Claims, underwriting and complaints each need their own track, because each signs off a different kind of agent decision. An insurer's programme should include a shared grounding for everyone, a reviewer track tied to the line of business, practice on real held claims and referrals, an exam plus supervised sign-off, and renewal every year as products and agents change.
What does each part of an insurer need to learn?
Agents in an insurer tend to start in three places: first notification of loss, underwriting referrals and complaint handling. The training differs because the risk differs.
| Team | Typical agent work | What reviewers must learn |
|---|---|---|
| Claims | Triage new claims, request documents, draft settlement letters | When a held payment is safe to approve, and which fraud signals the agent cannot see |
| Underwriting | Summarise submissions, check against appetite, draft quotes | When a refusal is right, and why an out-of-appetite risk must never be forced through |
| Complaints | Draft acknowledgements and final responses | Which replies need a person's judgement on fairness |
| Delegated authority oversight | Read binder and bordereaux data | How to spot when a coverholder's agent acts beyond what was granted |
Executives and the board need the shared grounding: what depth means, why it is earned on evidence, and what the record will show a supervisor.
What may a claims agent do, and what stays with a handler?
A sensible starting split for a personal lines claims team:
- Depth 1: read the policy, the claim form and the documents attached.
- Depth 2: draft the acknowledgement, the document request and the settlement letter; a handler sends them.
- Depth 3: chase missing documents and update claim status within set rules.
- Depth 4: paying a claim moves money, so it is held for a named handler until the agent is certified at that depth for that capability, and even then only within the insurer's own limit.
- Stays with a person: declining a claim, any suspected fraud referral, any customer flagged as vulnerable, and any settlement above the handler's authority.
Training must make reviewers fluent in this. A handler who does not know why a payment was held cannot judge whether to release it.
How should insurers practise on real decisions?
Replay last quarter's claims. Give each reviewer a set of held settlements and declined referrals from their own line of business, and ask for a decision and a reason on each. Include cases where the right answer is to refuse. A supplier invoice for a repair that arrived by email is external provenance, and an external claim cannot authorise a payment; reviewers should practise spotting a changed bank account on such an invoice.
Underwriters should practise reading verdicts. When the agent declines to quote, the verdict names the bound that decided: the insurer's own appetite limit, the agent's certificate, or a missing source. That tells the underwriter whether to fix the data or accept the refusal.
An example: motor glass claims
Take a regional insurer's motor team where an agent handles windscreen claims. Most are routine: a repairer invoice, a policy with glass cover, a payment of a few hundred to the repairer. The agent drafts and holds each payment. During the practicum a trained handler releases the routine ones quickly and stops the claim where the repairer's bank details differ from the approved supplier list. An untrained handler, seeing hundreds of near-identical holds, approves the lot.
That is the case the programme exists for. Speed on the routine is good only when the handler still sees the exception.
Which rules shape the training?
Under the EU AI Act, risk assessment and pricing for life and health insurance are listed as high-risk, and Article 4 expects staff who deal with AI systems to have sufficient AI literacy. Supervisors in most markets will expect the people overseeing such systems to be competent, and to show it. This is an explanation of the rules, not legal advice; confirm how they apply to you with counsel.
The approach for banks and utilities follows the same shape with different decisions. For an insurer's schedule, use the AI agent training plan template for insurers, and read what insurers get wrong about AI agent training before you start. The full method is in training teams for AI agents.
Where the Academy fits
Pryme Intelligence Academy sets module tests in the learner's own industry and role, so a claims handler is tested on claims. Handlers take the Operator track: a 40-question exam passed at 32 of 40, then two weeks of real review decisions with no missed red line, signed off by a Pryme assessor. The certificate lasts 12 months and is checked through VerifyDoc.ai.
Questions people ask
Do underwriters and claims handlers need different certificates?
They can hold the same reviewer certificate, but practise on different decisions. What matters is that each person's practicum used cases from their own line of business.
Should delegated authority partners be trained too?
Yes, if their agents act under your binder. Ask for evidence that the people reviewing their agent's work hold a current certificate, and check it at source.
How often should claims staff refresh their training?
Yearly at least, and whenever an agent gains depth for a new capability. A handler who reviewed drafts at depth 2 needs fresh practice before approving payments the agent now makes.