A Pilot Plan for Claims

In practice

The claims director, Tomas, agrees to a pilot on property claims, which carry real money and regular audits but are not in crisis. The analyst, Grace, names the stakeholders: two claims handlers, a team leader, the compliance officer, a data analyst, the test lead, and the engineer building a triage model. In the first fifteen days, the group collects nouns from the claims manual and old forms, builds an inventory of twenty-two things, and draws a map with four zones. Five core things emerge, and two Gold candidates: the Claim Decision and the Payment. Grace notes the starting point too: last quarter, a third of the change requests on property claims came back for rework. From day sixteen to day forty, she drafts a Gold Pack for the Claim Decision, with its purpose, sensitivity and main risks, and writes four cards: create the decision, read it, update it on appeal, and generate the decision letter. Two review sessions, with handlers and the compliance officer together, change the definition twice. From day forty-one to sixty, Grace and the test lead build a matrix for the Claim Decision, and the triage engineer adds the model as a row. Walking the current system against it reveals a report still using an outdated reason code. In the last thirty days, two real changes go through the matrix, and one catches a letter template nobody had listed. The pilot ends with Grace's short story to Tomas: the map, the Pack, the matrix, and the letter that would have gone out wrong.