AI Agents

Context

Designed for insurance within the Underwriting assessment stack, this agent is used when an application falls outside standard rules or presents conflicting evidence and needs a controlled hand-off to a senior underwriter or specialist. It operates after disclosures and verifications are structured, so exceptions are escalated with full context rather than as ad-hoc tasks.

What it does

The agent assembles a compact escalation packet from verified inputs—questionnaire outcomes, medical evidence checks, income/occupation verification where applicable, asset and usage profiles for P&C, and the provisional risk-tier result—then evaluates the case against your exception criteria and authorities. If escalation is warranted, it generates a one-page synopsis that states the issue, cites the precise fields and pages behind it, proposes the next action per policy, and routes the file to the correct queue with SLA tracking. Once a decision is made, it confirms execution of the authorized action and records the acknowledgments and notes required for a clean close.

Core AI functions

Policy-driven rule evaluation over normalized, verified inputs; confidence/materiality thresholds to separate true exceptions from routine cases; auto-drafting of an escalation rationale with evidence links; queue selection and authority mapping; SLA monitoring and reminders; and post-decision verification that required steps, disclosures, and notes are completed—maintaining a full audit trail.

Problem solved

Complex or borderline cases often bounce between teams with inconsistent documentation and unclear ownership. Decisions are delayed, actions exceed authority, or evidencing is incomplete—creating rework, uneven outcomes, and audit findings.

Business impact

Faster, consistent, and defensible exception handling: senior underwriters receive complete evidence in one place, decisions align with policy and authority, and every step—from escalation to closure—is traceable. Cycle time shortens, rework drops, and customer outcomes are more uniform.

Integration and adjacent use cases

Integration complexity: medium. The agent reads structured outputs from upstream steps in this stack—Medical questionnaire analyzer, Health history & diagnostic validator, Income & occupation verifier (life) where relevant, Asset & usage pattern extractor (P&C), and Risk tier assignment agent—and writes the escalation synopsis, routing, decisions, and completion checks back into the underwriting workbench; no core changes are required.

It is typically combined with those same agents so exceptions are raised only after inputs are verified and tiering is attempted, ensuring escalations carry a complete, evidence-linked packet.