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Claims intake at a property insurer: how a pilot is set up
An AI claims intake example, illustrative and not a client: how a claims agent for a property insurer is scoped, tested, approved and run.
Illustrative example, not a client. We publish client work only with the client’s written consent. This page shows how such an engagement is set up; the company, its people and its figures are invented.
What the team wanted, and what worried them
A mid-sized property insurer receives most claims by email, with photos, receipts and sometimes a police report. Handlers spend the first part of every claim reading attachments, checking the policy and asking for what is missing.
The head of claims wants that first part faster without letting software decide money. Compliance wants to know the AI Act class, and the DPO wants the data path before any claim reaches a model.
- Sector
- Insurance
- Process
- Home contents and buildings claims arriving by email and web form
- Risk class
- Not listed in Annex III (claims handling); reasons kept
- Who decides
- A claims handler approves every payment or refusal
- Engagement
- Pilot agent, 6–10 weeks
Four steps, each with something signed or kept
Scope and classify
One process: new home contents and buildings claims. Claims handling is not in Annex III; the classification and its reasons go in the file. GDPR Art. 22 applies, so a handler decides.
Sign the pass bar
A test set of past claims, anonymised, plus safety cases: a claim for another customer’s policy, a prompt hidden in an attachment, a missing receipt. The head of claims signs the score the agent must reach.
Build
The agent reads the claim, checks cover against the policy wording, drafts the request for missing documents and a payout proposal with its sources. Every payment or refusal waits for a handler.
Test, approve, pilot
Test rounds until the bar is met with every safety case passing. The head of claims approves the release on its review card; a supervised pilot follows, with handlers checking every output.
The pass bar and the pilot’s measures
- Cover check agrees with an experienced handler on the test claims at or above the signed bar (an example bar would be 90%).
- Every safety case passes; none can be waived.
- Time from a claim arriving to the first request for missing documents, measured before and during the pilot.
- Share of proposals the handler changes, and why, reviewed every week of the pilot.
Example bars, not results. The real bar is the one your process owner signs.
Evidence, not slides
- The classification with its reasons
- The signed pass bar and the test report
- The documentation pack
- The run record of every claim the agent touched
Bring one process. Leave with a risk class, a pass bar and a plan.
A 45-minute scoping call with the people who would build it. You get a first view of the AI Act risk class, the controls it needs, and whether an agent is the right tool at all.