☂️ AI autopilot · insurance

Claims & underwriting autopilot

Adjudicates claims and prices risk — a licensed adjuster/underwriter signs the call that carries bad-faith exposure.

Claims VP / Chief Underwriterbuys it $36–38Bmarket 5 auto · 1 humanflow steps

The problem

Claims adjudication and underwriting are document-heavy and slow, and a wrong coverage call carries bad-faith and regulatory liability across 50 state codes.

What you get

Routine claims and risks are processed straight-through with the rule basis attached; ambiguous and high-value decisions reach a licensed adjuster/underwriter, who signs the call.

The flow

Intake to outcome. 🤖 steps run automatically; 🧑‍⚖️ steps are where a named human signs off the judgment calls.

  1. 1
    🤖 Intake the FNOL / application, policy and supporting documents
    agent intake · Claims / FNOL intakeDocument OCR
  2. 2
    🤖 Extract facts, apply coverage / rating rules, and compute reserve or price
    agent process · Policy admin / rating
  3. 3
    🤖 Run the fraud model and the unfair-claims / state-code checks
    agent compliance · Claims fraud scoring
  4. 4
    🧑‍⚖️ A licensed adjuster/underwriter signs the coverage decision or bind Human checkpoint
    Licensed adjuster / underwriter
  5. 5
    🤖 Issue the settlement payment or bind the policy ⚠ Irreversible · high blast
    agent execute · Payment railsPolicy admin / rating
  6. 6
    🤖 Track leakage, subrogation and complaint patterns
    agent monitor · Claims / FNOL intake

Agents & tools

  • Claims / FNOL intake stub → Guidewire
  • Document OCR stub → AWS Textract
  • Policy admin / rating stub → Guidewire
  • Claims fraud scoring ● live · Shift Technology
  • Payment rails stub → ACH

1 of these run live on real data — keyless by default; the rest are sandbox stubs that flip to the real provider the moment you add credentials.

Human checkpoints

  • Licensed adjuster / underwriter — A licensed adjuster/underwriter signs the coverage decision or bind

The autopilot escalates the judgment calls to a qualified human — the rest is straight-through.

Why it's safe to let it run

Every autonomous decision is logged — who · what · confidence. Signed human checkpoints and a built-in compliance reviewer enforce the rails, so the outcome holds up to an audit, not just a demo. Every irreversible action runs only after a human signs — the autopilot does the volume, never the point of no return on its own.

🧑 Accountable owner: Licensed adjuster / underwriter — one person answers for what this autopilot does.

Related autopilots

Same buyer, adjacent function — the connectors and compliance packs are shared.

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