Quick Check‑In: Who's in Your Corner?

• Who will be attending or directly involved in decisions about workers' comp claims strategy for this initiative? Options: Risk Manager, VP of Claims / Head of Claims, CFO / Finance, Legal Counsel, HR / Benefits, Actuarial, TPA Operations Lead, Medical Director, Other
• Which single stakeholder holds primary sign‑off authority for vendor selection or operational changes? Options: Risk Manager, VP of Claims, CFO, Legal Counsel, CEO/President, Benefits Committee, Board/Trustee, Other
• How would you summarize what 'good' looks like to your executive sponsor in one sentence?
• Are there others whose buy‑in we should secure early to avoid later rework? Options: Legal, Finance, Claims Supervisors, Nurse Case Management, IT/Security, Union/Employee Rep, Broker/Consultant, Other
• Have there been recent reorganizations, audits, or personnel changes that affect decision timelines or risk tolerance?

If Nothing Changes, What Keeps You Awake?

• What would be the real cost—financial, operational, or reputational—if your current claims path stayed the same for the next 12–18 months?
• Which outcome areas concern you most when you picture 'business as usual' continuing? Options: Medical cost escalation, Longer indemnity durations, Rising litigation/attorney involvement, Opioid exposure, Regulatory non‑compliance, Employee retention/productivity impact, Other
• Who in your organization feels the impact of those outcomes most acutely, and how do they usually show their concern? Options: Very vocal and escalate quickly, Raise concerns periodically, Aware but not proactive, Not aware
• Tell us about a recent claim or trend that best captures the problem you’re most worried about—what happened and why did it matter?
• When a claim spirals, what internal workflow or escalation typically breaks down first? Options: Medical coordination, Utilization review, Adjuster workload/capacity, Legal engagement timing, Return‑to‑work planning, Data/reporting delays, Other

Who Really Holds the Power (Even When They Don't Show It)?

• Which informal influencers—opinion leaders, adjuster champions, outside advisors—can quietly make or break adoption of a new claims model? Options: Senior Adjuster/Examiner, Nurse Case Manager, Medical Director, TPA Executive, Broker/Consultant, External Defense Counsel, Union Representative, Provider Group Lead, Other
• Which of those influencers have historically resisted vendor recommendations, and what were their reasons?
• Who would be responsible for day‑to‑day governance of a pilot or rollout, and where would that role sit in your org? Options: Claims Operations, Risk Management, Clinical Services, Benefits/HR, Third‑party Governance Committee, Dedicated Program Manager, Other
• What engagement approach typically converts skeptics here—hard data, a short pilot, executive sponsorship, or hands‑on training? Options: Data and analytics, Small operational pilot, Executive sponsor endorsement, Process walkthroughs and training, Financial modeling, Other
• What evidence or experience would make those informal influencers publicly champion a change?

When 'Good' Differs by Title — Tell Us What Each Stakeholder Needs

• If the Risk Manager wrote a one‑line definition of success for this program, what would it say?
• For the VP of Claims / TPA leader, which measurable targets define success? Options: Cost per claim, Average indemnity days lost, Litigation escalation rate, Pharmacy spend per claim, Time to initial medical authorization, Claim closure rate, Other
• What financial metric and timeline would the CFO need to see to approve investment? Options: Payback <12 months, Loss ratio improvement, Year‑over‑year medical spend reduction, Cash flow benefit, Multi‑year ROI model, Other
• What legal or compliance conditions must be satisfied before Legal will approve execution (e.g., data controls, indemnity language, MSAs)? Options: Regulatory compliance confirmation, Data privacy/security controls, Indemnity/limitation clauses, Medicare Set‑Aside handling, Scope of liability, Other
• From the employee or union perspective, what outcomes or service standards must we meet to avoid pushback?

Procurement Speed Bump: What's Really Slowing You Down?

• What's the single procurement or contracting barrier that has torpedoed similar projects before? Options: Lengthy legal review, Budget/finance approvals, RFP mandated process, Vendor compliance/certification gaps, Data sharing/privacy concerns, Stakeholder misalignment, Other
• How long do procurement and contracting cycles typically take here for services like ours? Options: <3 months, 3–6 months, 6–12 months, >12 months, Varies greatly
• Which teams must sign off on contracts and which clauses create the most negotiation (select all that apply)? Options: Legal, Finance, IT/Security, Compliance, Claims Ops, Executive Sponsor, Procurement, Other
• Do you have pre‑existing vendor agreements, master service agreements, or procurement frameworks that could accelerate onboarding? Options: Yes — corporate MSA available, Yes — department agreements, No — must go through full RFP, Unsure
• Which compliance or certification documents do we need to provide up front (e.g., SOC2, HIPAA, state licensure)?

Small Pilots, Big Proof: How Would You Test It?

• If you had to design a pilot your toughest skeptic couldn't ignore, what would be the one metric it must move? Options: Average cost per claim, Days to return‑to‑work, Litigation escalation rate, Pharmacy/ opioid prescribing rate, Claim closure speed, Provider authorization time, Other
• What pilot duration and scale would feel persuasive for meaningful decision‑making? Options: 30 days, 60 days, 90 days, 180 days, Other
• Which KPI set would you prioritize to convince Finance, Claims, and Clinical leaders (choose up to three)? Options: Cost per claim, Indemnity days lost, Litigation rate/escalation, Pharmacy spend/opioid metric, RTW rate, Average medical bill reduction, Customer satisfaction / claimant experience
• What claim types, severities, or jurisdictions should we include to make the pilot representative and defensible?
• What operational constraints must a pilot respect (adjuster caseload, system integration windows, union rules, etc.)?
• Who would be the internal 'pilot owner' with authority to act on results and remove blockers? Options: Claims Manager, Risk Manager, Project Manager, TPA Lead, Other

The Unsaid Commitments: Timeline, Resources, and Signals to Proceed

• What would you need to see, hear, or receive to feel comfortable saying 'let's start' in the next quarter?
• What budget authority or funding cadence is available today for a pilot or initial engagement? Options: Allocated and available, Can reallocate within quarter, Requires new approval process, Unsure
• Which of these data sources are you willing and able to share for pilot setup? Options: Loss runs, Detailed claim files, Medical bills/EOBs, Pharmacy data, Return‑to‑work documentation, Provider network files, Legal files/attorney info, None / need approvals
• What privacy, security, or governance approvals will be required before data transfer, and how long do they typically take?
• What internal governance cadence will you commit to during pilot (so decisions aren’t delayed)? Options: Weekly, Bi‑weekly, Monthly, Ad hoc as needed
• Are there any blackout periods, fiscal deadlines, or other calendar constraints that would prevent a near‑term start?

Paint Your Current Claim Landscape

• How are new workplace injury reports most commonly submitted today? Options: Mobile app, 24/7 nurse triage line, Phone call to supervisor, Online claimant portal, Email/fax to claims, Third‑party reporting vendor, Other
• Walk me through, step‑by‑step, what happens from the initial report to the first clinical outreach—who does what and in what timeframe?
• What is your average new claim volume per week and how predictable is that volume? Options: 0–5 (very low), 6–20 (manageable), 21–50 (moderate), 51–100 (high), >100 (very high), Highly seasonal/unpredictable
• Which claim types make up the majority of your caseload? Options: Sprains/strains, Slips/falls, Traumatic injuries, Repetitive motion/MSDs, Occupational disease, Psych claims, Other
• Describe your adjuster structure and jurisdictional coverage—how many adjusters per claims, and who has specialized state expertise?
• Which systems capture your claim and medical data today? Options: TPA claims system, Carrier proprietary system, EHR/medical records integrations, Paper/scanned documents, Separate pharmacy system, Other

Are We Letting Small Problems Become Big Ones?

• Which routine early decisions in your current workflow most often precede a claim escalating into costly care or litigation?
• How quickly do you typically make clinical contact (nurse/physician) after a new report? Options: Within 24 hours, 1–3 days, 4–7 days, 8–14 days, >14 days
• What typically triggers nurse case management or utilization review today? Options: Initial injury severity, High expected medical cost, Provider requests, Claim duration, High lost time, Prescribing patterns, No formal trigger
• How do you detect and act on early opioid use or potentially inappropriate prescribing? Options: Real‑time pharmacy alerts, Periodic pharmacy reports, Manual review by clinical team, No consistent monitoring, Other
• Tell us about a recent claim that escalated quickly—what early signals were missed and how did that make the team feel?

Where the Dollars Leak — and Why It Hurts

• How many claims would you describe as ‘inefficient but tolerable’—the ones you don’t fix because fixing them feels harder than writing the check? Options: None/very few, A small but regular set, Many each year, A large portion of total spend, Unsure
• What are your current average KPIs: medical spend per claim, indemnity days lost, and litigation rate (or best estimates)?
• Which of these cost drivers have the biggest negative impact on your loss ratio right now? Options: Surgeries/specialist referrals, Chronic opioid use, Attorney involvement, Long indemnity duration, High out‑of‑network billing, Poor RTW options, MSA costs
• Which worker cohorts or claim causes disproportionately drive your catastrophic or long‑tail spend? Options: Older workers, Repetitive strain injuries, High‑impact trauma, Pre‑existing conditions, Remote/temporary workforce, Occupational disease
• How does this financial pressure show up in your internal conversations—what keeps leaders awake about claims spend?

Who’s Pulling the Strings (and Who’s Missing From the Table)

• Who ultimately owns decisions that materially change claim outcomes—clinical protocols, pharmacy rules, RTW policies—and are they represented in procurement conversations? Options: VP Claims/Head of Claims, Risk Manager/Benefits, Clinical Director/Medical Director, CFO/Finance, Legal/Compliance, Not sure/varies
• Which internal stakeholders most often resist changes to clinical or pharmacy practices, and why? Options: Operations (adjusters), Legal, Finance, Field HR/supervisors, No resistance
• How do you currently document and communicate jurisdictional responsibilities (state rules, payer obligations, MSA thresholds) between teams? Options: Central playbook, Local SOPs by state, Ad‑hoc emails, Not documented
• Who would need to sign off for us to implement clinical pathways, pharmacy prior‑auth rules, or a RTW pilot?
• Tell us about a time a stakeholder handoff failed—what happened and what would you have wanted done differently?

Regulatory Minefields and Local Rules

• Which state rule, reporting quirk, or regulatory practice has cost you time or money recently—what did it reveal about your readiness?
• Which jurisdictions drive the most complexity for you today? Options: California, New York, Texas, Florida, Pennsylvania, Multi‑state (no single driver), Other
• How integrated are your processes with Medicare conditional payment handling and MSA preparation? Options: Fully integrated, Partially integrated, Handled ad‑hoc by vendor, Not handled consistently, Unsure
• Have recent regulatory changes required you to change clinical or reimbursement practices? Give an example.
• What compliance checks or approvals typically delay clinical interventions or RTW placements? Options: State reporting, Legal review, Medical necessity confirmation, Employer sign‑off, Provider credentialing, None/other

Signals That Tell Us a Claim Will Go Bad (sooner than you think)

• Looking back at claims that ended up litigated or chronic, what single early signal would you have wanted flagged sooner?
• Which of these early signals do you currently track or alert on? Options: Opioid prescription within 7 days, No RTW attempt within 14 days, Multiple specialist referrals in 30 days, High initial medical cost estimate, Repeated missed medical appointments, Attorney contact or inquiry
• How often do you use predictive analytics to prioritize claims for clinical outreach? Options: Always, Often, Occasionally, Rarely, Never
• Give a concrete example of a claim that our early‑warning rules should have caught—what data would have changed the outcome?
• Which signals, if acted on within the first 7–14 days, do you believe would most reduce long‑term spend? Options: Early nurse case management, Pharmacy intervention on opioids, Immediate RTW planning, Rapid UR on high‑cost imaging/surgery, Medical network steerage

What Would Meaningful Early Change Actually Look Like?

• If early intervention reduced average indemnity days by 20% and medical spend per claim by 15%, what would that mean for your team and budget?
• Which KPI shifts would convince leadership to scale a pilot into a program? Options: Cost per claim, Days lost to indemnity, Litigation rate, Return‑to‑work within 30 days, Provider network utilization, Prescribing metrics
• What minimum ROI or payback period would you require to commit to a statewide or multi‑jurisdiction rollout? Options: <6 months, 6–12 months, 12–24 months, Unsure/depends on other benefits
• How would you prefer success be demonstrated—quantitative savings, improved worker outcomes, regulatory risk reduction, or a combination? Options: Quantitative savings, Worker outcomes, Regulatory risk reduction, All of the above, Other
• What cultural or operational barriers would we need to address to make early changes stick?

Immediate First Steps We’d Take Together

• If we agreed to a 90‑day proof of concept, what data and operational access could you realistically provide? Options: Sample claims with PHI following BAAs, De‑identified claims, Real‑time claims feed, Pharmacy data only, Limited datasets after approvals, None currently
• Which data elements are readily available to share: initial visit notes, prescription history, RTW status, adjuster notes, or billing detail? Options: Initial visit notes, Prescription history (PDMP), RTW status, Adjuster notes, Billing/UB‑04 detail, None of the above
• Who on your team would be the day‑to‑day contact for a pilot, and who needs to be kept informed? Options: Claims lead/manager, Clinical/medical director, Pharmacy lead, HR/Risk manager, Legal/compliance, Finance
• What timeline and decision gates do you have for piloting new clinical or pharmacy controls? Options: Immediate (30 days), Within 60–90 days, Quarterly review, Annual procurement cycle, Unsure
• What would make you say ‘yes’ this quarter to a focused pilot—we’ll be candid about what we need and what you’ll need to see.

Getting Started: Tell Us About Your Claims World

• Briefly describe your organization and the population you manage for workers' compensation (size, industries, locations).
• Which best describes your organization? Options: Self-insured employer, Insurance carrier, State fund / State board, Third-party administrator (TPA), Other
• What was your total workers' comp claim volume (closed claims) in the last 12 months? Options: Under 250, 250–1,000, 1,001–5,000, 5,001–20,000, 20,001+
• What is your current average total paid medical cost per indemnity claim (most recent 12 months)? Options: Under $5,000, $5k–$15k, $15k–$50k, $50k–$150k, Over $150k, Don't know / prefer not to say
• Who owns the KPIs tied to claims performance inside your organization? (Select all that apply.) Options: Risk Manager, VP/Head of Claims, CFO / Finance, General Counsel / Legal, Operations/HR, Actuarial/Analytics, Other
• Tell us about a recent claim that best represents the problem you want solved—what happened and why did it matter?

Are You Comfortable With the Costs You See?

• Which costs are you silently tolerating because they feel inevitable—and what would it mean to be able to challenge them?
• Which of these are the primary drivers of cost inflation in your book of business? (Select up to 4.) Options: Medical escalation / specialty surgeries, Opioid prescribing and pharmacy spend, Extended indemnity duration, High attorney involvement / litigation, Inappropriate utilization / overtreatment, Facility pricing / disputed bills, MSA / Medicare exposure, Other
• How does your current litigation/attorney involvement rate compare to your internal target or industry benchmark? Options: Significantly worse than target, Slightly worse than target, At target, Better than target, No internal target / don't know
• Which cost element feels most unpredictable month to month? Options: Pharmacy spend, Surgical / specialty interventions, High-severity indemnity claims, Catastrophic claims, MSA and resolution payouts, Other
• When cost spikes happen, who in your organization feels the impact most viscerally (emotionally and operationally)? Options: CFO / Finance, Claims leadership (VP/Director), Risk Manager / Benefits, Operations / HR, Board / Exec Team, Underwriting / Actuarial

What Keeps You Up at Night About Outcomes?

• When you picture a worst-case claim outcome, what is the single image or consequence that makes you most anxious?
• How do injured worker outcomes factor into your decision-making compared with pure dollar metrics? Options: Outcomes are primary, Outcomes and costs are equally weighted, Costs are primary, Unsure / need better visibility
• Which three outcome metrics would you insist improve for a program to be considered successful?
• How important is improving time-to-first-contact (triage) in your view of improving outcomes? Options: Critical, Very important, Somewhat important, Not important
• Describe the emotional or reputational consequences inside your organization when a claim goes sideways (e.g., executive reaction, client complaints, union issues).

Where Are the Bottlenecks Hiding?

• Which single process failure—if fixed tomorrow—would shorten claim duration the most?
• How quickly are new claims triaged today? Options: Immediate (within 1 hour), Within 24 hours, 24–72 hours, More than 72 hours, Varies widely / unknown
• Where do handoffs most commonly break down? (Select all that apply.) Options: Initial triage → medical management, Adjuster → nurse case manager, Provider billing → bill review, Claims system → analytics, MSA coordination → settlement, Provider network referrals
• How prevalent are delays due to missing or late clinical documentation (notes, IME, diagnostic reports)? Options: Constant problem, Frequent, Occasional, Rare, Not an issue
• Give an example of a recent handoff that failed and the downstream impact it created (timing, cost, outcomes).

If You Could Rewire a Claim From Day One

• Imagine a claim handled perfectly from day one—what would you see differently in the first 30, 90, and 365 days?
• Which of these improvements would signal success early in a pilot? (Select up to 4.) Options: Reduced cost per claim, Shorter indemnity duration (days lost), Lower litigation rate, Faster return-to-work / modified duty, Reduced opioid prescriptions, Improved claimant satisfaction
• What level of percent improvement in key KPIs within 12 months would you consider a clear win? Options: 5–10%, 11–20%, 21–40%, 40%+, Unsure / need modeling
• Which clinical, pharmacy, or RTW interventions have you tried already, and what stopped them from getting traction?
• If we could guarantee one operational change during the pilot (e.g., 24-hour triage, dedicated nurse case manager, pharmacy lock-in), which would you pick and why?

What Would It Take to Trust a New Partner?

• What vendor behavior during onboarding makes you lose trust faster than anything else?
• Which proof points would most accelerate your trust? (Select all that apply.) Options: Reference customers in our vertical, Live pilot with our claims, Guaranteed SLA / financial protections, Third-party outcomes validation, Transparent audit of processes
• Which legal, compliance, or procurement items are non-negotiable before you’ll start data exchange or a pilot? (Select all that apply.) Options: Signed MSA, Data processing agreement / BAA, Medicare compliance and MSA handling, State-specific regulatory approvals, Proof of insurance / E&O, Other
• Who on your side must sign off for a new claims partner to start a pilot, and what will each person's top concern likely be?
• How important are financial risk-sharing models (shared savings, fee-for-service reductions) to your decision to move forward? Options: Essential, Very important, Nice to have, Not important

The Data and Systems Reality Check — Are We Ready?

• If your data could answer one question about your claims right now, what would you want it to reveal?
• Which of these data feeds can you provide today? (Select all that apply.) Options: EDI 837 / 837P claims, Provider billing and remittance, Pharmacy / PBM claims, Nurse triage and case notes, IME and specialist reports, Adjuster notes / activity logs, RTW / HR attendance data, Other
• How would you rate the quality and completeness of the claims data we’d receive? Options: High quality / near-complete, Generally good with gaps, Patchy / inconsistent, Poor / significant cleanup required, Unknown
• Which technical exchange methods are acceptable to your IT/legal teams? (Select all that apply.) Options: Secure API, SFTP/data drops, Direct DB connection (read-only), EDI batch files, Manual secure portal upload, Other
• Are there contractual, legal, or platform blockers (e.g., union rules, vendor exclusivity, legacy contracts) that typically delay data sharing? Please describe.

Pilot to Full Rollout: What Would Make You Say Yes?

• What single pilot failure would cause you to cancel the program outright?
• What pilot structure would you prefer to validate value? (Select one.) Options: 100–300 claims across multiple jurisdictions, A focused cohort of high-cost claims, Single-jurisdiction end-to-end pilot, Service-specific pilot (pharmacy or nurse CM only), Proof-of-concept with synthetic/test data
• Which go/no-go criteria should be included in the pilot agreement? (Select up to 4.) Options: Cost per claim reduction threshold, Reduction in days lost threshold, Litigation rate improvement, Data integrity / completeness targets, Operational SLA adherence, Claimant satisfaction thresholds
• How frequently would you expect governance and performance reviews during a 90-day pilot? Options: Weekly, Bi-weekly, Monthly, Ad-hoc as needed
• What internal resources (roles and approximate FTE/time allocation) can you commit to a 90-day pilot?

Stakeholder Map — Who Holds the Real Levers?

• Who in your organization can stop this project with a single negative decision, and why would they say no?
• For each of these roles, tell us their primary success criteria for a claims program. (Select all relevant roles.) Options: Risk Manager / Benefits, VP/Head of Claims, CFO / Finance, General Counsel, HR / Operations, Actuarial / Analytics, Union/Employee rep
• What procurement or budget timeline constraints should we plan around (e.g., fiscal year, board reviews, renewal windows)? Options: Immediate / within 30 days, 30–90 days, 90–180 days, 6–12 months, Dependent on RFP process
• Have you run an RFP or formal procurement for these services in the last 24 months? If yes, what was the outcome and main learning? Options: Yes—selected a vendor, Yes—but did not select, No—handled via sole source / incumbent, No—haven't procured recently
• What previous vendor experiences or pilot results should we be aware of so we don't repeat past mistakes?

Quick Warm-Up — Tell Us About Today

• What is your role and primary responsibility for workers' compensation? Options: Risk Manager, Claims Director/VP, Adjuster/Examiner, CFO/Finance, Legal Counsel, Benefits/HR Lead, State Fund Administrator, Other
• Which organization type best describes you? Options: Self-insured employer, Insurance carrier, Third-party administrator (TPA), State fund, Broker/consultant, Other
• Roughly how many new indemnity claims do you handle per year? Options: <250, 250–999, 1,000–4,999, 5,000–19,999, 20,000+
• How are claims currently administered at your organization? Options: In-house examiners, Single outsourced TPA, Multiple TPAs by region, Carrier-managed, Hybrid model, Other
• What one success metric matters most to your leadership today? Options: Cost per claim, Days lost/indemnity duration, Litigation rate, Return-to-work rate, Provider spend, Customer satisfaction/employee outcomes, Other

Are We Quietly Accepting Broken Claims?

• Do you ever find yourself tolerating claims that keep getting more expensive without a clear plan to change that trajectory? Options: Regularly, Sometimes, Rarely, Never
• Which recurring claim problems frustrate you most right now? Select all that apply. Options: Prolonged time to first nurse/clinical touch, High opioid prescribing, Frequent attorney involvement, Poor RTW coordination, Inaccurate or late bills, Data/reporting gaps, Other
• Tell us about the most recent claim that felt like it slipped away from you — what happened and why did it stick in your memory?
• How often do early-stage claims (first 30 days) show signs that they will become high-cost or litigated? Options: Almost always, Often, Occasionally, Rarely, Unsure
• When a claim begins to escalate, what is the emotional impact on your team and stakeholders? Options: High stress/urgent escalation, Concern but manageable, Annoyance/frustration, Minimal reaction, Other

What’s Hiding in the Bottom Line?

• Which hidden or indirect costs worry you most (beyond headline medical spend)? Options: Prolonged indemnity payroll, Overtime/backfill, Productivity loss, Legal defense & reserves, Regulatory penalties, Reputational impact, Other
• Can you quantify average medical spend and indemnity per closed claim over the last 12 months? If not exact, please estimate.
• Which claim types or injury categories disproportionately drive your severity? Options: Soft-tissue/MSK, Back/neck, Surgery-requiring injuries, Psychological/mental health, Slip/fall with fracture, Occupational disease, Other
• How do you currently measure litigation propensity or the likelihood a claim will involve an attorney? Options: Claims adjuster judgment, Predictive analytics model, Vendor risk score, No formal method, Other
• Share a recent example where a 'small' claim turned expensive — what early signals were missed, and how would you have wanted it handled differently?

Where Early Intervention Actually Breaks Down

• Why do so many organizations think they’re intervening early when, in reality, the intervention comes too late? Options: Low data visibility, High adjuster caseloads, No clinical triage, Slow reporting from employer/provider, Lack of enforcement on pharmacy, Other
• How fast does a new claim typically get a clinical touch (phone triage, nurse outreach, or similar)? Options: Within 24 hours, 24–72 hours, 3–7 days, 7+ days, No routine clinical touch
• Describe how first notice of injury flows today — who gets notified, what systems are used, and where handoffs commonly fail.
• Do you have standardized protocols (scripts, escalation thresholds) for adjusters and nurse case managers to follow in the first 7–14 days? Options: Yes, standardized and enforced, Yes, but inconsistently followed, No formal protocols, We're designing them now
• When early clinical intervention happens, what barriers most often limit its impact? Options: Provider resistance, Incomplete data, Delayed authorization, Network access gaps, Employee noncompliance, Other

What Would True Success Feel Like?

• If you could wave a wand, what three measurable results would convince your CEO that the claims program is working?
• Which of these KPIs would you prioritize for a pilot that proves value? Options: Reduction in cost per claim, Decrease in days lost/indemnity duration, Lower litigation/attorney involvement rate, Reduced opioid prescribing, Faster time-to-first clinical touch, Improved employee satisfaction, Other
• What minimum percentage improvement on your top KPI would you consider a successful pilot? Options: 5–10%, 11–20%, 21–35%, 36–50%, 50%+
• How would improved claim outcomes change decisions outside of claims (e.g., pricing, reserve strategy, safety programs)?
• Which stakeholder beyond claims must see the metrics to sign off on a full rollout? Options: CFO/Finance, HR/Benefits, Legal, CEO/Board, Actuarial, Risk Management Committee, Other

Who Holds the Keys — Internal Politics and Decision Triggers

• Who are the required approvers for a new claims model and what does each one need to be convinced?
• What procurement, contracting, or budgeting constraints typically slow you down? Options: Annual budgeting cycle, Legal terms/MSA negotiation, MSA/Medicare approvals, Vendor accreditation, Board approval, Other
• What non-financial concerns (reputation, employee relations, regulatory scrutiny) carry the most weight in approvals? Options: Reputational risk, Regulatory compliance, Employee experience, Union concerns, Provider relationships, Other
• What internal stories or past vendor experiences would we need to address up front to build trust?
• What is your target timeline for making a decision about piloting a new model? Options: Immediately (30 days), 1–3 months, 3–6 months, 6–12 months, Undetermined

Designing a Pilot You Can't Say No To

• What would make a pilot effectively impossible to refuse internally? Options: Minimal IT lift, Short duration with clear KPIs, Shared risk/commercial alignment, Demonstrable ROI in first 90 days, Strong clinical validation using real claims, Other
• What pilot size and scope feels credible to you (claims count, jurisdictions, lines of business)? Options: Small sample (20–50 claims), Medium (51–200 claims), Large (200+ claims), By jurisdiction only, By injury type only, Other
• Which go/no‑go criteria should govern scaling from pilot to full deployment? Options: Pre-defined KPI lift met, Data integrity validated, Stakeholder sign-off, Operational readiness confirmed, Contract/financial terms agreed, Other
• What specific data access or sample claims would we need to run a meaningful pilot for your program?
• Who on your team would be the day-to-day owner of the pilot and who are the executive sponsors?

Can Our Tech and Data Actually Play Nicely Together?

• Where do your biggest integration pain points live — claims platform, billing data, Rx feeds, or reporting? Options: Claims management system, Medical bill/EDI feeds, Pharmacy/Rx data, Provider network data, HR/payroll feeds, Other
• Which claims systems and major vendor platforms will we need to connect to for a pilot?
• How timely and complete are your data feeds today (e.g., FROI/SROI, bills, Rx) — and where do gaps appear? Options: Near real-time & complete, Daily with occasional gaps, Weekly or batched, Significant latency or missing fields, Unsure
• What level of data validation or reconciliation would be required before you consider the pilot results reliable? Options: Full reconciliation with source-of-truth, Sample validation, Automated checks only, We'll accept vendor validation, Other
• What cadence and format of reporting will your stakeholders expect during a pilot? Options: Weekly dashboards, Bi-weekly executive summaries, Monthly detailed reports, Ad-hoc deep dives, Real-time analytics portal

Risk, Compliance, and the Fine Print

• What regulatory or compliance requirements are non-negotiable for any vendor engagement in your jurisdictions? Options: State-specific reporting, Medicare Conditional Payment processes, HIPAA/PHI safeguards, Provider credentialing, Workers' comp board rules, Other
• Do you have a Medicare-eligible population that requires MSA planning or centralized MSA administration? Options: Yes, large population, Yes, some cases, No, Unsure
• How have past audits or regulatory reviews influenced the controls you require from vendors?
• What legal or indemnity terms do you insist on before a pilot can start (e.g., limits, indemnities, data usage)?
• Are there any state-specific issues (fee schedules, utilization rules, claimant protections) we should know before designing the solution?

Next Moves — Small Wins That Build Confidence

• If you had to pick one immediate action that would reduce friction and accelerate a pilot, what would it be?
• Who on your side can commit the time this quarter to support discovery, data preparation, and pilot launch? Options: Claims leader, IT/data team, Clinical lead/nurse manager, Legal/compliance, Network manager, Other
• What are the top three blockers we must remove to get to an agreed statement of work?
• How soon could you provide a sample dataset (de‑identified) or claims extract for a pilot feasibility review? Options: Within 2 weeks, 2–4 weeks, 1–2 months, Longer than 2 months, Not possible
• On a scale from 1–10, how ready is your organization to pilot a new claims model within the next 90 days? Explain your score. Options: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10