AI Agents for Insurance Claims & Underwriting | Pokee AI
Customers First. Trust at Every Step.
AI agents remove friction, automate decisions, and deliver satisfying experiences across claims, underwriting, fraud, policy intelligence, and billing — with governance and audit trails carriers expect.
Capabilities
Resolve Faster. Underwrite Smarter. Stay Investigation-Ready.
Claims automation, underwriting workbenches, policy intelligence, and fraud-aware workflows — with governance and audit trails carriers expect.
Claims
Intake → Resolution, with Traceability
Structured extraction from any channel, coverage checks, reserves, and audit-ready decisions — every step logged and replayable for QA and regulators.
Underwriting
Evidence-Backed Submission Review
Risk signals, guideline alignment, and explainable recommendations grounded in policy and regulatory context — straight-through where it counts, referral where it matters.
Fraud & Compliance
Anomaly Scoring with Escalation Paths
Real-time anomaly scoring, specialised enrichment agents, and investigator-ready exports — designed for compliance teams that need a defensible paper trail.
Impact Highlights
- Claims cycle time: Up to ~70% faster
- Underwriting STP: 80%+ on standard lines
- Adjuster leverage: 3–7× productivity
Workflow Showcase
Elevate Policyholder Experiences. Reduce Claims and Underwriting Overhead.
Two production workflows live in deployments today — the End-to-End Claims Processing Agent and the Intelligent Underwriting Workbench — both wired to your policy corpus, your claims systems, and your guidelines.
Workflow Use Case · 1: End-to-End Claims Processing Agent
Intake → Assessment → Decision with full traceability — for claims operations and adjusters, aligned to our full claims demo.
- Claim Report: Water damage from a burst pipe on 03/15.
- Response: Coverage-oriented view from the policy packet and latest intake — consistent with intake → verification → decision:
- Coverage: Sudden pipe bursts under the water-damage endorsement; watch mold sublimits and flooring clauses per §4.2.
- Verification: Limits, deductibles, exclusions; cross-check prior claims and loss history.
- Next Steps: Photo validation, field inspection if needed, reserve range, fraud score, and audit-ready documentation.
Workflow Use Case · 2: Intelligent Underwriting Workbench
Submission intake, enrichment, and guideline-aligned decisions — for underwriters and managers, aligned to our underwriting demo.
- Commercial Property Submission for a mid-rise retail center.
- Response: Assessment aligned to triage → enrichment → guideline evaluation from the workbench demo:
- Triage: Classify by line, complexity, and priority from portal or email submission plus attachments.
- Enrichment: External signals (loss history, credit, property, market) assembled for risk assessment.
- Path: Routine risks: quote with terms, pricing, conditions. Complex risks: decision brief for human review.
Foundation Models
Command
A family of high-performance generative models.
- Supports 23 languages for global communication and discovery.
- Seamlessly integrates into existing systems.
- Powers AI applications that reason, act, and generate insights anchored in your data.
Embed
A model for semantic text representation.
- Captures the semantic meaning of text for accurate document comparison.
- Converts text to vectors for fast, scalable search.
- Uncovers hidden patterns and relationships in data.
Rerank
A model for relevant search results.
- Prioritizes the most relevant documents for better user experiences.
- Tailors results to individual user needs and preferences.
- Continuously updates results based on user interactions.
Get Started
Move your insurance roadmap from pilot to production.
Connect with our team to scope an agent that fits your policy corpus, your guidelines, and your regulator’s appetite for risk.
- Pilot with your real policy corpus and historical claims.
- Choose between VPC, on-prem, or on-device deployment.
- Live in under two weeks with our forward-deployed team.
Deployment & Governance
Private Deployment
A dedicated managed tenant, your own VPC on AWS, Azure or GCP, on premises, or air-gapped. Your data never leaves your boundary.
Approvals and Audit
Approval gates wherever you set them, role-based access, and a full audit log. Every agent action is attributable and reviewable.
Measurable Pilots
Pilots run on two or three real workflows, typically live inside two weeks. Measure time saved, accuracy and cycle time before rollout.