A quick snapshot of your specialty claims book

• Tell me briefly about the types of specialty claims your team refers externally and the common triggers for referral
• How many open specialty claims are currently assigned outside your core claims unit? Options: Fewer than 50, 50 to 199, 200 to 499, 500 or more
• Walk me through one recent complex file that exposed a gap in your coverage analysis or litigation handling
• Who on your team typically decides to escalate a file to an external administrator and what signals prompt that escalation
• Which business lines most often produce the referrals you find hardest to manage internally Options: Professional liability, Directors and officers, Errors and omissions, Environmental / pollution, Construction defect, Product liability, Excess casualty, Self-insured corporate programs

If a headline loss lands on your desk tomorrow, where would your process first show strain?

• If a sudden cluster of complex claims landed today, which operational step would break first and why
• Describe the current workflow from notice of loss to selection of outside counsel for a high-exposure claim
• On average, how long does it take your team to complete the initial coverage analysis and reservation of rights on a complex file Options: Under 48 hours, 2 to 5 business days, 6 to 10 business days, More than 10 business days
• Name the internal approvals required before a settlement recommendation is presented and the typical cycle time for that approval
• What single operational gap in your current workflow would make you stop a pilot with a new administrator immediately

Where coverage interpretation is costing you most, and who is feeling the pressure

• You may be tolerating inconsistent coverage positions across files, where do those inconsistencies surface most often
• List the policy forms, endorsements, or jurisdictional issues that produce the most recurring coverage disputes
• Who holds final sign off on a novel coverage position and how often does that authority shift during a claim lifecycle Options: Claims leadership, Legal counsel in-house, Underwriting leader, Committee review, Other
• Tell me about a recent coverage position that drew regulator attention or a bad faith allegation, what happened and how was it resolved
• If you had to keep only one control to prevent divergent coverage positions across your book, which control would it be Options: Centralized coverage counsel review, Standardized coverage playbooks, Mandatory peer review for complex files, Underwriting sign off, Automated coverage flags in system

Which metrics would convince your board specialty claims are under control

• If your board asked for three numbers to prove specialty claims performance, which three would you produce
• Name the reporting metrics you require from any external administrator for reserving, litigation spend, and counsel performance Options: Case reserves by claim and line, Loss development triangles, Monthly counsel spend by matter, Budget vs actual litigation spend, Frequency of coverage disputes, Subrogation recoveries, Other
• How frequently do you reconcile reserves from external administrators against actuarial rollups and central reserving Options: Monthly, Quarterly, Biannually, Annually, On ad hoc requests only
• Give an example of a specific report or dashboard that caused you to change claims strategy in the last 12 months
• What specific reporting failure, if unresolved before go-live, would cause you to pause a pilot

Assume a surge of high-severity claims, what governance or process gaps would amplify the damage

• Assume there is an unexpected surge of 50 high-complexity professional liability claims, where would you expect the biggest delays or cost overruns to occur
• Where in your approvals, legal review, or vendor selection process do decisions typically slow and why
• Estimate how quickly your current systems can ingest a new third-party feed of claims and what manual work remains Options: Within 24 hours, 2 to 7 days, 8 to 30 days, More than 30 days
• Describe any prior incidents where counsel selection or litigation management by an external party created unexpected budget pressure
• Is there any regulatory, contractual, or internal compliance constraint that would prevent you from handing claims to an outside administrator Options: Yes, regulatory restrictions, Yes, contract or policy clauses, Yes, internal governance, No major constraints identified

The other options you are weighing and why they still feel attractive

• If you kept your incumbent administrator, what would they have to prove to retain the work for the next three years
• Name the alternatives you are actively evaluating today, including internal up-skill or managed litigation-only models Options: Incumbent TPA, Internal up-skill / redeploy staff, Narrow litigation management vendor only, Boutique coverage counsel services, Other
• Has anyone inside proposed solving this without an external partner, and if so, what resource or timeline did they estimate
• What conditions would have to be true for you to stay with your current approach instead of changing vendors
• If the incumbent matched your price and produced the exact reports you want, would anything else stop you from switching Options: No, reporting and price are decisive, Yes, concerns about counsel management, Yes, contractual or political barriers, Unsure

How ready are you to provide the technical and governance pieces an implementation needs

• Many implementations fail on missing data, tell me whether your claims data is centralized, who owns it, and whether extraction APIs are available Options: Centralized with APIs available, Centralized but no APIs, Distributed across systems with partial APIs, Distributed and no APIs
• List the core systems that must be integrated for intake, reserving, and litigation tracking
• Do you have named owners enabled to approve data access, and are they prepared to sign data sharing agreements on a 30 day timeline Options: Yes, owners and ready to sign, Owners identified but timing uncertain, No named owners yet, Legal needs more time
• Describe your internal technical capacity to support integrations, are API engineers and a claims SME available during onboarding Options: Full capacity available, Limited capacity with dedicated points, Capacity will need to be carved out, No capacity currently
• If APIs are not available, would you accept a temporary SFTP feed or is that a deal breaker Options: Accept SFTP temporarily, Require API access, Unsure, need more info

If a short pilot proved the case savings and improved control, what would accelerate a full agreement

• If a pilot delivered a 15 percent reduction in litigation spend and improved reserve accuracy in 90 days, what would you need to see to sign an enterprise agreement that same month
• Identify the KPIs that will determine acceptance at the end of onboarding and the acceptable target for each
• Provide the role and level of the executive sponsor who will approve go-live and the signing authority they hold
• On a scale from 1 to 5, how do you prioritize rapid time to value versus achieving full scope fidelity on day one Options: 1 - Speed only, 2, 3 - Balanced, 4, 5 - Full scope accuracy
• What single acceptance criterion, if unmet, would prevent you from paying for initial services

Next steps, timing, and who will carry this forward

• Are you prepared to move a pilot into contract within 30 days if references and a security review meet your standards Options: Yes, Maybe, pending procurement, No, timeline will be longer
• When would you ideally begin a pilot or proof of concept if approvals align Options: Within 30 days, 30 to 60 days, 2 to 3 months, More than 3 months
• Please enumerate the roles on your side who should join an initial kickoff and the percent of their time available during the first 90 days
• Estimate the earliest realistic go-live date assuming a 60 day onboarding window and typical procurement cycles
• Which pre-contract checks, for example security review, procurement approval, and actuarial sign off, must be completed before a pilot can start Options: Security review, Procurement approval, Actuarial sign off, Legal contract review, Regulatory notification

• Solution Experience Session

• Confirm the current state and its cost
• You confirm the demonstrated workflows eliminate the coverage inconsistency and reduce the counsel spend overruns you described.
• Provide two representative complex claim files and associated counsel invoices for use in the session and follow-up analysis.
• Run Scenario A, end-to-end coverage handling
• You agree the reserve outputs and reporting meet actuarial and reserving needs without extra reconciliation.
• Deliver an annotated claim playbook and a cost projection for the two scenarios within five business days after the session.
• Run Scenario B, counsel selection and litigation oversight
• List the key reserve fields and report extracts your actuarial team requires for validation.
• You identify the remaining evidence required to move to scope and commit to a timeline for providing sample files and invoices.
• Schedule the Solution Scope workshop to finalize scope, responsibilities, and measurable deliverables within two weeks of validation.
• Show reserve and reporting outputs for the same scenarios
• Validate the future state
• Agree remaining evidence and next decision steps

• Solution Experience Session
• Solution Experience Deck
• Solution Brief — Specialty Claims Administration

• meeting
• slides
• document

• Assign Specialty Adjuster and Case Team
• Coverage Analysis and Reservation of Rights Drafting
• Comprehensive Claim Investigation and Liability Determination
• Defense Counsel Selection and Litigation Oversight
• Litigation Budgeting and Expense Management
• Reserve Setting and Loss Development Reporting
• Settlement Negotiation and Structured Resolution
• Subrogation Identification and Recovery Pursuit
• Real-Time Claims Portal Access and Data Exports
• Quarterly Claims Trend and KPI Reporting
• In-House Coverage Counsel Opinions and Briefing
• Expert Witness and Technical Consultant Management
• Regulatory and Bad-Faith Response Support

Assign Specialty Adjuster and Case Team

• Who will be the primary adjuster contact for files in your professional liability line?
• Which internal roles should receive automated notifications when a high-severity assignment is created? Options: VP Claims, Line-of-Business Head, Underwriting Lead, Risk Manager, Other
• How many active high-severity files (incurred > $250,000) do you plan to transfer at go-live? Options: 0-9, 10-49, 50-200, 200+
• Do you require adjusters with admitted-state bar membership or specific state adjuster licenses to participate in coverage counseling? Options: Yes, No
• Confirm the acceptance criteria that will validate an adjuster team assignment (example: named adjuster, system access to the policy file, initial strategy memo delivered within 5 business days).

Coverage Analysis and Reservation of Rights Drafting

• Which policy forms, endorsements, and declarations pages will you provide for sampled claims to support coverage analysis?
• How quickly do you require a formal coverage memorandum and reservation of rights draft after we receive the complete claim file (select target turnaround)? Options: 3 business days, 5 business days, 7 business days, Custom
• Do you require underwriting or compliance sign-off before issuing a reservation of rights letter on policies governed by your corporate forms? Options: Yes, No
• Describe any precedent coverage opinions or historic claim file references we must align to when drafting new opinions (include file numbers or dates where available).
• List the specific coverage triggers you want addressed in each ROR or coverage memo (duty to defend, professional services exclusion, pollution exclusion, contractual indemnity, etc.). Options: Duty to defend, Professional services exclusion, Pollution/environmental exclusion, Contractual indemnity, Other

Comprehensive Claim Investigation and Liability Determination

• Provide the case materials you will supply on transfer (examples: complaint, medical records, prior counsel file, surveillance, vendor reports).
• Specify how investigative interviews should be documented for litigation readiness (audio recording, sworn affidavit, investigator memo). Options: Audio recording, Signed affidavit, Investigation memo, Other
• Name the escalation contact for factual gaps discovered during investigation and provide preferred contact method.
• Are chain-of-custody forms required for physical evidence and vendor deliverables you expect us to obtain? Options: Yes, No
• When should we deliver an initial liability assessment for each transferred file (example target: 10 business days after transfer)? Options: 5 business days, 10 business days, 15 business days, Custom

Defense Counsel Selection and Litigation Oversight

• List any preferred defense counsel panels or pre-approved firms and indicate if rate schedules are provided.
• Is pre-approval required for hiring counsel outside the established panel when specialized expertise is necessary? Options: Yes, No
• Estimate typical hourly rate ranges your organization accepts for senior trial counsel and for junior associates in core jurisdictions. Options: Senior <$300/hr, Senior $300-500/hr, Senior $500+/hr, Varies by jurisdiction
• For complex matters, which litigation phases typically require separate approval pathways (discovery, expert retention, trial)? Options: Discovery, Expert retention, Trial, Appeal, Other
• Within what SLA should we escalate counsel-performance concerns or budget variances to your claims leadership? Options: 48 hours, 5 business days, Weekly summary, On milestone breach

Litigation Budgeting and Expense Management

• Select the preferred budget approval cadence for litigation matters. Options: Per-matter, Monthly aggregate, Quarterly review
• Designate the approver for budget increases above initial tranches and provide contact details or process notes.
• Explain your preferred structuring for expert-fee tranches and discovery holdbacks (examples: holdback percentage, escrow arrangement, contingency tranches).
• Indicate whether line-item e-billing upload is mandatory for outside counsel invoices. Options: Mandatory, Preferred but optional, Not required
• State the threshold percentage variance from budget that should trigger formal re-approval (example: 10%, 20%). Options: 10%, 15%, 20%, Custom

Reserve Setting and Loss Development Reporting

• Detail the reserve schedule format your actuarial team requires (per-file incurred, claim-by-claim, bulk IBNR buckets).
• Should we provide a sample monthly loss development triangle in CSV for your actuaries to validate our reserve methodology? Options: Yes, No
• Include any statutory reserve reporting templates or state filing formats that must be followed for regulatory disclosures.
• Where should we deliver per-file reserve updates and movement reports (portal, nightly SFTP, API endpoint)? Options: Portal, SFTP, API, Email
• By when must reserve reconciliations be completed after month-end close to align with your actuarial cycle? Options: 5 business days, 10 business days, 20 business days

Settlement Negotiation and Structured Resolution

• Will you allow structured settlement solutions such as annuities or escrow vehicles for multi-year obligations? Options: Yes, No, Case-by-case
• In settlement approvals, which documents are required before payment (signed release, settlement memo, proof of signatory authority)?
• Supply any preferred escrow or annuity providers acceptable for structured payouts if you maintain an approved vendor list.
• Attach or provide the settlement authority matrix or delegation-of-authority thresholds we should follow when seeking approvals.
• Authorize whether non-monetary settlement terms such as confidentiality or non-disparagement clauses require separate legal review or underwriting sign-off. Options: Yes - require review, No - included in standard authority, Case-by-case

Subrogation Identification and Recovery Pursuit

• Approve the minimum recoverable threshold for active subrogation pursuit (example: > $5,000 recoverable potential). Options: <$5,000, $5,000-$25,000, $25,000-$100,000, >$100,000
• Explain the documentation you require prior to issuing a subrogation demand (proof of payment, invoices, allocation of loss).
• Indicate whether contingency-fee arrangements for external recovery counsel are acceptable for pursuing subrogation. Options: Acceptable, Not acceptable, Case-by-case
• State typical booking instructions for recovered funds and how you want recoveries reported to your finance team.
• Detail any jurisdictional or contractual limitations (foreign courts, arbitration clauses, indemnity carve-outs) that frequently impede recovery in your files.

Real-Time Claims Portal Access and Data Exports

• Should portal access be provisioned with role-based permissions and single sign-on through your identity provider? Options: Yes - SSO, Yes - separate credentials, No - platform auth
• Include the specific data fields required in exports for actuarial reconciliation (policy number, claim ID, incurred, paid, loss date, status, reserve movements).
• Where will the integration endpoint be hosted for API or SFTP pushes (your cloud, private data center, platform-managed endpoint)? Options: Your cloud, Private data center, Platform-managed endpoint, Other
• By when do you require an initial export cadence (nightly batch, real-time streaming, weekly) to be established after go-live? Options: Nightly, Real-time streaming, Weekly, Custom
• Will you require a sample data validation run (30-day claims subset) and reconciliation prior to accepting live feeds? Options: Yes, No

Quarterly Claims Trend and KPI Reporting

• In which KPIs do you require trend reporting for quarterly business reviews (examples: paid severity, indemnity per file, defense burn rate, closed-within-reserve)? Options: Paid severity, Indemnity per file, Defense burn rate, Closed-within-reserve, Other
• Supply two sample report templates or KPI definitions your actuarial or finance team currently uses for quarterly reviews.
• Indicate the distribution list and delivery format for quarterly reports (PDF executive summary, interactive dashboard link, raw CSV export). Options: PDF summary, Interactive dashboard, Raw CSV, Combination
• State metric thresholds that should trigger executive escalation (example: litigation cost per file > $X, reserve variance > Y%).
• Detail preferred visualizations for trend analysis (loss triangles, waterfall charts, case timelines) to be included in the QBR pack. Options: Loss triangles, Waterfall charts, Case timelines, Custom visualizations

In-House Coverage Counsel Opinions and Briefing

• By when do you require draft coverage opinions after a coverage trigger is identified (example: 5 business days)? Options: 3 business days, 5 business days, 7 business days, Custom
• Where should formal opinion letters, redlines, and briefing memos be uploaded for your coverage counsel review? Options: Portal, SFTP, Email, Other
• Indicate who must sign off on formal coverage opinions (in-house coverage counsel, general counsel, underwriting representative). Options: In-house coverage counsel, General counsel, Underwriting representative, Other
• Do you require redline-capable drafts versus final sealed opinions when opinions will be included in regulatory or litigated productions? Options: Redline drafts, Final sealed opinions, Both
• Describe privilege and confidentiality markings you require on coverage memos to preserve attorney-client privilege and work-product.

Expert Witness and Technical Consultant Management

• Is pre-approval required for expert engagement and estimated hourly rates before retention? Options: Yes, No
• Will the organization permit remote expert depositions or does a jurisdiction require in-person testimony for certain matters? Options: Remote allowed, In-person required, Case-by-case
• Should we maintain a roster of preferred experts with CVs and rate cards for your review prior to engagement? Options: Yes, No
• Include any expert vetting criteria you require (examples: CV, prior testimony history, conflict checks, sample reports).
• Where should expert invoices, CVs, and final reports be delivered for procurement and matter documentation? Options: Portal, SFTP, Email, Other

• Master Services Agreement (MSA)
• Statement of Work (SOW)
• Service Level Agreement (SLA)
• Fee Schedule and Order Form
• Data Processing Agreement (DPA)
• Data Access & Integration Addendum
• Governance & Steering Committee Charter
• Acceptance Criteria & Handover Checklist
• Insurance, Indemnity & Liability Schedule
• Regulatory Compliance Addendum (insurance-specific, conditional)

• Go-live Health Check
• First Performance Measurement
• Acceptance Gate Review
• Quarterly Business Review
• Annual Outcomes and Continuous Improvement Review

• Publish the quarterly performance packet with KPI trend charts and root cause notes.
• Publish the formal acceptance decision document including pass/fail status and the buyer signatory record.
• Record remediation tasks for failed criteria with verification dates in the shared tracker.
• Execute the incumbent system wind-down tasks or archive data per the documented plan.
• Quarterly KPI trend review
• Confirm where quarterly results meet or miss targets recorded in Solution Scope and document required corrective actions.
• Close or re-scope persistent remediation items and update timelines in the shared tracker.
• Agree priority list for enhancement requests and schedule next steps for implementation.
• Re-confirm success criteria and owners
• Update the remediation burn-down board and move items to the next workflow state as appropriate.
• Create implementation tickets for approved enhancements and schedule sprint dates or working sessions.
• Annual performance summary
• Agree the prioritized 12-month improvement plan with measurable targets and verification dates.
• Document systemic changes to processes, counsel management, or reserve methodology to be implemented during the year.
• Confirm governance owners and the cadence for the shared issue and enhancement channel.
• Deliver the annual performance and trend report with recommended improvement initiatives.
• Create the prioritized improvement roadmap with milestones and verification metrics.
• Schedule quarterly checkpoints and assign owners for governance and shared channel maintenance.
• Deployment validation checklist completed and accepted by the buyer's named owners.
• Open issues captured with resolution dates and owners documented in the shared tracker.
• Short-term remediation plan agreed to restore any failed data feeds or access within the agreed window.
• Publish deployment verification report and checklist to the shared workspace.
• Create and populate the shared issue tracker with all blockers and target resolution dates.
• Enable production access for named owners and confirm account provisioning is complete.
• Present first KPI report
• Baseline KPI values are documented and compared to the numeric targets recorded in Solution Scope.
• Root causes for each underperforming metric are identified and prioritized.
• Corrective action plan with tasks and completion dates is agreed to reach the Acceptance Gate.
• Deliver the detailed KPI packet with source extracts and calculation logic.
• Launch the corrective action tasks in the shared tracker with target resolution dates.
• Configure automated reporting extracts to refresh before the Acceptance Gate review.
• Restate acceptance criteria and numeric targets
• Acceptance decision recorded with pass/fail per criterion and named signatory for the overall decision.
• Remediation plan for any failed criteria documented with dates for resolution and verification steps.
• Incumbent decommission or retention state documented and a plan for data archival or migration confirmed.
• Litigation outcomes and counsel performance
• Systemic trends and root cause synthesis
• Present outcome data against each criterion
• Diagnose root causes for any KPI gaps
• Deployment and migration validation
• Persistent issues and remediation burn-down
• Document pass/fail decision and signatory capture
• 12-month improvement plan and priorities
• Agree corrective actions and timelines
• Early adoption signals and usage patterns
• Governance and shared channel maintenance
• Open issues and blockers
• Confirm data fidelity and reporting cadence
• Enhancement requests and prioritization
• Agree remediation items for any failed criteria
• Agree immediate remediation actions
• Incumbent wind-down and data disposition