitment & Scheduling

• Recruited participants representing both Initiating and Non-Initiating Parties

• Coordinated sessions with diverse organization types, including:

  • Providers: Health care facilities, revenue cycle management firms, practice management firms

  • Payers: Group health plans, insurance issuers, TPAs, cost containment firms

• Scheduled and prepared 60-minute remote Zoom sessions

• Aligned research logistics, tooling, and team roles for remote facilitation

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3. User Interviews & Usability Testing

• Conducted 1:1 in-depth interviews and usability testing with representative users:

  • 3 Initiating Parties

  • 4 Non-Initiating Parties

• Tested both current emails and redesigned mockups

• Captured qualitative insights and satisfaction ratings (1–5 scale)

• Observed user behavior around scanning, interpreting, and acting on email content

• Debriefed regularly with CMS team to share early insights and shape follow-up questions

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4. Synthesis, Findings & Presentation

• Analyzed transcripts and observational notes to extract key pain points and behavioral patterns

• Mapped insights to stages in the IDR journey using a user-centered journey map

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• Produced a findings report and presented to cross-functional teams and CMS leadership

• Converted prioritized recommendations into Jira tickets for development alignment

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5. Follow-Up & Integration

• Conducted additional synthesis based on emerging feedback and team questions

• Collaborated with product and policy leads to validate the feasibility of recommendations

• Ensured integration of findings into upcoming design sprints and feature roadmap

• Continued to advocate for longer-term improvements, including centralized communication tracking and portal-based interaction

 

Key Findings

Through user interviews and email mockup testing, several systemic issues emerged that pointed to a communication model not designed for scale or transparency:

• Email overload created operational inefficiency.
  Users received up to 7 system-generated emails per dispute, often fragmented across time and systems. Managing these required manual workarounds, such as tagging, macros, and internal spreadsheets.
   

• Subject line inconsistencies disrupted workflow automation.
  Minor changes in phrasing caused rule-based email filters to break, leading to missed or misrouted information.
   

• Users lacked a centralized way to track dispute progress.
  Every action—submission, confirmation, deadlines—had to be inferred from scattered emails. Participants reported repeatedly resending forms or seeking status updates due to lack of visibility.
   

• Communication was often unclear or non-actionable.
  Key information like due dates, next steps, or IDRE assignments was either buried or missing. Many users expressed uncertainty after receiving messages labeled “informational only.”
   

• Users strongly preferred a dedicated portal for dispute tracking.
  Nearly every participant said that having a centralized space to view case history, confirm actions, and access communications would save hours of work weekly and reduce avoidable delays.

 

Recommendations

Based on these insights, I proposed targeted changes to improve clarity, reduce burden, and evolve the communication model from transactional to trackable:
 

• Consolidate and prioritize emails

  Group notifications into fewer, action-focused messages. Use headers and bolding to guide user attention.
   

• Freeze and standardize subject line structures

  Avoid mid-cycle changes and communicate updates proactively to maintain email rules.
   

• Embed critical information up front

  Highlight deadlines, IDR reference numbers, and assigned parties at the top of each email.
   

• Attach submitted materials for confirmation

  Include PDFs of forms in auto-responses to avoid resubmission confusion.
   

• Introduce a dedicated provider portal

  Build a centralized dashboard where users can view dispute status, communication history, due dates, and download prior submissions—removing reliance on email alone.
   

• Enhance support access

  Expand Help Desk with policy vs. technical triage and integrate real-time assistance options like live chat or embedded FAQs.

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Impact

The research not only diagnosed communication breakdowns but became the catalyst for a major strategic shift:
 

• A dedicated portal was formally approved and development initiated as a direct result of the findings. This was the single most important outcome, transforming communication from fragmented email threads into a unified, trackable experience.
   

• My journey map and email flow visualization were used by product managers, engineers, and policy leads to inform early portal design decisions.
   

• Several email templates were revised based on tested mockups and user feedback, with Jira tickets created for phased implementation.
   

• The research shifted CMS’s perspective: from simply editing message content to reimagining communication as a platform experience.
   

• This work elevated communication UX as a policy-level priority—linking user experience directly to regulatory compliance and processing efficiency.

 

Deliverables

• Research Plan
  Outlined research objectives, participant criteria, methods, timeline, and success metrics to align stakeholders and guide execution.
   

• Interview Script & Usability Testing Guide
  Created standardized moderator guides with task flows, behavioral prompts, and follow-up probes for consistent, insight-rich sessions.
   

• Email Flow Visualization
  Mapped all system-generated emails across the IDR process, highlighting triggers, recipients, volume, and timing gaps.

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• User Journey Map
  Illustrated the end-to-end IDR experience from both Initiating and Non-Initiating Party perspectives, overlaid with communication pain points.
   

• Tested Email Mockups
  Designed and validated revised email templates for confirmation, eligibility decisions, and role assignments, incorporating UX and compliance needs.
   

• Research Findings Report
  Detailed user insights, recurring patterns, unmet needs, and prioritized recommendations to improve communication workflows.
   

• Stakeholder Readout Deck
  Delivered a concise, visually supported presentation of key findings and next-step recommendations to CMS leadership and cross-funtional teams.
   

• Jira Ticket Mapping
  Converted validated insights into actionable development backlog items with supporting rationale and implementation guidance.

 

Reflection

This project reminded me that even something as routine as an email can carry enormous cognitive and operational weight, especially in high-volume, policy-driven systems. One of the most valuable aspects of this work was watching how users navigated communication through their own adaptations: color-coding inboxes, forwarding emails into spreadsheets, setting up custom alerts. These behaviors revealed the system’s gaps more vividly than metrics ever could.

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In hindsight, I would advocate even earlier for co-creation with operational staff who handle real-time triage—particularly those fielding help desk calls. Their insights could have deepened the research and made downstream policy recommendations even stronger.

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This work affirmed my belief that clarity is a service, especially when users are under pressure, navigating complexity, and expected to act quickly.

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* Due to the NDA restrictions, the final outcomes of this project are confidential and cannot be posted on this website.   Please contact me if you are interested in learning more about this project.

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