Case Study — GroupHEALTH Benefit Solutions

Transforming Customer Experience
Across a Complex Benefits Organization

How mapping the complete client lifecycle across three distinct customer types revealed systemic breakdowns and informed a multi-year transformation of digital experience, data infrastructure, and customer touchpoints.

TL;DR — Impact

  • Mapped complete client lifecycle serving 450,000+ Canadians across sales, underwriting, claims, and renewal—revealing data handoff failures and customer friction points
  • Led data infrastructure redesign that became backbone for system of record, eliminating redundant client data collection and automating error-prone manual processes
  • Redesigned explanation of benefits (EOB) documents in collaboration with legal, claims, and IT—reducing support calls and improving first-claim satisfaction
  • Launched plan member onboarding sessions achieving 80-95% satisfaction and established feedback loops where none existed

A Complex Organization Serving Multiple Stakeholders

GroupHEALTH Benefit Solutions is one of Canada's largest third-party group insurance administrators, serving 450,000+ Canadians through 7,000+ client organizations. With over $950 million in annual premium and a family of companies including specialized disability management and benefits consulting services, the organization operates across fragmented systems inherited through growth and acquisition.

I was hired as Client Experience Specialist with a mandate to improve how clients and plan members experienced GroupHEALTH's products and services. The role sat adjacent to marketing but separate from it, reporting directly to the SVP of Sales and Marketing with quarterly exposure to the executive team.

450K+
Canadians covered by GroupHEALTH plans
7K+
client organizations
$950M+
in annual premium

Three Distinct Customer Types

The complexity of the business stemmed partly from serving three overlapping but distinct customer groups, each with different needs, priorities, and relationships to GroupHEALTH:

Clients
Decision makers who purchase benefits plans for their organizations. Sales cycles ranged from 6–18 months.
Plan Administrators
HR representatives within client organizations, or the decision makers themselves at small businesses, responsible for managing benefits day-to-day.
Plan Members
Employees of client organizations who actually use the benefits. Their experience directly influenced client satisfaction and renewal likelihood.

This interdependency created a cascading risk: frustrated plan members escalate to plan administrators, who escalate to clients, who question their decision to purchase. My work needed to address friction across all three groups simultaneously.

Mapping the System Before Changing It

I spent my first six months learning the business by talking to people across departments and mapping how their work connected. Sales, underwriting, claims processing, client services, plan setup, marketing, IT development — I documented what came into each team, what they did with it, where it went next, and what systems were involved.

I transferred everything I learned onto large sticky-backed paper and created a journey map mural on the longest continuous wall in the office. The location was deliberate: high foot traffic, near the bathrooms, impossible to miss. People saw it, asked about it, contributed to it. It became a defining artifact of my role and established credibility across the organization.

Client Lifecycle Journey Map Created in-office on high-traffic wall • Collaborative artifact Prospecting Sales cycle 6-18 months Quoting & Underwriting Data collected Plan Setup ! Manual re-entry Error-prone Onboarding Plan members enrolled Claims Processing ! First claim confusion Renewal Annual cycle or exit Key Breakdowns Identified: Clients re-submitted same data multiple times (prospecting → setup) Manual plan setup introduced errors and delays First-claim processing created churn risk through confusion No plan member feedback loops existed Teams appeared siloed due to information handoff failures

The journey map revealed what no single team could see: how decisions made in one part of the organization created friction elsewhere, and how the customer experience broke down at nearly every handoff.

The map covered the complete client lifecycle: prospecting, quoting, sales, underwriting, plan coding, onboarding, maintenance, claims processing, renewal conversations, and either renewal or exit. It showed where information flowed smoothly and where it didn't, where teams had visibility into each other's work and where they operated blind, and where systems required manual human intervention to tie things together.

Click any breakdown to expand

Clients re-submitted the same information multiple times

Basic employee demographics were collected during underwriting to generate a quote, then requested again during plan setup. Additional data like staff positions and salary bands were gathered at different stages without showing clients what had already been provided. This created the perception that teams weren't communicating and extended sales cycles unnecessarily.

Sales overpromised what operations could deliver

The sales team occasionally committed to plan designs or coverage options that underwriting couldn't support within the client's budget or risk profile. This created internal conflict and damaged client trust when promises had to be walked back.

Plan setup was manual, slow, and error-prone

Information collected during sales and underwriting had to be manually re-entered during plan setup. This not only introduced errors but also delayed plan activation, frustrating clients who had already completed what they thought was the onboarding process.

First-claim processing created churn risk

Plan members often had their first claim denied or processed in a way they didn't understand. The explanation of benefits (EOB) documents were confusing, looked like legal letters, and used jargon. Members complained to their employers, who sometimes questioned whether they'd made the right purchase decision.

No feedback loops existed for plan members

GroupHEALTH surveyed clients but had no mechanism to gather feedback from plan members — the actual users of the benefits. This meant the organization had limited visibility into the experience that most directly influenced client retention.

Understanding these breakdowns allowed me to recommend targeted interventions that addressed root causes rather than symptoms.

Strategic Interventions Across the Lifecycle

Over the next two and a half years, I led or contributed to several initiatives that addressed the systemic issues uncovered during the mapping work. Some were contained projects with clear deliverables. Others were foundational efforts that informed long-term organizational change.

Client Lifecycle Data Redesign

I was tapped to lead one of three organization-wide business process redesigns. My focus was mapping how client and employee data moved through the organization from prospecting through renewal, identifying redundancies, and defining how it should flow in an ideal state.

The existing process required clients to submit the same information multiple times. Demographics collected for underwriting quotes weren't passed to plan setup. Additional data needed for plan customization was requested without showing clients what they'd already provided. This extended sales cycles, created errors, and made teams appear siloed.

I mapped the current state and the ideal future state, documenting every handoff and identifying where automation could replace manual re-entry. My work became the foundation for a system of record initiative that allowed clients to see what they'd already submitted, added progressive disclosure for additional fields only when needed, and automated data transfer to plan setup — eliminating a major source of errors and delays.

Explanation of Benefits (EOB) Redesign

First-claim processing was a make-or-break moment for plan member satisfaction. When claims were denied or processed in ways members didn't understand, they complained to their employers, creating churn risk. The EOB documents explaining how claims were calculated were a primary source of confusion.

I identified the need for the redesign, pitched it cross-functionally, and led the project in collaboration with legal, claims processing, client services, development, marketing, and graphic design. We also consulted domain experts to ensure the redesigned EOBs didn't stray too far from industry standards, as these documents are sometimes shared with other providers for coordination of coverage.

Changes included: Plain language explanations of what an EOB is and how to read it; moving claim processing codes from a footer to inline placement directly under each claim (improving scannability and reducing cognitive load); introducing color and typographic hierarchy to distinguish paid, denied, and partially covered claims; and creating layouts optimized for both digital delivery and print.

The project took a few months from pitch to launch. Post-launch, we saw a measurable reduction in support calls related to claims processing and improved satisfaction scores from plan members.

Plan Member Onboarding Sessions

For select large clients, GroupHEALTH offered customized onboarding sessions to introduce plan members to their benefits. These sessions were an opportunity to set expectations, reduce confusion, and build trust early in the relationship.

I overhauled the sessions entirely: created new presentation materials, trained client services representatives to deliver them consistently, and attended several sessions to gather feedback and refine the approach. We also launched a post-session survey to measure participant satisfaction.

Satisfaction scores ranged from 80–95%. Clients frequently praised the clarity and simplicity of the sessions, noting that they had expected purchasing benefits to be expensive, complicated, and a heavy lift. Many respondents specifically named the client services representatives who delivered the sessions, highlighting the quality of the experience.

Plan Member Feedback Loops

GroupHEALTH had surveys for clients but none for plan members. I scoped, drafted, and launched plan member feedback surveys to close that gap. The goal was to surface issues before they escalated to clients and to identify opportunities for product and service improvements.

I also ensured the feedback didn't disappear into a void. The claims and contact centre teams followed up with respondents, and I personally followed up with select clients, particularly those who could serve as references. This work led to writing over a dozen reference letters on behalf of clients after phone conversations with them.

Marketing Strategy & Messaging Shift

After completing training through Pragmatic Institute, I applied what I learned to shift GroupHEALTH's sales and marketing approach from product-led to problem-led. Rather than leading conversations by listing features and services (a common but confusing approach in the benefits sector), I created needs-based marketing assets that defined market problems, outlined GroupHEALTH's unique approach, and presented capabilities in the context of solving those problems.

I developed key metaphors that helped prospective clients think differently about benefits. One was the first aid kit: instead of describing products in isolation, we framed the conversation around health events and matched plan components to those events. Another was the emergency kit for disability coverage: you don't want to use it, but you need to have it, know it's there, and understand generally what's inside and how it works.

These assets were used by the prospecting teams and became foundational to how GroupHEALTH communicated its value to new clients.

Systemic Change Across the Organization

The work didn't result in a single shipped product or a one-time improvement. It informed a multi-year transformation of how GroupHEALTH understood and served its customers.

The client lifecycle data redesign became the backbone of a system of record initiative that streamlined sales cycles, reduced errors, and improved the client experience from first contact through renewal. The EOB redesign reduced confusion and complaints at a critical trust-building moment. The onboarding sessions set a new standard for client support at scale. The plan member feedback loops gave the organization visibility it had never had before. And the marketing strategy shift changed how the sales team approached prospective clients.

Throughout this work, I operated as a strategic generalist: translating customer insight into product improvements, content strategy, operational change, and executive communication. The role required navigating regulatory constraints, aligning cross-functional stakeholders, and making trade-offs between technical feasibility, business priorities, and customer needs.

Systems Thinking Customer Experience Strategy Cross-functional Leadership Journey Mapping Content Strategy Product Marketing Stakeholder Alignment Service Design Research Translation

What This Work Demonstrates

Mapping complex systems before recommending changes. The journey map wasn't documentation for its own sake. It was a diagnostic tool that revealed breakdowns no single team could see and built organizational alignment around a shared understanding of the customer experience.

Designing for multiple stakeholder types simultaneously. Clients, plan administrators, and plan members all had different needs and different relationships to the product. Improvements had to work across all three groups or risk creating new problems elsewhere.

Navigating constraints to deliver real improvements. Industry standards limited how far the EOB could change. Regulatory requirements constrained marketing claims. Legacy systems shaped what was technically feasible. Every project required balancing customer needs against operational and technical realities.

Influencing without direct authority. I didn't manage product, engineering, or marketing teams. I earned credibility through the quality of the work, built relationships across departments, and got seats at decision-making tables by demonstrating pattern recognition and strategic thinking.

Translating insight into action at multiple levels. Some insights led to tactical fixes (EOB layout changes). Others informed strategic initiatives (system of record). The work mattered at both the craft level and the organizational level.