Claims-Service Product Operating Model Architect

The mandate

Automation reduced handling time for straightforward claims, yet customers with vulnerability, disputed causation, multiple suppliers or long recovery paths still move between product, operations, technical and complaints queues without one outcome owner. Transformation teams organise work by projects and channels, while claims leaders manage volumes by portfolio. The defined problem is to create product ownership for enduring claims services so customer outcome, operational flow, decision quality, supplier behaviour and technology change are governed together.

The principal artefact is a claims-service product operating model covering product boundaries, accountable leaders, journey states, decision rights, multidisciplinary teams, technical authority, supplier integration, automation lifecycle, customer-outcome measures, risk controls, funding and portfolio governance. It will include a service-product taxonomy, role charters, interaction model, minimum outcome data, prioritisation method, funding logic and transition roadmap. Catastrophe surge and vulnerable-customer scenarios must be designed as core conditions rather than exceptions to steady-state flow.

Four milestones structure the engagement. Week three maps five customer journeys and current ownership breaks. Week seven presents product-boundary options with workforce, control and funding implications. By week twelve, two target designs are simulated through a catastrophe surge, contested complex claim, vulnerable customer and failed supplier. At week sixteen, the selected model, implementation sequence, team archetypes, governance calendar and executive decision paper are delivered, with milestone billing released only for the corresponding accepted evidence.

The group claims executive owns acceptance, supported by the customer officer and risk leader. Completion requires every sampled journey to have one accountable outcome owner, reserved technical decisions to remain protected, supplier and automation transitions to be explicit, and finance to trace funding from portfolio choice to product capacity. Frontline leaders must run the four scenarios without consultants repairing ambiguous interfaces. Dissent on legal or regulatory interpretation is recorded and referred rather than resolved by operating-model preference.

The client will provide claims files under secure protocols, journey measures, complaints, supplier contracts, automation inventory, risk policies, funding data and designated frontline participants. Consultants will not decide individual claims, give legal interpretation, select software, renegotiate supplier agreements, design algorithms or implement organisational changes. Detailed workforce consultation, technology build and rollout beyond the four-month design are excluded; access limitations will be stated in the final evidence boundary and may change the recommendation.

Why this is external work

Claims executives are accountable for current service while transformation sponsors are invested in existing automation programmes, making boundary redesign politically difficult. Product-model expertise inside the insurer is concentrated in digital channels rather than complex end-to-end service. External specialists can provide neutral customer-case evidence and a finite tested design without taking claim authority or selling a platform implementation.

What you will own

• Trace five claims journeys across intake, assessment, technical decision, suppliers, payment, recovery, complaint and closure.
• Define service-product boundaries that preserve one outcome owner across channels, complexity and customer vulnerability.
• Design role charters joining claims expertise, operations, customer design, data, technology, risk and supplier management.
• Simulate catastrophe, complexity, vulnerability and supplier-failure scenarios through competing accountability and funding models.
• Specify outcome measures connecting timeliness, decision quality, customer effort, remedy, leakage, cost and colleague load.
• Protect reserved claim, legal, clinical and risk judgments within faster multidisciplinary product-team decisions.
• Deliver the transition roadmap, governance forums, capacity logic, capability plan and unresolved decision register.

Candidate qualifications

• Has designed product-based operating models for insurance claims or another regulated, case-intensive customer service.
• Can evidence ownership changes that improved complex journeys rather than only accelerating low-complexity digital transactions.
• Understands claims technical authority, vulnerability, complaints, catastrophe surge, suppliers, automation and portfolio funding.
• Has tested organisation designs using real case journeys and adverse scenarios before recommending structural change.
• Can distinguish customer-outcome accountability from individual claim authority, legal judgment and regulatory ownership.
• Is independent from claims-platform and outsourcing vendors that could benefit from the selected operating design.

Non-negotiables

• Can lead fortnightly Sydney sessions and complete three frontline, technical or supplier evidence immersions.
• Will work from secure sampled claim evidence rather than relying exclusively on process maps and executive interviews.
• Brings regulated claims operations and product-model experience; agile coaching alone does not meet the requirement.
• Will not weaken technical claim authority or present an operating design as a regulatory interpretation.

1. 49 words maximum. Which claims journey boundary did you redraw after examining a complex customer file end to end?
2. 49 words maximum. How would you test whether a product owner can remain accountable without deciding individual claims?
3. 49 words maximum. What catastrophe scenario most effectively exposes weaknesses in a claims product operating model?