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Insurance Operations Automation
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Basado en la clasificación ocupacional SOC
Insurance Claims Processor
Policy Writer
Manage Allstate insurance with Drivewise and Milewise programs.
Analyze latest policy analysis sweep runs (*_policy_analysis_*) by comparing episodes/summary metrics, diagnostics, and video artifacts; generate a concise markdown report and optional frame snapshots.
既存の自動車保険契約を解約し、contracts.csv を更新する。
新規の自動車保険契約を contracts.csv に登録する。
| name | afrexai-insurance-automation |
| description | Insurance Operations Automation |
Comprehensive insurance operations framework for AI agents. Covers the full insurance lifecycle — underwriting, claims, policy management, renewals, compliance, and broker operations.
Guides your AI agent through insurance-specific workflows with industry benchmarks, regulatory requirements, and automation priorities.
| 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 |
| 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 |
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
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.