A claims handler who approves an agent's draft settlement is making a coverage decision on the agent's reasoning. That is why handlers should be certified before agents go live: the job shifts from building each claim to judging prepared ones, and a handler who cannot see how a draft was built will pay, query or decline on trust.
How does the claims handler's job change?
Most of a handler's time today goes on gathering. A first notification of loss arrives. The handler checks the policy is in force, reads the cover and exclusions, collects photographs, estimates and reports, and works out whether the loss fits. Then they decide: settle, ask for more, or decline.
A governed agent takes much of the gathering. At depth 1 it reads the policy system and the claim file. At depth 2 it drafts the coverage view, the reserve and the letter to the customer. For low-value, clearly covered claims, an insurer may let it settle at depth 3 within limits the claims function sets, once Attest has shown it handles those cases correctly on the insurer's own history. Anything larger, anything disputed and every decline is held for a named handler.
So handlers see fewer claims but harder ones. Their queue is the claims the agent would not settle alone, which are, by design, the ones where judgement matters.
Why is a decline the decision most at risk?
Declines are where a weak review does the most harm. A wrongly settled small claim costs money. A wrongly declined claim costs a customer the cover they paid for, often at a bad moment in their life, and it produces a complaint, a possible ombudsman referral and reputational damage.
An agent's draft decline will usually cite the policy wording accurately. The question a handler must ask is whether the wording applies to these facts. Did the agent read the right version of the policy? Is the key fact, say the date of the leak, sealed by an engineer's report or merely declared by the customer? Has anything the customer said suggested vulnerability that should change the tone or the route?
A certified handler checks those things by habit, because certification tests them. An uncertified handler, faced with a well-written draft and a long queue, tends to sign. That is not laziness; it is what anyone does when they have not been taught what to look for in someone else's reasoning.
What should certification test for claims handlers?
Not claims knowledge. Handlers already have that, or should. Certification tests the new part of the job:
- Reading the verdict. For each held claim, which bound held it: the agent's scope, its certificate, its sources, the insurer's limits, or the platform floor?
- Provenance. Which facts in the file are sealed by the policy library or a verified assessor, and which are declared by the claimant or arrived as external documents?
- Correcting well. When the draft is wrong, the handler corrects it in a way that teaches the agent, not just fixes this one letter.
- Red lines. Never issue a decline the agent drafted without checking the exclusion against the facts. Never settle above authority because the agent's draft says the claim is covered.
The test that matters most is the practicum, where the handler makes real decisions on real held claims and an assessor scores them. A practicum log template for claims handlers helps you capture the decisions in a form you can show later.
Why before go-live and not after?
Because the first weeks are when the agent's drafts are least familiar and the temptation to trust them is highest. Handlers who learn the system after go-live learn it on live customers.
There is a second reason. Once agents are running, the record shows every approval with a name on it. If a handler approved a decline that proves wrong, the question of whether claims handlers are accountable for an agent's mistakes will be asked of that handler. Giving them the training first is fairer to them as well as safer for customers.
And the system keeps moving. The agent's own certificate lapses after 90 days and must be renewed; if a run fails, its depth drops to 1 that day and more claims arrive in the handler's queue. Handlers need to recognise that shift and absorb it, and preparing them for the 90-day recertification rhythm is part of the same training.
What is the trade-off?
Claims teams are often stretched, especially after a weather event. Pulling handlers off the queue for exams and a practicum before go-live can look like the wrong priority when customers are waiting.
The practical answer is sequencing. Run the agent at depth 1 and 2 first, so it gathers and drafts while handlers still make every decision. That saves time without adding risk. Certify handlers in groups during that period. Only allow depth 3 settlements in a team where the people sampling those settlements are certified.
You also accept some administration: tracking certificates, renewals and what happens when one lapses. That cost is small next to a run of wrong declines. The same reasoning applies to neighbouring roles such as collections agents and customer support agents, where a poor decision lands on a customer who is already under strain.
What should a claims director do differently?
Make handler certification a go-live criterion, written into the plan with dates and names. Keep declines held for a certified handler regardless of the agent's depth on other capabilities. Use practicum results to decide who reviews the hardest claims first. And treat a lapsed certificate as a reason to reroute held claims, not as an admin note. The guide to AI literacy and certification for people who work with agents explains how the levels fit together.
Where the Academy fits
Pryme Intelligence Academy's Operator track is for the people who review a live workspace every day, which in insurance means claims handlers and their team leads. Module tests are set in the learner's own industry and role. Certification combines a written exam with a two-week practicum of real review decisions, signed off by a Pryme assessor, and the certificate can be checked at source by number or QR code.
Questions people ask
Should an agent ever issue a claim decline on its own?
In most deployments, no. Declines carry the most harm if wrong, so they stay held for a named, certified handler even when the agent settles small covered claims at depth 3.
Do loss adjusters need certification too?
If they review or approve agent-prepared work, yes. If they only supply reports the agent reads, they do not need the Operator certificate, though a basic grounding helps them understand how their reports are used.
How do you handle a surge in held claims after an agent's depth drops?
Plan for it. Keep a rota of certified handlers who can absorb extra held items, and treat the drop as the system working: the agent lost authority because the evidence no longer supported it.