01The systems in the way
A claim arrives as an email with photographs and a scanned form. Somebody reads it, finds the policy in a mainframe screen, checks cover, prices the routine part and passes the rest on. Multiply by volume and the constraint is not adjudication skill — it is the hours spent moving information between a green screen, a PDF and a portal.
| System | What it gives you |
|---|---|
| Policy admin | mainframe |
| Claims portal | web only |
| Rating engine | SOAP |
| Broker portal | no API |
| Documents | scanned PDF |
| Payments | batch |
02Why the usual approaches stall
Document AI products extract fields well and then have nowhere to put them, because the policy system has no write interface. RPA bridges that gap until the mainframe session times out differently on a Monday. What survives in production is the approach that treats the green screen and the scanned PDF as first-class integration targets rather than exceptions.
If a human can do it in a browser or a terminal, an agent can do it — at volume, with an audit trail. That is the whole basis of how we approach insurance: we treat the systems you already run as the integration surface, rather than waiting for an API that is never going to ship.
03What an agent actually does here
Worked example
A claims triage agent reads first-notice emails and scanned attachments, matches them to the policy in the mainframe system, prices the routine ones and flags the rest for an adjuster — with the extracted evidence attached to each decision.
This is a reference design drawn from the problems we are asked about most often in insurance — not a case study of delivered client work. Where we have shipped a build, we say so plainly and put you in touch with the client.
04Constraints we design to
- Routine and non-routine are separated explicitly; only the routine path is automated
- Every price or cover decision is traceable to the policy record and document it came from
- Runs against your systems in a sandbox with writes suppressed before anything goes live
- Deployable in-region where policyholder data must stay in country
Tell us which system is the problem
Describe the workflow that is done by hand today and the system that blocks it. We will come back within one working day with an initial read on feasibility — including if the honest answer is that an agent is the wrong tool.
Scope your agent →