Settlements, declines, reserve changes and payments to new bank accounts are the rows that matter most in a claims approver authority matrix. For each claim action, it states whether an AI agent may complete it or must hold it, which handler or manager approves, up to what value, and which certificate the approver needs.
What does a claims authority matrix decide?
Claims teams already work under authority limits: a handler settles up to one value, a senior up to another. Agents slot into that structure. A claims agent can read a first notification at depth 1, draft settlement offers and correspondence at depth 2, and in narrow lines pay small, simple claims at depth 3 within the insurer's own limits. Larger payments are depth 4 and held.
The matrix adds two things the old authority letter lacked. It sets depth per action, so the agent's freedom is explicit. And it ties approval rights to skill: a business can adopt the practice that only people holding a current certificate may approve agent-held actions at each depth. The general idea of an authority matrix is old; applying it to agents is what is new.
How do you fill it in?
- Start with your existing claims authority letters. Their limits are the ceiling for anything an agent does.
- For each action, set the agent's depth, always below the lowest handler's authority for that action.
- Name the approver for held actions and their limit.
- Add a second approver where the action is adverse to the customer or large.
- Note the certificate required.
- Add one condition that always forces a hold, regardless of value.
The template
| Claim action | Agent depth | Agent limit | Approver | Approver limit | Second approver when | Certificate | Always held if |
|---|---|---|---|---|---|---|---|
| Acknowledge and register claim | |||||||
| Request documents | |||||||
| Set or change reserve | |||||||
| Offer settlement | |||||||
| Pay claim | |||||||
| Decline claim | |||||||
| Refer for fraud investigation | |||||||
| Change payee bank details |
A worked example
A hypothetical home insurer's claims team: twenty handlers, five seniors, a claims manager. Values are illustrative.
| Claim action | Agent depth | Agent limit | Approver | Approver limit | Second approver | Certificate | Always held if |
|---|---|---|---|---|---|---|---|
| Register claim | 3 | All | Handler | n/a | None | Foundations | Injury mentioned |
| Request documents | 2 | n/a | Handler | n/a | None | Foundations | Customer vulnerable |
| Set reserve | 2 | n/a | Handler | 20,000 | Above 20,000, senior | Operator | Large loss |
| Offer settlement | 2 | n/a | Handler | 10,000 | Above 10,000, senior | Operator | Disputed liability |
| Pay claim | 3 / 4 | 500 at depth 3 | Handler | 10,000 | Above 10,000, senior | Operator | New bank account |
| Decline claim | 2 | n/a | Senior | All | Always, second senior | Operator | Any decline |
| Fraud referral | 2 | n/a | Senior | All | None | Operator | n/a |
| Change bank details | none | Refused | Senior via call-back | All | Always, claims manager | Operator | Any change |
Small glass and contents claims under 500 pay at depth 3, which the agent earned on the insurer's own past claims. Above 500 the payment is a depth 4 action held for a handler. If the agent's certificate lapses after 90 days, every one of those small payments becomes a held item until it is recertified, so the reviewer rota for the claims team should show the lapse date and extra cover.
Every decline needs two seniors. A decline is adverse to the customer, often contested, and the agent's draft must quote the policy wording it relies on. A senior who approves a decline is confirming that wording applies to these facts.
Bank-detail changes are refused for the agent. A customer emailing new account details mid-claim is a known fraud route, and an external claim cannot authorise a payment. The approver rows for this kind of change mirror those in the approver authority matrix for the compliance team, where unusual payments get second-line attention. The exact thresholds belong in the approver rule for the claims team.
Where the Academy fits
Pryme Intelligence Academy's Operator track is set for claims handlers and seniors who decide held actions, with module tests in insurance claims. Its practicum allows no missed red line across two weeks of real decisions. The admin view lets a claims manager see which approvers hold a current certificate before setting the day's queue.
Questions people ask
Can the agent pay a claim to a new bank account?
No. A new account always forces a hold, whatever the value, and the change itself must be verified by a senior through a known channel. Skills for each role are in AI agent skills by role.
Should handlers approve declines?
Not in this model. Declines go to seniors with a second approver, because they are the decisions most likely to be challenged and most harmful if wrong.
How often should limits be reviewed?
At least yearly, and whenever loss patterns, the agent's depth or authority letters change. Limits that were right for a calm year may be wrong after a storm.