Connect the agent to the claims system under its own identity, with permissions action by action. The agent can read claims and cover, register new claims, request documents, keep notes and raise fraud flags. Reserves, coverage decisions, declines, settlement offers and payments are drafted at most and decided by a named claims handler. Every write is recorded against the agent.
What does the connection cover, and who owns it?
A claims system holds the life of each claim: first notification of loss, the claim record, documents, notes, reserves, fraud indicators, offers and payments. Much of a handler's day is administration around those records, which is where an agent helps. The decisions that settle a claim, and the money that leaves the insurer, need a person's judgement and a person's name.
The head of claims owns what the agent may do. The claims system administrator implements permissions. Fraud, finance and compliance each own a slice: fraud flags, reserves and payments, and customer communications. The general approach to integrations is in how do you connect an AI agent to your systems?
What are the steps to connect it?
- Person, head of claims: lists the actions wanted from the claims system, one per row, with a proposed depth.
- Person, claims system administrator: creates the agent's identity and a role per capability, avoiding any handler or supervisor role.
- Person, claims system administrator: grants read on claims and documents for the lines of business in scope, and read-only access to cover through the policy administration system.
- Person, head of claims: sets the held actions and the named approvers for each.
- Person, fraud lead: sets fraud rules: the agent may raise indicators, never clear them, and never reveal them to the claimant.
- Agent, depth 1: runs in shadow on live claims, proposing actions that handlers compare with their own.
- Person, head of claims: approves the agent's depth from the shadow and replay results.
- Person, administrator: tests revocation, confirming a disabled identity can no longer read or write.
Which permissions are granted per action, and at what depth?
| Step | The agent does | Depth | Stays with a person |
|---|---|---|---|
| Read claim, documents and cover | Retrieves for the task | 1 | Nothing |
| Register a new claim | Creates the claim from the notification | 3 | Checking unusual cases |
| Request documents | Sends approved requests to the claimant | 3 | Template wording |
| Notes and diary tasks | Writes notes, sets follow-ups | 3 | Nothing |
| Raise a fraud indicator | Flags with reasons | 3 | Clearing or acting on it |
| Set or change a reserve | Proposes an amount with basis | 2 | Setting the reserve |
| Coverage decision | Drafts the analysis | 2 | The decision |
| Decline a claim | Drafts the letter at most | 2 | Deciding and sending |
| Settlement offer | Drafts the offer | 2 | Approving and making it |
| Payment | Prepares the payment for approval | 4 at most | Releasing it |
Registering claims is the most common first capability; how to let an AI agent register claims in your claims system goes into it. Many insurers keep payments at depth 2 for a long time even when evidence would allow more, because a wrong claim payment is hard to recover, as irreversibility in insurance claims explains.
What stays with a person, and why?
Coverage and declines. Whether a policy responds is a judgement with legal and conduct consequences. A decline in particular needs a handler who can explain it and who is accountable for it.
Reserves. Reserves feed the insurer's financial reporting. The agent can propose with its basis; a handler or reserving specialist sets it.
Clearing fraud indicators. An agent that could clear flags could be manipulated into clearing them. Only a person clears.
Money. Settlement offers and payments are approved by a named handler within their authority limit.
What is recorded?
The claims system history shows every agent write under its own identity. Each entry carries the identifier of the verdict in the agent's own record, which holds the sources used, their provenance (a claimant's statement is declared, a police report is signed by a named party, an emailed invoice is external), the bound that decided and the approver for held actions. A claim can then be reconstructed from first notification to payment.
Which controls make it safe?
Cover read from the source. The agent reads cover from the policy administration system, not from the claimant's account of their policy; see how to connect an AI agent to your policy administration system.
External documents cannot authorise. A repair invoice attached to an email is external. It can support a draft, not release a payment.
Authority limits apply to approvers. A held payment goes to a handler whose limit covers it.
Vulnerability routing. Claims involving bereavement, serious injury or signs of vulnerability go to a handler, not through routine automation.
What should you measure?
Claims registered by the agent and corrected afterwards, document requests that had to be re-sent, reserve proposals accepted unchanged, fraud indicators raised and confirmed, held items by type and decision time, and complaints linked to agent actions.
Where does it usually go wrong?
A handler role is reused. The agent gets a standard handler profile, which includes reserve and payment rights. Build agent roles from nothing.
Claimants are told too much. The agent mentions a fraud check in a document request. Templates must never reference indicators.
Notes become decisions. The agent writes "cover confirmed" in a note, and the next handler treats it as a decision. Agents should write "cover appears to apply; for handler review".
Bulk catch-up runs. After an outage, the agent registers a backlog quickly, without the checks it applies one by one. Throttle backlog processing.
Where Pryme fits
In Pryme, each claims agent is certified on your own past claims, and every action meets the minimum chain of five bounds, so payments and declines are held for a named person. The deployment path is set out in deploying an AI agent: train, shadow, certify, widen.
Questions people ask
Can the agent settle small claims on its own?
Some insurers allow very low-value, simple claims to be paid automatically under strict rules. If you do, treat it as a depth 4 capability, with a low limit, sampling after the fact and a clear route for the claimant to challenge.
Should the agent talk to claimants directly?
It can send approved document requests and status updates, telling claimants they are dealing with an AI system. Anything that discusses cover, offers or a decline should come from a handler.
What about third-party claimants?
Treat them as a separate scope. They have no policy relationship with you, and their data and complaints are handled differently, so start the agent on first-party claims.