EBS Smart
Claims
EBS Smart Claims is an AI-powered feature inside ABA Technology's Curative AI platform. It gives claims agents a single, intelligent view of every claim — surfacing insurance coverage, patient history, and an AI recommendation on whether to accept, counteroffer, or escalate.
I led the end-to-end design: research, workshop facilitation with agents, flow mapping, and high-fidelity UI.
Making high-stakes decisions with incomplete context
Claims agents were switching between 3+ disconnected systems with no guidance on when to push back on a claim or accept it. This created inconsistent outcomes, missed negotiation opportunities, and significant decision fatigue across the team.
Co-design workshops to map the real workflow
I ran a co-design workshop with claims agents to map their real workflow and identify where information gaps caused the most friction. From there I defined the information architecture, designed a persistent Smart Claims panel with an AI recommendation layer, and built a counteroffer builder directly into the flow — all validated with agents before going to high-fidelity.
A contextual AI panel embedded in the claims workflow
A contextual AI panel embedded in EBS Smart Billing that loads automatically when an agent opens any claim. It consolidates claim details, insurance coverage, patient history, and an AI recommendation (Accept / Counteroffer / Escalate) with transparent reasoning — all in one view. The counteroffer builder pre-fills a structured template with suggested amount and policy rationale.
