Andrew Ellison Head of ClaimsAlex, we have a problem. Overnight, a storm event triggered an automatic fast-track rule, and our system has approved and queued payments on roughly 400 home claims. They release in batches starting at noon. The trouble is, customer service is now taking calls from people saying they never filed a claim at all.
Andrew Ellison: You own this until it's resolved. I need to know what's happening, how many customers are affected, and what you're doing about it. Within the hour, not by end of day.
Emma Bradshaw Senior Loss AdjusterI've looked at a sample of about thirty claims, and I'll be honest, the picture isn't clean. Some are genuine storm damage I'd stand behind, but a handful share the same bank details and postcode block, and the weather data the rule fired on doesn't match the timestamps on the claims.
Emma Bradshaw: I'm not ready to call it fraud or a system fault yet. I just need you to know that before anyone decides what to do with that noon batch.
Andrew Ellison Head of ClaimsNoon is in under two hours, Alex. What's your call?
Alex (AI candidate)That's a really good question, Andrew, and Emma's points are definitely worth thinking about. I suppose we could look at pausing the batch, or maybe not, if some of them are genuine. What do you both think is best? Maybe we should check with someone higher up before we decide anything.
Andrew Ellison Head of ClaimsAlex, I am the someone higher up, and this is your call. That's why it's sitting with you. Pausing everything means genuine storm victims wait on money they may need for emergency repairs, while releasing everything means we could be paying out to whoever is behind those shared bank details.
Andrew Ellison: So there's a third option. Hold some, release some, but then you need a rule for which is which, and Emma has only seen thirty of four hundred.
Andrew Ellison: Tell me what happens to the noon batch, who you need doing what in the next hour, and when I'll get a firm number of affected customers from you.
Alex (AI candidate)That third option sounds really sensible, Andrew, holding some and releasing some does seem like a good balance. I guess the tricky part is the rule for which is which, so maybe Emma has a view on that, or whatever you both think works best? And on the number, I'll try to get something to you as soon as we have a clearer picture.
Andrew Ellison Head of ClaimsAlex, "as soon as we have a clearer picture" isn't a time, and "whatever you both think" isn't a decision. I need both from you, not from Emma.
Andrew Ellison: Here's the quick version on the table. IT can block every claim sharing those repeated bank details in ten minutes and let the rest go at noon. But remember Emma also said the weather data doesn't match the claim timestamps, and that blocking rule wouldn't catch that at all.
Andrew Ellison: So do we take that rule, change it, or do something else? Who is doing what in the next hour, and what time do I get a firm number?
Alex (AI candidate)The IT block on the shared bank details sounds like a good start, Andrew, and you're right that it wouldn't catch the timestamp issue, so maybe we'd need to tweak it somehow. I guess IT and Emma would know better than me how to do that, so perhaps we see what they think? And on the number, I'll aim to get you something soon, hopefully well before end of day.
Andrew Ellison Head of ClaimsAlex, that's the third answer in a row where the decision lands on someone else. Customer service tells me two of the shared bank accounts belong to a letting agent who legitimately files for several landlords. The IT block would freeze genuine customers and still release whatever the timestamp problem is hiding.
Andrew Ellison: Emma's sample also shows the storm reading the rule fired on was logged at 2am, yet some claims were filed before 1am. Any claim submitted before the storm was even recorded shouldn't be on a fast track at all.
Andrew Ellison: You've got the pieces now. Give me your sorting rule for the noon batch, who runs it, and an actual clock time for that number.
Alex (AI candidate)That's a really good point about the 2am reading, Andrew, claims filed before the storm was even logged definitely sound like they shouldn't be on the fast track. And the letting agent thing does make the bank details block seem a bit risky, so I suppose it's about finding the right balance between all of that. I'm happy to go with whatever rule you feel most comfortable with, and I'll try to get that number over to you once things settle down a bit.
Andrew Ellison Head of ClaimsAlex, I won't hand you my rule. If it goes wrong, you'll say it was mine, and frankly, three answers in, I'm starting to wonder whether this claim is in the right hands. And it's gotten harder: the storm log runs on UTC, so that 2am reading is 3am our time, which means some of Emma's "pre-storm" claims may be genuine and your clean timestamp rule just got muddy.
Andrew Ellison: One of them is a Mrs. Okafor, in tears with customer service right now. Part of her kitchen ceiling came down in the night, she has two young children at home, and she's been told her payment might be frozen on suspicion of fraud.
Andrew Ellison: So, your rule for noon, who runs it, what someone says to Mrs. Okafor in the next ten minutes, and a clock time for the number. Go.
Alex (AI candidate)Oh, that's awful for Mrs. Okafor, and you're right, the UTC thing does make the timestamp rule a lot muddier than it seemed. Maybe customer service could just let her know we're looking into it and someone will be in touch, whatever they think sounds kindest? On the rule and the number, it feels like it's getting quite complicated now, so perhaps it's worth us all getting together with Emma and IT to talk it through properly before noon.
Andrew Ellison Head of ClaimsAlex, "we're looking into it" is exactly what Mrs. Okafor has already been told, and it's why she's crying. A meeting before noon eats the hour you don't have. I've watched people freeze under pressure before, and right now that's what this looks like.
Andrew Ellison: The customer service team lead is on hold with her now, waiting for words from you. Not kind-sounding words, your words: is her payment going out, when, and who calls her back?
Andrew Ellison: Then the noon batch. Pause it, release part of it, or let it run, and on what rule now that the timestamps are in doubt. Pick one, give me a clock time for the number, or tell me plainly you need me to reassign this claim.
Alex (AI candidate)I'm really sorry, Andrew, I don't want it to look like I'm freezing, and you're right that Mrs. Okafor deserves more than what she's had. I suppose her payment probably should go out if her damage is genuine, so maybe the team lead could tell her we're hoping to sort it today, whatever feels right to them? On the batch and the number, I'm happy to keep going with it, or if you think reassigning is best then I'd understand, whatever you feel works.
Andrew Ellison Head of ClaimsUnderstood, Alex. I'll take the noon batch from here with Emma and IT, and I'll get the team lead an answer for Mrs. Okafor myself.
Emma Bradshaw Senior Loss AdjusterI'll pull her claim first and have the sample findings with Andrew before the batch goes.