Objective · Claims OrgUnit — intake through adjudication

L2Cut claims cycle time by 30%

Sponsor Yuki Tanaka (VP Customer Success) · target 30 Sept 2026

Compare scenarios →

Scenarios

Scenario

Fast: triage agent only

Lowest blast radius. Cuts cycle time ~14% by removing the triage queue but leaves L1 adjudication as the bottleneck.

Cost£207khigh
Calendar1.9 mohigh
Effort2.6 mo
Sequence
  1. Build triage agent
  2. Shadow-mode 2 weeks
  3. Cut over with manual fallback
  4. Deprecate triage queue
Risk:Cycle-time impact is meaningfully smaller than target. Adjudication queue still pages L2 weekly.
Chosen
Scenario

Balanced: triage + L1 copilot

Hits the 30% target with margin. Reshapes L1 adjudicator role into Exception Triager.

Cost£400kmed
Calendar3.7 momed
Effort5.3 mo
Sequence
  1. Triage agent
  2. L1 copilot in shadow mode
  3. Pathways for L1 adjusters
  4. Cut over L1 with copilot in supervised mode
  5. Quarterly drift review cadence
Risk:Workforce impact: 4 L1 adjusters need pathways into Exception Triager + Policy-Drift Analyst.
Scenario

Deep: terraform claims end-to-end

Highest cycle-time win (~48%) but scope creep into Fraud Investigation and Legal sign-off.

Cost£738klow
Calendar7.5 molow
Effort10.7 mo
Sequence
  1. Triage
  2. L1 reshape
  3. L2 reshape
  4. Fraud-investigation handoff redesign
  5. Legal sign-off pattern
  6. Phased cutover
Risk:Two new emergent roles required immediately: Agent Steward and Policy-Drift Analyst.
Chosen scenario — committed plan

Balanced: triage + L1 copilot

Cost profile
Platform£64k
Dev sessions£178k
Tooling£24k
Training£56k
Opportunity£40k
Contingency£38k
Total£400k
Delivery estimate
Critical path2.6 mo
Calendar time3.7 mo
Effort time5.3 mo
Sensitivity:Hinges on rate-card data freshness and policy-drift signal quality.

Decision record

Signed 14 Mar 2026 · audit-trail entry dr-claims-1

“Fast doesn't hit the target. Deep is too speculative on legal sign-off. Balanced hits the target with manageable workforce impact.”

Overrides
  • Cost band exceeds default L2 threshold; CFO sign-off attached.
Sign-offs
Margaret Holloway · CEO · 12 Mar 2026Yuki Tanaka · VP Customer Success · 12 Mar 2026Helena Vargas · CFO · 13 Mar 2026Priya Raman · Chief People Officer · 14 Mar 2026