Industry Solutions: Insurance

Reimagining Risk and Claims with AI

Deploy the intelligence layer for modern insurance operations—automating underwriting workflows, accelerating claims adjudication, and detecting fraud with explainable AI that meets regulatory requirements.

Key Business Outcomes

70% faster quote turnaround
50%+ straight-through claims processing
45% improvement in fraud detection
60% reduction in claims cycle time

Enterprise Solutions

Production-ready AI solutions designed for the specific challenges facing Insurance organizations.

01

AI-Powered Underwriting Workbench

Transform underwriting from days to hours with AI-augmented risk assessment

The Challenge

Commercial underwriters review 100+ pages of documents per submission—financial statements, loss runs, applications, and supplemental data. Manual data extraction and risk assessment take 5-7 days per submission, and underwriter capacity limits quote volume. Inconsistent risk selection across underwriters leads to adverse selection and unprofitable books of business.

Our Solution

Deploy an AI workbench that automatically extracts data from submissions, enriches risk profiles from external sources, generates risk scores with full explainability, and presents underwriters with pre-analyzed submissions and recommended actions. Underwriters focus on judgment and relationships while AI handles data processing.

How It Works

1
Document AI extracts data from applications, financials, loss runs, and supporting documents
2
Data enrichment pulls from 100+ external sources (credit, property, claims history, industry benchmarks)
3
ML models generate risk scores aligned to your underwriting guidelines and appetite
4
Workbench presents pre-scored submissions with highlighted risk factors and recommendations
5
Underwriter reviews, adjusts, and approves—with all decisions building institutional knowledge

Business Impact

-70%
Quote Turnaround
From 5-7 days to same-day for standard risks
+40%
Underwriter Capacity
Handle more submissions with existing staff
+60%
Risk Selection Consistency
AI-assisted decisions aligned to appetite
85%
Data Entry Elimination
Automated extraction replaces manual keying

Key Capabilities

Multi-document extraction100+ data enrichment sourcesConfigurable risk modelsExplainable scoringContinuous model learning
02

Straight-Through Claims Processing

Settle eligible claims in minutes, not days—with AI-powered automation

The Challenge

45% of claims require manual handling despite being straightforward—first notice of loss intake, document collection, coverage verification, and damage assessment all involve human reviewers. Average claims cycle time is 15-20 days, frustrating policyholders and driving up per-claim handling costs. Adjusters spend time on routine claims instead of complex ones that need expertise.

Our Solution

Automate the claims lifecycle for eligible claims with AI that handles FNOL intake, extracts information from photos and documents, validates coverage, assesses damage, and initiates payment—all with human oversight for exceptions. Straight-through processing settles simple claims in minutes while routing complex claims to experienced adjusters.

How It Works

1
Conversational AI captures FNOL via voice or digital channels with intelligent questioning
2
Document and photo extraction pulls claim details, damage evidence, and supporting information
3
Coverage verification checks policy terms, deductibles, and limits against the loss
4
AI damage assessment estimates repair costs from photos using computer vision models
5
Payment initiation triggers settlement for eligible claims with audit trail and explainability

Business Impact

50%+
Straight-Through Rate
Eligible claims auto-settled without manual handling
-60%
Cycle Time
Claims settled in hours instead of weeks
$12 vs $45
Cost Per Claim
Automated vs manual handling costs
+30pts
Customer Satisfaction
Faster settlements drive higher NPS

Key Capabilities

Conversational FNOLPhoto-based damage assessmentCoverage verification engineFraud scoring integrationPayment automation
03

Fraud Network Detection

Uncover organized fraud rings with graph AI that sees connections humans miss

The Challenge

Insurance fraud costs the industry $80 billion annually—10% of claims involve some form of fraud. Traditional rules-based detection catches obvious cases but misses sophisticated organized fraud rings. SIU teams are overwhelmed with false positives while real fraud networks operate across multiple claims, claimants, and providers. Individual claim review cannot detect coordinated schemes.

Our Solution

Deploy graph neural networks that analyze relationships across claims, claimants, providers, and entities to detect organized fraud patterns. Our system identifies suspicious networks, scores claims for fraud risk, and provides SIU investigators with visualized evidence and explainable alerts—dramatically improving detection rates while reducing false positives.

How It Works

1
Entity resolution creates unified profiles for claimants, providers, attorneys, and other parties
2
Graph construction builds relationship networks across historical and current claims
3
Pattern detection identifies suspicious connections (shared addresses, phone numbers, providers)
4
ML models score claims for fraud probability with network-aware features
5
Investigation workbench visualizes networks and provides explainable evidence for SIU review

Business Impact

+45%
Fraud Detection
Catch sophisticated schemes rules miss
-30%
False Positives
More accurate alerts for SIU team
$4.5M
Annual Recovery
Identified fraud stopped before payment
+50%
Investigation Efficiency
Pre-analyzed cases with evidence visualization

Key Capabilities

Graph neural networksEntity resolutionNetwork visualizationExplainable alertsSIU workflow integration

Enterprise Integration

Seamlessly connect with your existing infrastructure. No rip-and-replace required.

Policy Administration Systems

Native integration with leading policy admin platforms for seamless underwriting and claims workflows.

Guidewire InsuranceSuite
Deep integration with PolicyCenter, ClaimCenter, and BillingCenter for end-to-end automation
Duck Creek Platform
Embedded AI within Duck Creek Policy and Claims for real-time decisioning
Majesco Policy & Claims
Cloud-native connectivity for modern P&C and L&A administration

Data Standards

Industry-standard data formats ensure interoperability across carriers, reinsurers, and partners.

ACORD XML/JSON
Full support for ACORD data standards for policy, claims, and reinsurance messaging
ISO 20022
Payment messaging standards for claims settlement automation
Lloyd's Market Standards
Compliance with London market data standards for specialty lines

Regulatory Compliance

Built for regulated insurance environments with explainable AI and audit capabilities.

State Filing Compliance
Model documentation supporting rate and form filing requirements
Explainable AI Requirements
Full model transparency for regulatory review and consumer explanation
Audit Trail & Documentation
Complete decision logging for examination and compliance review

Ready to Transform Your Insurance Operations?

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