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Covers the full insurance lifecycle — underwriting, claims, policy management, renewals, compliance, and broker operations.\n\n## What This Skill Does\n\nGuides your AI agent through insurance-specific workflows with industry benchmarks, regulatory requirements, and automation priorities.\n\n## Capabilities\n\n### 1. Underwriting Assessment\n- Risk scoring framework (12 factors, weighted by line of business)\n- Data enrichment checklist (credit, claims history, property data, telematics)\n- Referral triggers and authority limits by tier\n- Combined ratio targets by line: Auto (95-98%), Home (85-92%), Commercial (88-95%), Life (varies by mortality table)\n\n### 2. Claims Processing Pipeline\n- FNOL intake automation (voice + digital, structured extraction)\n- Severity triage: Green (auto-approve <$2K) → Yellow (adjuster review $2K-$25K) → Red (SIU referral >$25K or fraud indicators)\n- Subrogation identification triggers\n- Reserve estimation formulas by claim type\n- Settlement authority matrix\n\n### 3. Policy Administration\n- Quote-to-bind workflow (target: <15 min for personal lines)\n- Mid-term adjustment processing\n- Renewal scoring: retention probability model (7 factors)\n- Cancellation/non-renewal compliance by state/jurisdiction\n\n### 4. Broker Operations (Jointly AI Model)\n- 5-agent pipeline architecture: Intake → Research → Quoting → Analysis → Delivery\n- Market panel management and placement optimization\n- Quote comparison normalization across carriers\n- FCA/state regulatory compliance verification\n- Parallel execution: up to 4 simultaneous carrier interactions\n\n### 5. Compliance & Regulatory\n- **US:** State DOI requirements, NAIC model laws, Solvency II (reinsurers)\n- **UK:** FCA handbook (ICOBS, SYSC), Consumer Duty, IDD compliance\n- **EU:** Solvency II, IDD, GDPR for policyholder data\n- Anti-fraud indicators (SIU trigger list — 15 red flags)\n- SAR/suspicious activity reporting thresholds\n\n### 6. Insurance Metrics Dashboard\n| Metric | Personal Lines Target | Commercial Target |\n|--------|----------------------|-------------------|\n| Combined Ratio | 95-98% | 88-95% |\n| Loss Ratio | 60-70% | 55-65% |\n| Expense Ratio | 25-32% | 28-35% |\n| Claims Settlement Time | <48h (auto) | <14 days |\n| Policy Issuance Time | <15 min | <24h |\n| Renewal Rate | >85% | >80% |\n| Quote-to-Bind Ratio | >25% | >15% |\n| NPS | >40 | >35 |\n\n### 7. Automation Priority Matrix\n| Process | Hours/Month (50-person broker) | Agent-Ready? | Expected Savings |\n|---------|-------------------------------|--------------|-----------------|\n| Quote comparison | 160h | Yes — now | $140K-$280K/yr |\n| FNOL intake | 120h | Yes — now | $105K-$210K/yr |\n| Policy document generation | 80h | Yes — now | $70K-$140K/yr |\n| Renewal processing | 100h | Yes — now | $87K-$175K/yr |\n| Compliance checks | 60h | Yes — now | $52K-$105K/yr |\n| Subrogation identification | 40h | Partial | $35K-$70K/yr |\n| Complex claims adjustment | 200h | Human-in-loop | $50K-$100K/yr |\n\n### 8. Insurance-Specific Agent Prompts\n\n**Underwriting Agent:**\n```\nYou are an underwriting assessment agent. For each submission:\n1. Extract all risk factors from the application\n2. Score each factor against the risk matrix (1-10 scale)\n3. Calculate composite risk score (weighted by line of business)\n4. Flag any referral triggers (prior losses >3 in 5yr, credit <600, high-hazard occupation)\n5. Recommend: Auto-approve / Refer to senior / Decline with reason\n6. Generate underwriting memo with supporting data\n```\n\n**Claims Triage Agent:**\n```\nYou are a claims triage agent. For each FNOL:\n1. Extract: date of loss, type, description, estimated amount, policyholder details\n2. Verify active coverage and applicable endorsements\n3. Assign severity: Green (<$2K auto-process) / Yellow ($2K-$25K adjuster) / Red (>$25K or fraud flags)\n4. Check fraud indicators against the 15-point SIU trigger list\n5. Set initial reserve based on claim type benchmarks\n6. Route to appropriate handler with priority score\n```\n\n## 90-Day Deployment Roadmap\n\n**Month 1:** Deploy intake + quote comparison agents. Target: 70% of personal lines quotes handled autonomously.\n\n**Month 2:** Add claims triage + policy document generation. Target: FNOL processing <5 minutes, auto-approval for Green claims.\n\n**Month 3:** Compliance monitoring + renewal automation. Target: 85%+ renewal rate, zero compliance gaps.\n\n## Cost Framework\n- **Solo broker/MGA:** $2K-$5K/month (2-3 agents)\n- **Mid-size broker (20-50 staff):** $5K-$15K/month (5-8 agents)\n- **Carrier/large broker (100+ staff):** $15K-$50K/month (10-20 agents)\n\n## Resources\n- **Calculate your insurance automation ROI →** [AI Revenue Leak Calculator](https://afrexai-cto.github.io/ai-revenue-calculator/)\n- **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\n- **Configure your insurance agent stack →** [Agent Setup Wizard](https://afrexai-cto.github.io/agent-setup/)\n- **Bundle:** Pick 3 packs for $97 | All 10 for $197 | Everything $247\n","readmeExcerpt":"Insurance Operations Automation Comprehensive insurance operations framework for AI agents. 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