How a Regional Health Insurer Built a Provider Experience Strategy

What Is Provider Experience and Why Does It Matter to Health Plans?

Provider experience is the cumulative quality of the interactions that physicians, office managers, and billing teams have with a health plan: across contracting, credentialing, coverage verification, authorization, payment, and communications. When those interactions are difficult or inefficient, the administrative burden falls on providers and ultimately affects patient care.

For health plans, provider experience is as critical as member experience: providers interact with the plan every day, and friction in those interactions drives support-center volume, payment disputes, and network dissatisfaction.

Client Context

Andrew Reise served a large regional health insurer serving millions of members across multiple states. Like many healthcare payers, the organization was balancing complex regulatory requirements, evolving reimbursement models, and rising expectations from both members and healthcare providers.

While many health plans focus primarily on member satisfaction, our client recognized that provider experience is equally critical to delivering quality care. Physicians, office managers, and billing teams interact with health plans every day to verify coverage, obtain authorizations, and manage payments. When those interactions are difficult or inefficient, the burden falls on providers—and ultimately impacts patient care.

At the same time, the client had recently formed a dedicated customer experience (CX) organization tasked with improving how the health plan listens to and acts on feedback from its stakeholders.

Leadership recognized an opportunity to better understand the provider experience and design a structured voice of the customer (VoC) strategy to guide improvements.

Andrew Reise stepped in to help define that strategy.

The Challenge

Despite strong relationships with many providers, the client faced a challenge that’s familiar to large healthcare payers: The provider experience was fragmented, complex, and difficult to measure.

Providers reported several recurring pain points when interacting with the health plan.

Complex Coverage and Network Structures

Healthcare providers must frequently verify patient coverage, confirm benefits, and determine cost-sharing requirements before delivering care. However, providers reported that health plan networks and benefit structures were difficult to navigate. In many cases, staff members needed to call the provider support center to obtain basic information.

As one provider explained: “I am very busy, and the complexity of networks and the lack of self-service capabilities mean that I spend time on the phone with the health plan instead of caring for the patient.”

Inconsistent Communication Across Departments

Providers also noted that interactions with the health plan often involved multiple departments and points of contact, making it difficult to resolve issues quickly. 

In some cases, providers felt that different teams within the health plan weren’t aligned.

As another provider mentioned, “There are multiple points of contact within the health plan, and they do not seem to know what the others are doing.”

Limited Visibility into Provider Journeys

While our client had access to several sources of feedback—provider support center data, internal reports, and survey responses—the information was siloed across the organization.

This made it difficult for leaders to answer key questions:

• Where were providers experiencing the most friction?
• Which interactions mattered most to providers?
• What improvements would deliver the greatest impact?

Without a structured VoC strategy, it was challenging to turn provider feedback into prioritized improvements and measurable outcomes. To move forward, the client needed a clearer understanding of the provider experience—and a roadmap for improving it.

Actions Taken

Conducting Deep Provider Research

The first step was to understand the provider experience directly from those who interact with the health plan every day.

Andrew Reise conducted 22 in-depth interviews with provider organizations, including:

• Healthcare executives
• Practice administrators
• Billing and coding professionals
• Contracting specialists

These interviews provided detailed insights into how providers navigate coverage verification, authorization processes, and billing interactions. To complement the external research, the team also conducted focus groups with provider support center representatives and workshops with internal provider account managers.

These sessions helped identify operational challenges that affect both providers and internal teams.

Mapping the Provider Ecosystem

Using the research findings, Andrew Reise mapped the full provider ecosystem and identified the critical interactions between providers and the health plan.

Five key provider journeys emerged as particularly important:

1. Contracting with the health plan
2. Provider onboarding
3. Determining patient coverage
4. Getting paid for services
5. Communications and reporting

Each journey was analyzed to identify moments of truth—interactions that have the greatest impact on provider satisfaction and operational efficiency.

Developing Provider Personas

The research also revealed that different provider roles experience the health plan in different ways.

To reflect these differences, Andrew Reise developed three role-based provider personas:

• Executive leaders, such as practice owners and healthcare CEOs
• Office managers responsible for daily operational coordination
• Billing and coding professionals managing insurance verification and reimbursement

These personas helped the client better understand the goals, constraints, and expectations of each group.

For example, healthcare executives were focused on financial stability and strategic partnerships, while billing staff were primarily concerned with accurate coverage information and faster issue resolution.

Designing a CX Measurement Framework

Understanding the provider experience was only the first step. Our client also needed a way to measure and manage CX performance over time.

Andrew Reise designed a CX measurement strategy that defined:

• Key experience metrics
• Data collection methods
• Governance processes for managing feedback

The team also evaluated the enterprise feedback management technology landscape and provided the client with a short list of recommended vendors capable of supporting the new VoC program.

Creating a Strategic CX Roadmap

Finally, Andrew Reise synthesized the research findings into a strategic CX roadmap that prioritized improvement initiatives.

The roadmap identified 15 key insights across the provider journeys and 30 opportunities and recommendations to improve the provider experience.

These recommendations addressed several areas, including:

• Improving digital self-service capabilities
• Simplifying coverage verification processes
• Streamlining provider communications
• Reducing unnecessary administrative burden

The roadmap also defined the steps required to build long-term CX measurement and governance capabilities.

Outcomes & Impact

• First, the project created a clear, structured view of the provider experience, helping leaders understand where providers were experiencing the most friction.

• Second, the research identified moments of truth that have the greatest influence on provider satisfaction and operational efficiency. This allowed our client to prioritize improvements that would deliver meaningful value for both providers and the organization.

• Third, the CX measurement framework established the foundation for a sustainable VoC program, enabling the client to continuously collect, analyze, and act on feedback.

• Finally, the CX roadmap helped guide multiyear investment decisions and a broader provider transformation initiative focused on making it easier for providers to do business with the health plan.