PRODUCTION DEFINITION
Claims review assistant · Organization: [Organization] · Business owner: [Name, role] · Technical owner: [Name, role]
- 1. Scope
- Pre-checks each incoming claim and drafts a decision note for the handler. Out of scope: payment decisions.
- 2. Success criteria
-
- Agreement with senior handlers on 90% or more of 500 labeled claims
- No claim decided without a handler
- Draft ready in under 60 seconds per claim
- 3. Evaluation set
- 500 historical claims, labeled by two senior handlers, frozen at signature
- 4. Security
-
- Data stays in the organization’s own cloud tenant
- Single sign-on with the organization’s identity
- Every action logged
- 5. Approvals
- A handler approves every decision. The system never writes to the claims system on its own.
- 6. Go-live
- [Date] · Three weeks alongside the current process before cut-over