Maxwell Getz CASE 04 / 05
PBM SCALE ABARCA HEALTH

Claims Operations at PBM Scale

Designing the operational interfaces behind a pharmacy benefit manager: high-density tools that let teams move thousands of claims a day through adjustments, reprocessing, and rebates without losing the thread.

ROLE  Principal UX Designer YEAR  2023—Present COMPANY  Abarca Health
FIG.01 · CLAIMS MOVING THROUGH OPERATIONS
CONTEXT

At PBM scale, the interface is the operation.

A pharmacy benefit manager sits between payers, pharmacies, and patients, adjudicating enormous volumes of claims. When something needs a human, whether an adjustment, a reprocess, or a rebate reconciliation, operators need tools that surface the right record instantly and make the next action obvious.

I design the operational surfaces behind that work: dense, data-heavy interfaces where clarity and speed directly affect how many claims a team can resolve in a day.

PBM scale Data-dense UI Operational tooling Part of a design system
ROLE & TEAM
ROLE Principal UX Designer · claims operations
TIMELINE 2023—Present
TEAM Cross-functional · product, engineering, operations
SCOPE Claims tooling across adjustments, reprocessing, rebates
FOCUS Information density, workflow speed, system consistency
PROCESS
01

Sit with operators

Observed claims teams to understand the real bottlenecks hiding inside high-volume, repetitive work.

02

Tame the density

Designed information-dense layouts that stay scannable and calm even under heavy data loads.

03

Standardize patterns

Built repeatable patterns for tables, filters, and bulk actions that carry across every claims tool.

04

Measure throughput

Tracked how each design change moved real operational throughput, not just satisfaction.

KEY DECISIONS & CRAFT THREE DECISIONS
DECISION 01

Density without noise

Packed more data per screen while preserving a clear hierarchy, so operators see everything without hunting for it.

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DECISION 02

Scannable by default

Tuned type, alignment, and contrast for fast vertical scanning of tabular data, the operator's primary motion.

DECISION 03

Bulk actions, safely

Designed multi-select and batch operations with clear affordances and guardrails, so operators act on many claims at once with confidence.

OUTCOMES
40%
FASTER CLAIM
RESOLUTION
1000s
CLAIMS HANDLED
EVERY DAY
3+
OPERATIONS SURFACES
UNIFIED

The claims tooling is part of Abarca's broader platform, where small interaction improvements compound across millions of claims a year.

REFLECTION

Operational design is invisible when it works. The reward isn't a beautiful screen. It's an operator clearing their queue faster and trusting the result. Constraint and consistency matter more than novelty here.

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Design System + AI Component Bridge

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