Roles and handoffs
What happens between the agent and the people who answer for it
An agent that pauses for a person is only as good as the work that follows the pause. This is one exception, start to finish, told from the side of the six roles that each had a part in it.
The payment the agent would not make on its own
A claims agent at an insurer is working through water-damage claims. Most of them it settles itself: the policy is active, the damage is covered, the amount is inside its limit. On a Tuesday morning it proposes paying $42,000 on one claim.
The rule says payouts over $25,000 need a person with the settlement authority to approve them. So the agent stops, the application saves where it was, and the claim waits.
That is where most descriptions of human oversight end. The interesting part is everything around it: who wrote that rule, who made sure the agent could be checked against it, who gets asked, who can accept what the rule does not cover yet, and who comes along three months later to check it all. Here is the example, one person at a time. It is illustrative, but every handoff in it is one VeriProof runs today.
Before any of it: the administrator
Months earlier, the administrator set up the claims application and gave people access that matches their work. The senior adjuster was given the reviewer role for large claims. The developer can see the application's integration and nothing about settlement authority. The auditor will get access later, scoped to the engagement.
None of that is visible on Tuesday. It is the reason the right person gets asked.
Three weeks earlier: the developer
The $25,000 rule also checks how many claims the policyholder filed in the last twelve months. When the governance engineer first tested it, the agent was not sending that number.
That gap did not turn into a meeting. It became a fix request in the developer's portal, attached to the claims application and the rule that needed the data. The developer added the field to what the agent sends. The request closed when the data arrived, and compliance was asked to check the rule again.
Two weeks earlier: the governance engineer
The limit used to be $50,000. Claims operations asked for $25,000 after a run of large water-damage claims, and the governance engineer wrote the change.
It did not go live straight away. The new version ran in Shadow first, recording what it would have decided without changing what the agent did. A week of Shadow showed roughly how many claims would pause at the new line, which told claims operations how much reviewer time to plan for.
Then it needed approval. The governance engineer could not approve their own change, so it went to a second person, who read the Shadow results and approved it. From that moment, the rule version, its author, and its approver travel with every decision it touches.
Tuesday, 9:40: the reviewer
The senior adjuster gets the exception in the VeriProof Inbox, and by email. It shows the claim amount, the coverage limit, the twelve-month claim count the developer made sure was there, the rule that paused it, and where each fact came from.
The answer is not a yes or a no. The adjuster approves the payment up to $38,000, which is the documented repair estimate, and adds a note about the contents claim that should be handled separately.
Had the adjuster been away, reminders would have gone out, and overdue work would have escalated rather than sitting quietly in a queue. As it is, the signed answer goes back to the claim that was waiting. The application checks it against current policy and its own rules, then pays $38,000. The record holds the request, the adjuster, the limit they set, and what the application did.
What stayed with the application
VeriProof did not pay the claim. It returned the reviewer's answer. The claims application owns the payment, checked the answer, and reported what it did, so the record shows both the decision and the outcome.
The following week: the compliance officer and the business owner
Reviewing the new rule, the compliance officer notices something it cannot check yet. Whether a property sits in a flood zone would change how some water-damage claims should be handled, and that data source will not be connected until next quarter.
They can assign that as a fix with an owner, a due date, and a priority. In the meantime they propose accepting the risk until the source is connected, and they name the approver: the head of claims operations, who owns the agent and the results it delivers.
That is the business owner's handoff. The decision lands with them by name, in their own portal, with reminders until they answer. They accept the risk for one quarter. Because it was accepted rather than forgotten, it comes back for review when the quarter ends.
End of the quarter: the auditor
Internal audit opens an engagement scoped to the claims application and the quarter's dates. The auditor does not ask anyone to assemble a folder.
Inside the engagement they can follow the $42,000 claim from the proposal to the $38,000 payment, see which rule version paused it, who wrote that version, the Shadow period, who approved it, and the risk the business owner accepted and when it is due back. They can also see which evidence is missing for the controls in scope, and they can check that the exported record has not changed since it was written. They cannot change the work.
Who did what, in one place
Scroll horizontally to see all columns.
| Role | What reached them | How it closed |
|---|---|---|
| Administrator | Access for each person on the claims application | The right reviewer held the right permission when it counted |
| Developer | A fix request: the rule needed a field the agent did not send | Closed when the data arrived; compliance was asked to check again |
| Governance engineer | A limit change requested by claims operations | Ran in Shadow, then approved by someone other than its author |
| Reviewer | The exception, in the VeriProof Inbox and by email | A signed answer with a limit went back to the waiting claim |
| Business owner | A risk decision, proposed by compliance, naming them | Accepted for one quarter, then back for review |
| Auditor | An engagement scoped to the application and dates | Followed the evidence and saw what was missing |
No one in this story rebuilt the story for anyone else. Each person worked in their own portal, on the part of the job that was theirs, and the record kept up.
If you own an agent that is waiting on approval, that is the thing to look for. Not whether it can pause for a person, but whether everyone around it can do their part without a chain of emails. You can see a week of one agent's work from the business owner's side, or open each portal yourself.
Open the portals yourself
The demo lets you switch between the six roles and see what each person works with.