Insurance practice

Complete files on day one. Adjusters and underwriters on the decisions.

Carriers, MGAs and TPAs spend skilled attention keying submissions, chasing missing information and updating the same record in several systems. We find the workflows where that preparation can run on agents, keep coverage, payment and binding decisions with people, and measure the result per claim and per submission.

Built for: COO · Chief Claims Officer · Chief Underwriting Officer · VP Operations

Assess a Workflow Book an AI Operating Leverage Audit call

The operating reality

Loss costs and expense ratios are under pressure, experienced adjusters and underwriters are hard to replace, and brokers and customers expect fast answers. Much of the cycle time sits before any decision is made: incomplete submissions, FNOL details spread across calls and emails, and documents that someone has to read and key.

Most insurers already pay for AI in some form. The question is which workflows it should run, which decisions it must never touch, and how you will show that the expense per claim or policy actually moved without any change to how fairly customers are treated.

Workflows

Where the leverage hides

For each workflow: how it runs today, what agents and plain automation take over, and where people keep the judgment.

FNOL and claims intake

Today: Intake staff take first notice by phone, email and portal, key the details into the claims system and request the documents that are missing.
Agents and automation: Agents capture the loss details from each channel, match the policy, check the record is complete and request missing items before the file reaches an adjuster.
People keep: Adjusters own coverage, liability, reserves and every conversation with a distressed or vulnerable customer.

Measured by: Time from first notice to assignment · Claims assigned with a complete file · Intake touches per claim

Submission intake and underwriting file preparation

Today: Underwriting assistants read broker emails, ACORD forms, schedules and loss runs, key them into the rating and policy systems and chase what is missing.
Agents and automation: Agents extract the submission data, check it against appetite and required fields, pull prior history and assemble the file for the underwriter.
People keep: Underwriters decide on risk, terms, price and whether to quote. Binding authority stays with them.

Measured by: Submission-to-quote time · Submissions cleared per assistant · Files returned for missing information

Policy servicing requests

Today: Service teams work endorsements, address changes, certificates and cancellation requests one email at a time across several systems.
Agents and automation: Agents classify each request, process the routine ones within the rules you set and prepare the rest with the policy context gathered.
People keep: Staff approve changes that alter coverage or premium, and handle complaints and exceptions.

Measured by: Servicing turnaround time · Requests completed without rework · Backlog age

Document extraction and validation

Today: Estimates, invoices, medical records, inspection reports and IDs arrive as scans. Someone reads each one and keys the fields that matter.
Agents and automation: Extraction reads the document, validates it against the policy and claim data, and flags inconsistencies and possible duplicates.
People keep: People review low-confidence reads and anything that affects a payment, a reserve or a fraud referral.

Measured by: Documents processed per hour · Field error rate · Time from receipt to usable data

Missing-information chase and evidence gathering

Today: Adjusters and assistants track outstanding documents in notes and calendars, send reminders by hand and lose days when nobody follows up.
Agents and automation: Agents track every outstanding item, send reminders to customers, brokers and third parties, and attach what comes back to the right file.
People keep: Adjusters decide what evidence the claim needs and when a file can move without it.

Measured by: Days waiting on information · Open requests per file · Reminders sent by hand

Exception routing

Today: Referrals, large losses, possible fraud and complaints reach the right specialist late because someone has to notice them first.
Agents and automation: Rules and agents flag files that meet referral criteria, summarize why, and route them to the right queue with the evidence attached.
People keep: Specialists decide on every referral. Agents never close or deny a claim.

Measured by: Time from trigger to referral · Referrals missed or late · Specialist time spent on triage

Agent, broker and customer communications

Today: Staff answer “what is the status?” calls and emails by checking the claims or policy system and writing a reply.
Agents and automation: An agent answers routine status questions from live system data and sends proactive updates at the milestones customers care about.
People keep: Staff own coverage explanations, decisions, complaints and any message that carries bad news.

Measured by: Status contacts resolved without a person · First-response time · Inbound status volume per claim

Cross-system updates

Today: The same change is keyed into the policy admin, claims, billing and document systems, and records drift out of sync.
Agents and automation: Integrations and agents carry each change across systems, reconcile differences and keep an audit trail.
People keep: People resolve conflicts the rules cannot settle and own the system of record.

Measured by: Manual re-keying hours · Records out of sync · Cycle time between systems

What we measure

Every workflow gets a baseline before anything changes.

Expense per claim handled
Submission-to-quote time
Time from first notice to assignment
Files complete at first touch
Error and rework rate

Risks and controls

Risks and the controls that address them
Risk	Control
An agent influences a coverage, payment or underwriting decision.	Agents prepare files and draft messages only. Coverage, payments, reserves and binding need a named person with the authority.
Automated steps treat similar customers differently.	Routing and prioritization rules are documented, tested for consistent outcomes and reviewed on a schedule with claims and compliance.
Nobody can explain later why a file moved the way it did.	Every extraction, routing rule, draft and approval is logged against the file, so any step can be audited.
Personal, health or financial data reaches a system it should not.	Each agent reads only the systems and fields its role needs, with access reviewed before go-live and on a schedule.

How we would approach it

An example workflow design

This is illustrative. It shows how responsibilities split between systems, automation, agents and people. It is not a client result.

Claims intake desk

Trigger: A first notice of loss arrives by phone, email, portal or broker.

Reference architecture

An illustrative design showing how we would approach the workflow. Not a client result.

1SystemThe contact centre, inbox and portal capture the notice and attachments.
2AgentExtracts loss details, matches the policy and lists what the file is missing.
3AutomationValidates the data against the policy and claims systems and applies referral and routing rules.
4AgentRequests missing documents and drafts the acknowledgement for the customer or broker.
5HumanThe adjuster reviews the file, decides coverage and next steps, and approves the outbound message.
6SystemThe claims system is updated and every step is logged for audit and measurement.

Controls

Agents never decide coverage, payments or reserves
Routing rules are documented and reviewed for consistent treatment
Low-confidence extractions route to a person
Full log of notice, extraction, routing, draft and approval

What we would measure

Time from first notice to assignment
Files complete at assignment
Intake touches per claim
Expense per claim handled

Related use cases

Assess a Insurance workflow

Bring us one workflow that is slow, repetitive, error-prone or expensive. We'll help determine whether AI is actually the right lever.