Amanda Klausmeier

Case Study

Reducing claim denials and delays for 900K+ health care beneficiaries

Transforming a paper-only reimbursement process with a 50% send-back rate into the first fully digital health care claims and resubmission experience for 900,000+ Veterans and their families.

My Role
Design Lead
Organization
U.S. Department of Veterans Affairs
Launched
Fall 2025
Type
0-to-1 Product / Service Design

Impact

  • 8,982 — New digital claims per month - up from 1,449 at launch
  • 76% — CSAT score - up from 66% before launch
  • 800+ — Successful resubmissions per month as of February 2026
  • 0 — Paper steps remaining - the first fully digital CHAMPVA experience

A paper-era process failing the people it was built to serve

CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) provides health care coverage to spouses, dependents, and survivors of Veterans — over 900,000 beneficiaries. When a beneficiary sees a provider who does not bill VA directly, they have the right to file a claim for reimbursement. Until 2025, that process was entirely paper-based.

The PACT Act expanded eligibility significantly, driving record claim volumes into an already strained system. Physical mail and fax meant claims sat for 30+ days before even entering the processing pipeline. A 50% send-back rate - claims returned for missing or incorrect documentation - was compounding the backlog and eroding trust with beneficiaries.

The work was not just designing a form. It required navigating legacy systems, paper-era business rules, and multi-stakeholder alignment - while keeping the people at the end of the process at the center.

  • 900K+ — Qualifying beneficiaries - spouses and survivors of Veterans
  • 50% — Claims returned for missing or incorrect documentation
  • 30+ — Days of delay before a mailed claim entered the processing system
  • 0 — Digital options available to beneficiaries before this project

Transformation

Before

  • Paper claim submission only
  • Physical mail or fax to submit evidence
  • 30+ day delay before claims entered processing
  • 50% send-back rate due to missing documentation
  • No status visibility for beneficiaries
  • Required to mail VA original letter back to VA

After

  • Fully digital claim submission on VA.gov
  • Online document upload with verification guidance
  • Faster reimbursement - months removed from the timeline
  • Proactive education to prevent send-backs before submission
  • Claims status tool integration on the roadmap
  • Letter upload requirement eliminated entirely

Key decisions

01. Map the full system, not just the form

Service Design / Stakeholder Alignment

The initial service blueprint only covered enrollment. Nobody had fully mapped what happened after - the claims journey, back-office systems, and operational dependencies that determined whether a claim succeeded or failed.

I led the team through group interviews with business partners and subject matter experts to build an end-to-end service blueprint. This artifact became more than documentation - it became the primary tool for aligning stakeholders, exposing outdated constraints, and creating space to challenge paper-era requirements with evidence.

The blueprint was particularly critical for the resubmission and re-open flows, where it took numerous sessions with business partners to gain traction on the right service design. Without a shared understanding of the system, those conversations would not have been possible.
Full CHAMPVA service blueprint mapping the end-to-end claims journey
Detail of the CHAMPVA service blueprint focused on resubmissions and re-opens

02. Eliminate a requirement that existed only because of paper

Policy Influence / User Advocacy

The paper process required beneficiaries to physically mail VA original send-back letter back to VA as part of a resubmission. When translating the process to digital, this requirement had no logical equivalent - but it remained in the business requirements.

Using the service blueprint to make the redundancy visible, I worked with my product partner to advocate directly with the program office. The requirement was eliminated - simplifying the resubmission flow and reducing a significant source of user friction.

Paper process

  1. VA mails send-back letter
  2. Beneficiary receives letter
  3. User uploads letter back to VA
  4. Evidence uploaded
  5. Resubmission processed

Digital experience

  1. VA mails send-back letter
  2. Beneficiary enters claim number
  3. Evidence uploaded online
  4. Resubmission processed

03. Solve the send-back problem upstream, not at the error state

Research Synthesis / Content Strategy

Usability research with Veterans and their families revealed a clear pattern: most claim errors were not carelessness - they were a terminology problem. Many beneficiaries had never filed a claim with an insurer before. They assumed the bill handed to them after an appointment was sufficient. CHAMPVA required a provider-issued superbill, which must be specifically requested - and most users had no idea.

We also collaborated with the program office to revise the printed send-back letter itself, adding explicit mention of the online resubmission option. This extended the design work beyond the product into the broader service touchpoint.

Upload verification states and error messages were redesigned to explain what was being checked and what specifically went wrong - giving users a clear recovery path rather than a generic failure message.

What research found

Beneficiaries submitted the bill they received at checkout, not the superbill CHAMPVA requires. Most had no prior experience filing health claims directly and did not know a superbill needed to be specifically requested from their provider.

How we responded

Introduced and defined "superbill" and "EOB" on the form intro page - before users entered the flow - explaining that these documents must be requested from the provider, not assumed to be the checkout bill.

Constraints and trade-offs

Not everything we wanted to build was possible. Several constraints shaped the roadmap - and surfacing them early meant decisions were made deliberately, not by accident.

  • [RESOLVED] Letter upload requirement — A paper-era business rule requiring beneficiaries to upload VA send-back letter back to VA. Eliminated through direct advocacy with the program office.
  • [ROADMAP] Pre-fill from prior claims — Users expected entering a claim number to pre-fill their data. A technical feasibility spike confirmed this is blocked by legacy back-end systems. Flagged as a roadmap priority and cross-team conversations initiated.
  • [ROADMAP] Sponsor and beneficiary pre-fill — Known user data cannot be surfaced yet due to API limitations. A top roadmap priority - a small change with an outsized impact on the user experience.
  • [EXPLORING] AI-assisted document verification — We designed and integrated Amazon Textract to verify uploaded documents matched required evidence. Extraction accuracy was not at an acceptable threshold before launch. Continuing on the roadmap.

IN PROGRESS

CHAMPVA will become the first health product added to the VA.gov claims status tool

The most consistent request from beneficiaries was visibility - knowing where their claim stood without calling or waiting for mail. After discussions with government peers, CHAMPVA is on track to integrate with the VA.gov claims status tool, giving beneficiaries real-time status and a direct path to submit documents from within their claim.

My product lead partner and I advocated for the budget and team resources to make this happen. A dedicated team onboarded in January 2026.