Insurance AI That
Executes Work.
Governed, auditable AI agents that work directly inside Guidewire, Duck Creek, Salesforce, and your policy administration systems — not alongside them. Claims cycle under 3 minutes. Underwriting turnaround from days to hours. Fraud scoring automated at intake.
What changes when CAIBots
executes a claim.
A single P&C claim, before and after. Same policy. Same adjudicator. Different execution model.
40% faster claims.
90% straight-through rate.
Claims operations is where the largest measurable ROI exists for insurers. CAIBots automates the full FNOL-to-routing workflow — adjudicators focus on judgment, not data gathering.
First notice of loss received — CAIBots retrieves the policy record, verifies coverage, classifies claim complexity, and routes to the correct adjuster tier automatically. Zero manual triage for standard claims.
Evidence gathered, policy rules applied, reserve recommendation generated with full rationale, and payment routing executed — with mandatory adjudicator gate for complex or high-reserve decisions.
Rejected claims trigger automatic root cause analysis, documentation gap identification, and appeal brief generation — with the full evidence package routed to the adjudicator for review before any response is sent.
Statutory reporting deadlines trigger automated data aggregation, validation, and direct filing to State DOI portals — with exception flagging and compliance officer notification for any anomalies detected before submission.
Underwriting turnaround
from days to hours.
Underwriting operations teams gain speed without sacrificing governance. Standard submissions scored and triaged automatically. Senior underwriter attention reserved for complex risk decisions requiring professional judgment.
New submissions received, risk factors scored against actuarial models, coverage eligibility determined, and decisions routed — standard risks auto-scored and cleared, complex risks packaged for senior underwriter review with a complete data brief.
Renewals and endorsement requests processed automatically — loss history reviewed, rate changes calculated, policy terms assessed, and renewal packages generated with coverage recommendations for the underwriter to review and approve.
40% reduction in
SIU investigation workload.
Fraud scoring runs at intake, not after the claim has aged. Every claim cross-referenced against ISO ClaimSearch, provider networks, and behavioral indicators before an adjudicator touches it. False positives scored and cleared automatically.
Every claim scored against fraud typology models at the moment of intake — provider billing patterns, claimant prior history, network relationships, and behavioral indicators. SIU referral executed automatically above threshold. False positives cleared without investigator time.
High-confidence fraud indicators trigger automatic SIU case creation — evidence package assembled, network visualization generated, and case file routed to the investigator with everything needed to begin the investigation without manual setup work.
See a claim close.
Watch fraud get caught.
Each demo path runs against production-accurate scenarios. Live system writes. Real audit trails. Not a mockup.
30-day deployment
entry points.
Claims operations first — where the largest and most measurable ROI exists. Underwriting and fraud follow with clear expansion paths.
Deploy on your highest-volume, lowest-complexity claim type first. Standard auto glass, simple medical, or routine property. Immediate measurable reduction in handling time with full State DOI audit compliance on every decision from day one.
Automate the underwriting intake queue for your highest-volume, most standardized line of business. Standard submissions scored and cleared automatically. Senior underwriters engage only on complex risks requiring professional judgment.
Deploy fraud scoring across all incoming claims. Every alert scored against typologies, ISO cross-referenced, and either cleared or escalated with a full evidence brief. No investigator time wasted on false positives from day one.
Pre-built insurance
execution agents.
Every agent production-ready. Configures to Guidewire, Duck Creek, Applied Epic, ISO ClaimSearch, and your policy admin systems in under 90 days.
Examiner-ready.
Every execution.
NAIC model laws, State DOI requirements, and HIPAA privacy controls enforced at the architecture layer — determining what executes, when, and who must authorize it. Your DOI examiner can pull the governance matrix on demand.
NAIC model law compliance for claims handling, market conduct, and unfair claims settlement practices enforced at the Execution Layer. Every claims decision generates an audit record meeting State DOI examination requirements across all jurisdictions.
PHI access governed by RBAC at the Governance Layer — minimum necessary rule enforced at every data retrieval. Full BAA support for Business Associate compliance. PHI audit log with access purpose, actor identity, and timestamp on every interaction.
Claims handling timelines, PA response windows, and market conduct requirements enforced across all operating jurisdictions simultaneously. Jurisdiction-specific compliance rules maintained at the Foundation Layer and applied automatically to every workflow execution.
Continuous security monitoring, access controls, data encryption, and processing integrity verification across all five trust service criteria. Audit reports generated automatically for carrier IT and compliance teams.
Solvency II risk-based capital calculation workflows and IFRS 17 insurance contract measurement execution with full data lineage and audit trail. Pillar 3 reporting data aggregation automated with BCBS 239-compliant quality indicators.
Policyholder PII access governed by RBAC. Right-to-be-forgotten workflow automated. Data residency enforced — European policyholder data never leaves EU infrastructure boundaries in on-premise deployments.
Every decision boundary
enforced at the architecture layer.
Your State DOI examiner can pull this matrix on demand. No black boxes. No silent overrides. Every material decision is either auto-executed within policy bounds or routed to a named human approver with a full authorization record.
| Workflow | Trigger | Governance | Auth Required | Reg Reference |
|---|---|---|---|---|
| Claims — Straight-Through | Claim submitted · below complexity threshold | Auto-Execute | None | NAIC Unfair Claims Settlement |
| Claims — Complex / High-Reserve | Above reserve threshold or complex coding | HITL Gate | Senior Adjudicator | State DOI · NAIC Model Law |
| Prior Auth — Standard | PA request · within coverage criteria | Auto-Approve | None | CMS Interop Rule · HIPAA |
| Prior Auth — Clinical Edge Case | Complex presentation · documentation gap | Physician Gate | Medical Director | HIPAA · State DOI |
| Fraud — Low-Risk Alert | Pattern flag · below SIU referral threshold | Auto-Flag | None — logged for review | ISO · State Fraud Bureau |
| Fraud — High-Confidence Match | Multi-signal fraud pattern confirmed | HITL Gate | SIU Investigator | ISO · State DOI Fraud Regulation |
| UW — Standard Submission | Submission within appetite, below risk threshold | Auto-Score | None | NAIC · State Filing |
| UW — Complex / High-Value Risk | Above risk threshold or complex profile | HITL Gate | Senior Underwriter | NAIC · Solvency II |
The leaders who own
carrier operations.
See a claim close in
under 3 minutes.
30-minute session. We map your highest-value claims or underwriting workflow, run a live execution demo, and scope a 90-day path to production with full State DOI compliance documentation.