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Claims, underwriting, and policy

AI agents for insurance: claims, underwriting and policy

AI agents for insurance handle the document-heavy, rule-bound work between a customer event and a decision: first notice of loss, claims triage, underwriting submission intake and policy servicing. Unmatrix AI builds them on your claims and policy systems, with adjusters and underwriters reviewing the agent weekly during a twelve-week onsite deployment.

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Workflows

What do we build for insurance?

The workflows we usually start with, and the architecture each one is built on.

  • First notice of loss and triage

    Extract the claim from email, portal or call notes, check the policy, set an initial reserve and route injury or fraud flags to a person.

    Built as

    LangGraph workflow agents

  • Underwriting submission intake

    Turn broker submissions, loss runs and schedules into a structured file, flag missing data and pre-fill the rating tool.

    Built as

    LangGraph workflow agents

  • Claims document review

    Read medical, repair and invoice documents, match them to the claim and surface inconsistencies for the adjuster.

    Built as

    Autonomous agents (ReAct)

  • Policy and coverage questions

    Answer agent and customer questions from the policy wording with clause-level citations.

    Built as

    RAG agents

Constraints

What shapes the build?

Fairness and explainability
Every triage or scoring outcome carries a justification, and protected attributes are excluded from scoring.
Fraud controls
Fraud signals route to your special investigations unit, never to an automatic denial.
Record-keeping
Claim files include the agent's trace, so market conduct examinations and audits can reconstruct every decision.
Data protection
Health and injury data is detected and redacted before hosted model calls, or the system runs fully on-prem.

Worked example

A typical build: first notice of loss for motor claims

A personal lines insurer receives most claims by email and portal. Handlers re-key the same fields into the claims system and miss the injury flags that matter.

  1. 01

    Trigger

    A first notice of loss arrives by email or portal with photos attached.

  2. 02

    Extract

    The agent pulls the claim fields from the message and the photos into a typed record.

  3. 03

    Check

    It looks up the policy, confirms cover and checks for duplicate claims.

  4. 04

    Decide

    Coverage is confirmed and an initial reserve set. Third-party injury or fraud indicators route the claim to a senior adjuster.

  5. 05

    Record

    The claim is created in Guidewire and the acknowledgement goes to the policyholder.

Handlers start from a complete claim with the risky ones already flagged. Acknowledgements go out within the hour.

Integration

Which systems do we work with?

  • Guidewire
  • Duck Creek
  • Majesco
  • Sapiens
  • Salesforce
  • ServiceNow
  • Microsoft Dynamics

Anything with an API or a file interface can be integrated. These are the systems we meet most often in insurance.

Questions

What insurance teams ask

Will the agent deny claims?

No. It can complete routine, in-policy items below a threshold you set and drafts everything else for a handler. Denials always go through a person.

How does it handle fraud indicators?

It flags them with reasons and routes the claim to your investigations queue. It never acts on a fraud suspicion alone.

Can it work with Guidewire?

Yes. Guidewire, Duck Creek and Majesco expose APIs we build against. Older systems can be integrated through files or robotic automation where necessary.

How do you handle medical records in claims?

Health data is detected and redacted before any hosted model call, or the whole pipeline runs on-prem. Access follows your existing roles.

Related

Next step

Pick one workflow. We will be at your office in two weeks.

A thirty-minute call to find the right first workflow, followed by a written scoping note. No deck, no pilot.

Book a call