The Side Door Is the Whole Building Now

A claims manager has a stack of cases on her second monitor that she’s been putting off since lunch, and she already knows why. None of them are simple.

One photo doesn’t quite match the damage description. One claim has two pieces of documentation that don’t agree with each other, and neither is obviously wrong. One has a fraud indicator that fired for a reason nobody can fully explain, attached to a claim that otherwise looks completely legitimate. One is just a customer with a perfectly reasonable situation that nobody happened to anticipate when the policy language was written.

She’s been doing this job long enough to remember when a stack like this took most of a week to clear, spread out between the ordinary claims. Documentation arrives, coverage is clear, damage fits a familiar pattern, somebody signs off, payment goes out. The ordinary claims were most of the job. The strange ones were the exception, which is what everyone still calls them, out of habit. They’re not the exception anymore. They’re a slow Tuesday.

Somebody designed that process at a point when the hard cases showed up once in a while. Refer it, escalate it, send it to a specialist, get a sign-off from someone two levels up, that’s fine when it happens twice a week. It’s a different thing entirely when it’s the whole job. So she does what the process asks anyway. She refers the fraud-indicator case to a specialist who has eleven other referrals ahead of hers. She flags the mismatched documentation for a supervisor’s sign-off, even though she’s handled a hundred cases like it and already knows what the answer should be. The process doesn’t ask what she thinks. It asks whether this fits, and when it doesn’t, its only instruction is to ask somebody else.

Migrating Scarcity argues that technology doesn’t eliminate scarcity. It moves it. Automate execution and something else becomes scarce instead: context, coordination, judgment, the standing to act. I believe that more than when I wrote it, but what I hadn’t followed all the way through was where the migration ends up. It doesn’t stop at “judgment becomes valuable.” It runs straight into whatever part of the organization was built to hold judgment, and in most companies, that part was built for overflow, not for the main event.

Her queue used to be five hard cases mixed in with twenty easy ones. Now it’s mostly the five. The easy claims didn’t get harder or disappear on their own. A machine took every one it could actually solve, and what’s left on her desk wasn’t picked for typical difficulty. It was picked for everything a straightforward rule couldn’t touch.

The dashboard upstairs still says the department is thriving. Cost per claim is down. Processing time is down. Somebody in finance is probably building a case right now that says her team should shrink by roughly the same percentage the automated share grew. It’s the same average that lied to a call-center manager not long ago, telling the truth about the machine’s work and increasingly nothing about hers. Maybe her team should shrink. I’m not going to pretend automation doesn’t reduce how many people you need, it usually does. But shrinking the team isn’t the same decision as running the smaller team on the old assumptions.

If she used to process twenty routine claims and five hard ones, the answer isn’t to make her process five hard claims as cheaply as the old twenty. It might be closer to the opposite: put her in front of the specialist directly instead of behind eleven other referrals, let her sign off on the calls she’s already qualified to make instead of walking them up two levels, and stop timing her against a handling-time target that was built for work she doesn’t do anymore. The total cost of the process can keep falling. The cost of her part of it might need to rise. The machine is producing the savings, and she’s the one left dealing with the cases where saving time was never really the point.

The same shift is underway anywhere a queue used to be sorted into routine and exception. Cybersecurity teams triaging alerts after the obvious ones get closed automatically. Accounts payable clearing invoices after the clean ones settle themselves. In each case, the queue doesn’t just get shorter. What’s allowed into it changes.

Companies are pouring enormous effort into redesigning the automated path right now. Models, agents, workflows, integration, all of it necessary. I’m less sure we’re redesigning the other path, the one we used to call the exception process, on the assumption that it isn’t an exception anymore. We spent decades building organizations around the normal case and bolting an escalation process onto the side for whatever didn’t fit. AI is getting very good at the normal case.

The side door is the whole building now.