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Industry · Insurance

Agentic AI
for claims, underwriting, and policy operations

CognitiveBricks helps insurers automate claims triage, empower business users with governed text-to-SQL, and streamline underwriting—with compliance and audit built into every agent workflow.

Faster decisions with defensible AI, brick by brick.

Claims automationText-to-SQLUnderwriting assistFraud detection

Insurance operations stack

Policy & claims

PAS · CMS · FNOL

Underwriting & pricing

rules · models · submissions

Customer & agent

CRM · portals · comms

Data & analytics

warehouse · semantic · BI

Governance layer

PII · audit · model risk

90%

Text-to-SQL success rate for business users

10 min

Average governed query turnaround

$800K+

Typical annual productivity gains at scale

Why insurer AI initiatives underdeliver

Carriers need agents that integrate with policy admin and claims systems—not copilots that bypass underwriting rules or mishandle PII.

  • Claims adjusters spend hours on repetitive triage while straight-through processing rates stay low

  • Business users wait days for IT-written SQL instead of self-serve analytics on governed data

  • Fraud signals are scattered across claims, SIU, and external data without unified agent reasoning

  • Regulatory filings and actuarial reports require manual assembly from disconnected sources

  • Model risk and fair-lending reviews lag behind rapid AI experimentation in the business

Industry solutions

Insurance focus areas

Claims, underwriting, policy servicing, and data intelligence for insurers.

Claims Triage & Automation

Straight-through processing with human oversight

Agents classify FNOL, extract evidence, check coverage, and route claims—escalating exceptions to adjusters with full context packages.

  • Document extraction from photos, PDFs, and emails
  • Coverage and exclusion checks against policy terms
  • Straight-through processing for low-complexity claims
  • Adjuster copilots with citation-backed summaries

Higher STP rates and faster customer payouts.

Governed Text-to-SQL

Self-serve analytics for underwriting and actuarial teams

Natural language queries over governed semantic layers—agents generate SQL, enforce row-level security, and produce narrative reports.

  • Semantic models over policy, claims, and premium data
  • 90%+ query success with optimization agents
  • PII detection and row-level security enforcement
  • Export to Tableau, Power BI, and executive briefings

90% query success; 10-minute average turnaround vs days.

Underwriting Assist

Faster submissions with risk-aware copilots

Agents summarize submissions, flag gaps, and draft quotes within appetite rules—underwriters retain final authority on bind decisions.

  • Submission ingestion from email and portal uploads
  • Appetite and guideline retrieval with citations
  • Comparable loss and exposure analysis drafts
  • Audit logs for every recommendation and override

Shorter quote cycles without weakening risk discipline.

Fraud & SIU Support

Investigation assist with graph-enriched context

Connect claims, providers, and external signals—agents draft investigation plans and SIU referral packages for specialist review.

  • Network analysis across claimants and vendors
  • Anomaly scoring with explainable factors
  • SIU case summarization and evidence indexing
  • Regulatory-safe handling of sensitive fraud data

SIU focuses on confirmed leads, not manual triage.

Engagement roadmap

Begin with text-to-SQL or claims triage on governed data, expand to underwriting and fraud with model risk sign-off.

01

Data & governance

Weeks 1–4

  • · Semantic layer
  • · PII zones
  • · MRM alignment
02

Analytics pilot

Weeks 3–8

  • · Text-to-SQL
  • · RLS policies
  • · User enablement
03

Claims automation

Weeks 6–14

  • · FNOL triage
  • · STP rules
  • · Adjuster copilot
04

UW & fraud expand

Parallel rollout

  • · Submission assist
  • · SIU agents
  • · Reg reporting

Ready to build with CognitiveBricks?

Book a strategy session with our architects to map your agentic AI roadmap, platform foundation, and first production use case.