Skill: 1kalin/afrexai-insurance-automation (version 1.0.0)

# 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](https://afrexai-cto.github.io/ai-revenue-calculator/) - **Full Insurance & Fintech Context Pack →** [AfrexAI Context Packs](https://afrexai-cto.github.io/context-packs/) — $47, includes fintech agent configurations, compliance frameworks, and industry benchmarks - **Configure your insurance agent stack →** [Agent Setup Wizard](https://afrexai-cto.github.io/agent-setup/) - **Bundle:** Pick 3 packs for $97 | All 10 for $197 | Everything $247


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