Claims AI Blueprint Director — Consulting, General Insurance

The mandate

The defined problem is that isolated claims-AI pilots optimise individual tasks without a portfolio view of leakage, customer fairness or adjuster accountability. The insurer needs a blueprint before buying additional automation.

The deliverable combines a claims-journey baseline, use-case portfolio, data and model-control standard, target human-review design, quantified economics and an implementation roadmap for motor and health.

Milestone one is due 15 October 2026 with the baseline; milestone two on 30 November with prioritised use cases; milestone three on 15 January 2027 with design-tested controls and workflows; milestone four on 15 February with economics and board roadmap.

The Claims Transformation Council accepts the blueprint when fifteen use cases are scored consistently, three priority journeys pass tabletop testing, service and fairness thresholds are explicit, and finance validates benefits and costs within a ten-percent sensitivity band.

The insurer provides two years of claim and complaint samples, process documents, pilot results, model artefacts, vendor terms and named motor and health adjusters. Secure access must be live by the fifth working day.

Why this is external work

Pilot owners are advocating their individual technologies, while claims leaders lack capacity to integrate them. An external team supplies independence from vendors and experience connecting model controls to real adjuster work. The assignment ends when the blueprint is accepted, before implementation procurement.

What you will own

• Build the milestone-one baseline for cycle time, touch, leakage, complaint and overturn outcomes.
• Score fifteen use cases by value, evidence, harm, data readiness and workflow feasibility.
• Select three journeys for milestone-two detailed design with council agreement.
• Define human review, explanation, escalation and post-deployment monitoring controls.
• Tabletop-test priority workflows with adjusters, medical reviewers and customer service.
• Quantify benefits, run cost and sensitivity for milestone four finance validation.
• Deliver the sequenced roadmap, procurement guardrails and acceptance evidence to the board.

Candidate qualifications

• 18–22 years in insurance claims, analytics, AI or operating-model transformation.
• Direct delivery of claims automation across motor, health or property lines.
• Experience measuring leakage and service without treating claim denial as benefit.
• Practical knowledge of document AI, fraud signals, decision support and human review.
• Evidence of designing model controls for customer-impacting insurance decisions.
• Ability to remain independent of automation-platform vendors.

Non-negotiables

• Senior director present for all adjuster design tests and council reviews.
• No vendor resale, implementation option or contingent share of projected savings.
• Client data remains inside the insurer's secure environment.
• Finance and claims measures must reconcile before final acceptance.

1. 49 words maximum. Which claims-AI use case did you take into production, and how did you measure fairness and leakage together?
2. 49 words maximum. How would you rank fifteen use cases without allowing vendor maturity to dominate business value?
3. 49 words maximum. Which claim, complaint and model artefacts must be available by working day five?