Special Issues Tool - VA Claims Processing Interface

Screenshot of a digital interface titled 'Special Issues Tool' with options for managing health insurance claims related to headaches and migraines, including buttons for adding, recommending, and removing specific issues.

Project Overview
As part of my work on a VA modernization initiative, I designed a tool to help claims reviewers accurately identify and assign special issues—complex or sensitive factors that affect how a veteran’s benefits claim is processed. This tool reduces human error, saves time, and ensures veterans receive the attention their situations require.

The Challenge
Identifying special issues within a veteran’s claim was previously a manual, time-consuming process. Staff had to sift through multiple data sources, often under pressure, to determine if special handling was required. This led to:

  • Missed or incorrect issue tags

  • Delays in processing

  • Inconsistent experiences for veterans

The system needed a more efficient, user-friendly way to surface relevant information at the right time.

The Solution
I helped design the Special Issues Tool, which displays as a pop-up interface that appears during the claims review process and shows suggested tags based on automated analysis of a veteran’s data and documentation.

Key functions include:

  • Automated suggestions for special issues based on claim details

  • Labels like “Add,” “Remove,” or “SI Assistant” (for suggestions needing human review)

  • Direct access to evidence so users can verify why a suggestion was made

  • Quick-select options for adding/removing tags with minimal clicks

My Role

  • Designed the user interface and interaction flow

  • Simplified complex language and workflows

  • Balanced automation with human review

  • Ensured accessibility and clarity across varied use cases

Key Design Features

  • Integrated pop-up that doesn’t interrupt workflow

  • Labels for quick decision-making

  • Smart recommendations powered by backend logic

  • Evidence links to maintain user trust

  • Reduces decision fatigue and improves consistency

Impact & Results

The tool streamlines a previously manual process, enabling VA staff to:

  • Tag claims more accurately and consistently

  • Reduce rework and processing errors

  • Save time and effort on each claim

  • Improve fairness and efficiency in the claims process

  • Deliver a better overall experience for veterans

Screenshot of an online insurance claims platform showing a form to edit a contention with fields for the contention, classification, type, date of contention, and medical status. There is a highlighted link labeled 'Special Issues Tool' next to the special issues field, with an instructional note to click it to open the tool for recommending relevant issues.
A screenshot of an online claim management system with a pop-up window titled 'Special Issues Tool'. The window displays options to add or remove special issues related to a claim for headaches and migraine, including 'Fully Developed Claim' and 'TERA', with checkboxes for selection, and a blue button labeled 'Apply Selected Special Issues'. The background shows the claim details page with navigation options and input fields.
Screenshot of a healthcare claims processing software showing the 'Edit Contention' section, with a 'Special Issues Tool' pop-up asking if a medical opinion was requested for a contention, with options to select a response.
Screenshot of an online insurance claim management system with the 'Special Issues Tool' pop-up window open, showing recommendations for headaches and migraines, including 'Fully Developed Claim,' 'TERA,' and 'VONAPP Direct Connect,' with a blue button labeled 'Apply Selected Special Issues' at the bottom.
A screenshot of a claim management system interface showing the 'Edit Contention' section where users can input details about a claim, including contention as headaches or migraine, classification, date, medical status, special issues, and rated issues. There is also a note about applied issues and a pink icon with the number 6.