An Operating Model for a Claims Team

In practice

Back at the insurer, the claims director asks the analyst, Grace, to make sure the Claim Decision's Pack never goes unopened again. Grace starts with hats. She becomes the steward for the Claim Decision and the Payment. A technical writer, Owen, takes the Pack Editor's hat for all claims Packs. The test lead becomes matrix custodian. The architect who reviews vendor tools becomes the AI Safety Lead, with two days a month set aside for it, because the book warns that the role needs real time. Next, rituals. The Claim Decision gets an object review every six months, with the next date in the calendar. The weekly change meeting adds one question: which things are materially affected, and have we checked their matrices? Every AI proposal must fill the five gate items before build. Stories that change a claims thing carry the three definition-of-done lines. The first test comes in month two. The vendor offers the same recommended-outcome feature from the opening scene. At the gate, the proposal states that it writes a pre-filled outcome on every claim. The AI Safety Lead applies the boundary test: if nobody looks, the pre-fill becomes the decision. The team accepts the feature only as a suggestion shown beside the decision, not inside it, and logs every accept, edit and reject.