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AurumGene

INSURANCE

Insurance leaders want faster claims and lower cost to serve without losing the judgement that protects customers and the book. We help you decide where Agentforce is appropriate, set the guardrails and govern the programme, designed with compliance and data privacy teams from the first workshop.

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The pressure

The moment of claim defines the brand. Too often, legacy process defines the claim.

  • Claims journeys with too many handovers

    Customers repeat themselves at every stage. Handlers spend their time gathering information instead of deciding.

  • Policy data locked in old systems

    Policy, claims and billing platforms each tell part of the story. A single view of the customer remains out of reach.

  • Intermediaries left waiting

    Brokers and agents place business where it is easiest. Slow answers on quotes and policy changes cost premium.

  • Scrutiny of every automated decision

    Leaders must be able to explain how customers were treated. Uncertainty about AI oversight holds programmes back.

Our advisory approach

Four stages, with conduct and privacy considered in each.

  1. 01

    Discover

    We review claims, servicing and distribution journeys with operations, conduct and technology leaders together.

    Outputs

    • AI and agent readiness assessment
    • Data and control map
    • Opportunity longlist

  2. 02

    Define

    We prioritise use cases and draw a clear line between tasks an agent may complete and decisions reserved for people.

    Outputs

    • Prioritised use case portfolio
    • Business case
    • Decision boundaries for agents

  3. 03

    Design

    We shape the operating model, oversight and roadmap for Agentforce, designed with compliance and data privacy teams from the first workshop.

    Outputs

    • Target operating model
    • Agent governance framework
    • Phased roadmap

  4. 04

    Direct

    We guide, govern and assure the work your teams and chosen partners carry out, with an audit trail leaders can stand behind.

    Outputs

    • Independent programme assurance
    • Value realisation tracking
    • Executive reporting

Where agents fit

Agents gather, summarise and inform. People decide.

  • Claims intake and updates

    An agent captures the first notification of a claim and keeps the customer informed of progress. Claims handlers make every coverage and settlement decision.

  • Broker and agent service

    An agent answers intermediaries on appetite, quote status and policy queries. Underwriters handle referrals and anything outside set rules.

  • Policy servicing requests

    An agent handles simple changes such as contact details and document requests. Changes that affect cover or premium are reviewed by staff.

  • Claims file summarisation

    An agent summarises documents and correspondence on a claim for the handler. The handler checks the summary against the file and owns the decision.

  • Renewal and retention outreach

    An agent identifies policies approaching renewal and drafts tailored outreach. Retention teams approve the offer and the message.

  • Underwriter submission preparation

    An agent collects and organises submission information and flags gaps. The underwriter assesses the risk and sets the terms.

Outcomes

Agreed with operations, conduct and finance leaders before work starts.

Targets are set with each client against their own baseline.

  • Claims cycle time

    The time from first notification to a settled claim.

  • Customer effort

    How many contacts and repeated explanations a customer needs to get an answer.

  • Handler capacity

    The share of handler time spent on decisions instead of gathering information.

  • Intermediary responsiveness

    How quickly brokers and agents receive a useful answer.

  • Decision traceability

    How fully each agent action and human decision can be explained after the event.

  • Value against business case

    Realised benefit compared with the approved case, reviewed at each stage.

Engagement pattern

Illustrative

A general insurer modernising its claims front door

Situation

A mid-sized insurer takes most claims by phone, and customers call again and again for updates. Handlers spend much of their day collecting information that could have been captured at the start. Leaders see a role for an agent at intake and for status updates, and conduct and privacy teams want clarity on where it would stop. The executive team needs a plan it can explain to the board.

How we would approach it

  1. 01We would map claims journeys, contact demand and data sources.
  2. 02We would agree with claims and conduct leaders which tasks an agent may handle.
  3. 03We would set out a business case, oversight model and phased roadmap.
  4. 04We would then assure the work carried out by the insurer and its chosen partners.

What we would measure

  • Claims cycle time
  • Repeat contacts per claim
  • Handler capacity
  • Decision traceability

An illustrative scenario describing a typical situation. It is not a client case study and reports no results.

A first conversation is enough to tell whether we can help.

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