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CASE 03 / ENTERPRISE DATA & PRODUCT DISCOVERY

Making claims more observable

Connect a received record to an outcome, an owner, and a next action.

MY CONTRIBUTION

Problem discovery · data investigation · business framing · operational follow-through

WHO IT SERVES

Claims operations, data teams, support, and business leaders

THE PRODUCT VISION

Make exceptions visible and actionable across a complex processing journey.

An anonymized experience narrative. Demonstrations use reconstructed flows and invented inputs; internal metrics and artifacts are excluded.

A use case worth solving.

RECONSTRUCTED SCENARIO

An operations reviewer sees that an incoming record has no obvious processing outcome. It may still need attention, or it may have been handled through another channel. A recovery action without that distinction could create duplicate work.

Context

Claims processing spans systems and teams. A dashboard for one stage cannot by itself establish what happened across the entire journey. My work connected received records, processing results, alternative handling paths, and the actions needed to resolve a difference.

What I owned

I owned investigation and impact framing, worked through reconciliation logic, and connected findings with a correction process and operational monitoring. Communicating the issue to leadership meant explaining both the business significance and the path to a durable change.

THE STARTING CHALLENGE

An isolated status view

A record is visible only within the system or channel currently being inspected.

THE PRODUCT DIRECTION

A reconciled outcome

The process connects receipt, handling, and resolution across the journey.

The reasoning behind the product.

DECISION 01

Reconcile end to end

Compare incoming records with the outcomes the organization can account for.

The tradeoff

A component-level success measure can miss work that never reaches that component.

DECISION 02

Check alternate handling

Distinguish truly outstanding records from work completed through another path.

The tradeoff

An unmatched record is a signal to investigate, not proof that the work has never been done.

DECISION 03

Design the response

Give exceptions an owner, a resolution path, and ongoing monitoring.

The tradeoff

A count or a one-time correction does not establish what happens the next time the condition appears.

Follow a use case through the decisions.

The example records and branches below are invented to explain the reasoning. They do not reproduce a workplace incident.

Enable JavaScript to play the synthetic scenarios and inspect the decision flow.

What would convince us it works?

A reconstructed evaluation plan showing the questions I would make explicit. These are evaluation criteria, not reported test results.

Use caseExpected behaviorEvidence to inspect
Known outcomeMatch the record without generating unnecessary work.Reconciliation coverage; false exceptions.
Handled through another channelLink the existing outcome before any recovery action.Duplicate prevention; traceability of the match.
No accounted-for outcomeCreate an actionable exception with context and ownership.Resolution completeness; visibility; recurrence detection.

What the work
changed.

The work improved visibility and linked corrective action with ongoing monitoring. Incident specifics, financial exposure, and internal architecture are intentionally excluded. The portfolio demonstrates the investigative approach and the design of an accountable operating process.

WHAT I WOULD CARRY FORWARD

I would treat reconciliation as a product capability from the beginning. It answers a question every operating team eventually needs to ask: can we account for the work we received?

KEEP EXPLORING / CASE 04Earn the right to release