Case Study One: New Claims Processing Training

Challenge

Customer Service Representatives need to apply updated claims-processing policies while making decisions about eligibility, documentation, and escalation.

The challenge wasn't simply teaching the updated process. Reps need to make those decisions while helping real customers, often when a situation doesn't fit neatly into an example they've seen before.

The goal was to create a short learning experience that would help learners understand the updated process, practice applying it, and feel confident making the right decision when it matters.

The Learner

Audience: Customer Service Representatives 

Context: Applying updated claims policies during customer interactions 

Need: Make accurate eligibility, documentation, and escalation decisions.

Real-world moment: A customer presents a situation that doesn't fit neatly into the expected process. The representative needs to know what information matters, what decision to make, and when to escalate.

Learning Objectives

By the end of the training, learners will be able to:

• Given a customer scenario involving eligibility and documentation questions, determine whether to approve or escalate a claim with at least 90% accuracy.

• Identify the documentation required to make a claims decision without referring to outside materials.

• Apply the updated claims policy to novel customer situations not explicitly covered during training.

Solution

I designed a 10-minute scenario-based training experience for BrightCare Health, a fictional healthcare organization.

Rather than asking learners to memorize a long list of policy updates, I built the experience around the decisions they would need to make on the job. Learners move from reviewing the updated process to practicing eligibility and documentation checks, responding to a customer situation, and ultimately deciding whether to approve or escalate a claim.

The course combines interactive process steps, knowledge checks, realistic customer scenarios, decision-making practice, and a final assessment.

Why I designed it this way

I didn't want the scenarios to be interaction for interaction's sake. The job itself requires representatives to make decisions, so the learning experience should give them a chance to practice making those decisions.

I used an "explain, demonstrate, practice, decide, assess" progression to gradually move learners from understanding the process to applying it.

The later scenarios intentionally ask learners to use the policy in context rather than simply recall information from earlier screens. That distinction matters: knowing the policy and knowing what to do with it are two different skills.

Tools

Articulate Storyline 360 - course development, interactions, scenarios, knowledge checks, and assessment

Synthesia - a short AI-generated welcome video

Canva - visual assets and supporting graphics 

Design Considerations

Short-form learning: The course was designed to fit into approximately 10 minutes, so I prioritized information learners needed to make decisions and avoided adding content simply because it was available.

Realistic decision-making: Scenarios allow learners to practice deciding whether to approve or escalate a claim before they're faced with that decision in a live customer interaction.

Immediate feedback: Feedback explains why an answer is correct or incorrect rather than simply revealing the right answer.

Visual clarity: Information is presented in short, focused sections to reduce cognitive load and make the process easier to scan and apply.

Accessibility: The experience was designed with accessibility in mind, including clear visual hierarchy, readable text, meaningful interaction design, and appropriate alternatives for visual information.

Reflection

This project reinforced something I keep coming back to in instructional design: the goal isn't simply to make information easier to understand. It's to help people use that information when they need it.

For this course, that meant giving learners opportunities to make approval and escalation decisions before they encountered those situations with a customer.

If this were moving into a real pilot, I would look beyond course completion and assessment scores. I'd want to know whether the training actually improved performance, particularly whether escalation errors decreased and whether new representatives reached proficiency more quickly.

If I expanded the course, I'd add more branching scenarios with ambiguous or competing pieces of information. Those situations would give learners more opportunities to practice the gray areas that often make real-world decisions difficult.