There’s a fine line between a leader’s ambition and an unacceptable level of risk. My experience with a complex claims team put a spotlight on this tension, and it serves as a good example of an instance where risk arises when structure and governance are still evolving. It’s also a helpful analogy for considering design principles for agentic AI in insurance, in an environment in which regulations and best practices continue to evolve.

I was working with a claims function that had experienced a period of rapid growth. The team was made up of expert claims handlers who had been operating as an early-stage firm. Leaders were responsible for multiple roles and had meaningful control over team structure, function and how they were measured. Alignment between teams was informal; there were broad-based targets in place, though reporting and practical visibility across the whole function were relatively low. Similar to a startup, the flexibility of this environment was an ideal space for entrepreneurial leaders to flourish, and many had taken advantage of this opportunity. On the flipside, the risk of over-extending one’s authority was real. In one such case, a leader had independently negotiated an informal arrangement with a vendor in return for access to their services. This agreement was strategically imbalanced. It represented a significant opportunity for the vendor yet realized only localized benefit for the carrier.