openclaw/1kalin/afrexai-insurance-automation

Insurance Operations Automation

Comprehensive insurance operations framework for AI agents. Covers the full insurance lifecycle — underwriting, claims, policy management, renewals, compliance, and broker operations.

What This Skill Does

Guides your AI agent through insurance-specific workflows with industry benchmarks, regulatory requirements, and automation priorities.

Capabilities

1. Underwriting Assessment

• Risk scoring framework (12 factors, weighted by line of business)
• Data enrichment checklist (credit, claims history, property data, telematics)
• Referral triggers and authority limits by tier
• Combined ratio targets by line: Auto (95-98%), Home (85-92%), Commercial (88-95%), Life (varies by mortality table)

2. Claims Processing Pipeline

• FNOL intake automation (voice + digital, structured extraction)
• Severity triage: Green (auto-approve <$2K) → Yellow (adjuster review $2K-$25K) → Red (SIU referral >$25K or fraud indicators)
• Subrogation identification triggers
• Reserve estimation formulas by claim type
• Settlement authority matrix

3. Policy Administration

• Quote-to-bind workflow (target: <15 min for personal lines)
• Mid-term adjustment processing
• Renewal scoring: retention probability model (7 factors)
• Cancellation/non-renewal compliance by state/jurisdiction

4. Broker Operations (Jointly AI Model)

• 5-agent pipeline architecture: Intake → Research → Quoting → Analysis → Delivery
• Market panel management and placement optimization
• Quote comparison normalization across carriers
• FCA/state regulatory compliance verification
• Parallel execution: up to 4 simultaneous carrier interactions

5. Compliance & Regulatory

• US: State DOI requirements, NAIC model laws, Solvency II (reinsurers)
• UK: FCA handbook (ICOBS, SYSC), Consumer Duty, IDD compliance
• EU: Solvency II, IDD, GDPR for policyholder data
• Anti-fraud indicators (SIU trigger list — 15 red flags)
• SAR/suspicious activity reporting thresholds

6. Insurance Metrics Dashboard

| Metric | Personal Lines Target | Commercial Target | |--------|----------------------|-------------------| | Combined Ratio | 95-98% | 88-95% | | Loss Ratio | 60-70% | 55-65% | | Expense Ratio | 25-32% | 28-35% | | Claims Settlement Time | <48h (auto) | <14 days | | Policy Issuance Time | <15 min | <24h | | Renewal Rate | >85% | >80% | | Quote-to-Bind Ratio | >25% | >15% | | NPS | >40 | >35 |

7. Automation Priority Matrix

| Process | Hours/Month (50-person broker) | Agent-Ready? | Expected Savings | |---------|-------------------------------|--------------|-----------------| | Quote comparison | 160h | Yes — now | $140K-$280K/yr | | FNOL intake | 120h | Yes — now | $105K-$210K/yr | | Policy document generation | 80h | Yes — now | $70K-$140K/yr | | Renewal processing | 100h | Yes — now | $87K-$175K/yr | | Compliance checks | 60h | Yes — now | $52K-$105K/yr | | Subrogation identification | 40h | Partial | $35K-$70K/yr | | Complex claims adjustment | 200h | Human-in-loop | $50K-$100K/yr |

8. Insurance-Specific Agent Prompts

Underwriting Agent:

You are an underwriting assessment agent. For each submission:
1. Extract all risk factors from the application
2. Score each factor against the risk matrix (1-10 scale)
3. Calculate composite risk score (weighted by line of business)
4. Flag any referral triggers (prior losses >3 in 5yr, credit <600, high-hazard occupation)
5. Recommend: Auto-approve / Refer to senior / Decline with reason
6. Generate underwriting memo with supporting data

Claims Triage Agent:

You are a claims triage agent. For each FNOL:
1. Extract: date of loss, type, description, estimated amount, policyholder details
2. Verify active coverage and applicable endorsements
3. Assign severity: Green (<$2K auto-process) / Yellow ($2K-$25K adjuster) / Red (>$25K or fraud flags)
4. Check fraud indicators against the 15-point SIU trigger list
5. Set initial reserve based on claim type benchmarks
6. Route to appropriate handler with priority score

90-Day Deployment Roadmap

Month 1: Deploy intake + quote comparison agents. Target: 70% of personal lines quotes handled autonomously.

Month 2: Add claims triage + policy document generation. Target: FNOL processing <5 minutes, auto-approval for Green claims.

Month 3: Compliance monitoring + renewal automation. Target: 85%+ renewal rate, zero compliance gaps.

Cost Framework

• Solo broker/MGA: $2K-$5K/month (2-3 agents)
• Mid-size broker (20-50 staff): $5K-$15K/month (5-8 agents)
• Carrier/large broker (100+ staff): $15K-$50K/month (10-20 agents)

Resources

• Calculate your insurance automation ROI → AI Revenue Leak Calculator
• Full Insurance & Fintech Context Pack → AfrexAI Context Packs — $47, includes fintech agent configurations, compliance frameworks, and industry benchmarks
• Configure your insurance agent stack → Agent Setup Wizard
• Bundle: Pick 3 packs for $97 | All 10 for $197 | Everything $247