Insurance · Agentic Operations Layer

The AI operations layer
for your book of business.

Put a team of agents on yourFNOL intake.

Rach.Dev runs claims & quote intake, coverage triage, FNOL documentation, renewals and fraud/lapse monitoring across the systems you already use — with a licensed adjuster or producer in the loop on every coverage decision, and a full audit trail on every action.

State-DOI & NAIC-aligned by designWorks with your policy admin & claims platformLicensed-human-in-the-loopEnglish & Spanish
The operating picture

What an agent team takes off your floor

Most of a carrier's load isn't coverage judgement — it's intake, paperwork, chasing documents and renewal outreach. Here's where agents own the busywork, mapped to how your book actually runs.

In demo

The Front Door

Every FNOL, quote and policy question captured, qualified and routed — 24/7, in English or Spanish.

  • Multi-channel intake (phone, SMS, WhatsApp, web, agent portal)
  • Policy match & policyholder identity verification
  • Coverage-in-force and effective-date confirmation
In demo

Coverage Triage

Severity and coverage scoring with explicit red-flag detection and instant routing.

  • Routes by line of business, severity and complexity
  • Total-loss, injury and SIU red-flags page a licensed adjuster
  • Matches to the right adjuster or producer by license & state
In demo

Claim & Quote File

FNOL write-ups, photo/document capture and cited policy references — the adjuster decides.

  • Loss narrative drafted from the policyholder's own words
  • Photo, estimate and document intake with completeness checks
  • Coverage citations pulled from the actual policy form
In demo

Evidence & Verification

The full loop — third-party data ordered and SIU referrals escalated the moment a flag trips.

  • Police report, ISO ClaimSearch and prior-loss lookups
  • Damage estimate / appraisal ordering and routing
  • SIU referral staged when fraud indicators surface
In demo

Servicing & Coordination

Endorsements, payments, status updates and the renewals customers never hear about.

  • Endorsements, ID cards and billing changes staged for sign-off
  • Claim status updates and rental / repair coordination
  • Renewal outreach & lapse-prevention nudges (EN / ES)
In demo

Billing & Payments

The fastest ROI for a CFO: clean every premium transaction, settle every covered claim faster.

  • Premium quote, bind-ready packet and invoice generation
  • Claim payment / reserve recommendations for adjuster sign-off
  • Subrogation and salvage flags before the file closes
In your build

Back-Office & Compliance

Producer licensing, DOI complaints and the regulatory filings no one wants to do.

  • Producer appointment & license-status tracking
  • State DOI complaint logging and timeline tracking
  • Required disclosures and AI-interaction notices by state
In demo

Knowledge Layer

A role-aware assistant grounded only in your approved policy forms and bulletins.

  • Separate views for policyholder, producer and adjuster
  • Every answer cites the policy section or bulletin
  • Hard guardrails — never a binding coverage determination

Watch the team run a claim

Pick a case and press play. Watch the agent team run it end to end — a licensed adjuster or producer approves every coverage decision.

Control Tower
Robert Daniels · Policy AU-48213Rear-end collision, drivable — first notice of loss
Phone · FNOL line
Front Door
Triage
File Build
Evidence
Decision
Servicing
Follow-up
Agents
AvaFront Desk · Claims & Quote Intake
Idle
MarcusCoverage Triage & Safety
Idle
NoraClaim & Quote File
Idle
OwenServicing & Coordination
Idle
RileyBilling & Payments
Idle
IrisKnowledge Assistant
Idle
HopeClaims & Lapse Sentinel
Idle
Decision trace0/7

Press Run the journey — or scroll in and watch it play automatically. Every clinical action waits for a clinician.

Every coverage decision waits for a licensed human. Rach.Dev drafts, stages and routes — an adjuster or producer approves.

Seven specialists, one conductor

Each agent owns one job and hands the next a complete, structured file. Atlas routes the work, enforces the human-in-the-loop gates, and writes every action to an audit log.

Atlas

Atlas is the orchestrator. It routes each claim or quote to the right specialist, carries the shared policyholder and policy context between them, pauses for a licensed adjuster or producer to approve every coverage decision, and records a complete, timestamped audit trail.

Live handoff pipeline
AvaIntake
MarcusTriage
NoraFile
OwenService
RileyBilling
IrisKnowledge
HopeSentinel

Click Ava below — the full FNOL-to-settlement workflow plays out automatically.

MarcusCoverage Triage & Safety

Coverage triage. Scores severity and coverage, watches for injury, total-loss and SIU red flags, and routes straight to the right licensed adjuster — never sitting on a high-exposure claim.

Context from Ava
Robert Daniels · AU-48213Auto collisionNo injuries · drivable
Severity scored — material damage, standard complexity
Red-flag scan clear (no injury, no total-loss, no SIU hit)
Routed to the licensed adjuster for the policyholder's state
Severity & coverage scoringRed-flag detectionAdjuster routing
NoraClaim & Quote File

File specialist. Drafts the loss narrative from the policyholder's own words, captures photos, estimates and documents, and cites the applicable coverage form — leaving the adjuster to decide, not type.

Context from Marcus
Material damageDeductible $500Coverage: Part D collision
Loss narrative drafted from the recorded statement
Damage photos and third-party info captured and checked for completeness
Applicable coverage and exclusions cited from the actual policy form

Draft only. Coverage is determined solely after a licensed adjuster reviews and approves.

Loss narrativeDocument & photo intakePolicy-form citations
OwenServicing & Coordination

Servicing & coordination. Orders estimates, books repairs and rentals, sends status updates, and keeps policyholders on track through renewals with reminders and lapse-prevention nudges.

Context from Nora
Network-shop appraisalRental within limitStatus link → SMS
Appraisal scheduled and prior-loss lookups ordered
Rental authorized under the policy limit; repair booked
Status updates and renewal reminders scheduled (EN / ES)
Estimates & repairsStatus & renewalsReminders
RileyBilling & Payments

Billing & payments. Builds bind-ready quote packets and invoices, prepares claim payment and reserve recommendations from the file, and flags subrogation and salvage before a file closes — all for a licensed human to release.

Context from Owen
Estimate $4,180Deductible nettedAt-fault: third party
Payment packet prepared from the file for adjuster release
Reserve recommendation staged; deductible applied
Subrogation flag opened against the at-fault carrier
Quotes & invoicingPayment & reserve prepSubrogation & salvage
IrisKnowledge Assistant

The role-aware knowledge assistant. Answers policyholders, producers and adjusters from your approved policy forms and bulletins only — every answer cited, and never a binding coverage determination.

Context from Riley
Policyholder viewApproved forms onlyEN / ES
Answered the policyholder's questions from approved policy materials
Every answer carried its policy-section or bulletin citation
Coverage-determination request → handed to a licensed adjuster, not answered

Iris informs. It never determines coverage, denies a claim or overrides a licensed professional.

Role-awareCited answersNever a binding ruling
HopeClaims & Lapse Sentinel

The Claims & Lapse Sentinel. Always on across the open book — flagging fraud indicators on live claims, renewal-lapse risk before expiration, and claim-SLA clocks running toward a fair-claims-practices breach, and staging the response for the team.

Context from the book
Open claimsRenewals in 30 daysFair-claims SLA clocks
How Hope calibrates for this carrier
Baselines normal claim and renewal patterns by line of business
Loads each state's fair-claims-practices timelines and DOI rules
Tunes fraud thresholds to your SIU appetite to cut false positives
What Hope watches in real time
Fraud indicatorsLapse riskSLA clocksReserve driftTotal-lossLitigation
Fraud — prior-loss pattern and estimate-vs-photo mismatch on a new claim
Lapse — renewal nearing expiration with no payment and a recent rate change
SLA breach — acknowledgement or decision clock past the state deadline
Reserve drift — incurred trending past the set reserve
Total-loss — repair estimate crossing the salvage threshold
Litigation — attorney representation or DOI complaint detected

Hope is advisory. It alerts and stages — a licensed adjuster or producer decides and acts. Every alert is logged with the signal that triggered it.

Live · BookAlways-on monitorFraud & lapse & SLAAdvisory only

Ava captures patient intake by voice, then hands a structured summary to 6 downstream agents — triage, documentation, coordination, billing, knowledge and ICU monitoring — each acting on the shared context, with Atlas orchestrating and a clinician approving every clinical action.

Ava starts the workflow.

One layer over the systems you already run

Rach.Dev sits on top of your policy admin system, claims platform and CRM — orchestrating agents, enforcing governance, and keeping a licensed human in the loop. No rip-and-replace.

Layer 4Human-in-the-loop

Every coverage decision — coverage confirmations, reserves, payments, denials, SIU referrals — pauses for a licensed adjuster or producer to approve. Agents draft and stage; people decide.

Approval gatesAdjuster / producer sign-offRole-based access
Layer 3Governance & audit

State-DOI and NAIC-aligned controls, fair-claims-practices guardrails, AI-interaction disclosures, and a complete, timestamped audit trail on every action and every data touch.

State-DOI & NAIC-alignedFull audit logFair-claims guardrailsSource citations
Layer 2Agent orchestration

Atlas routes each claim or quote to the right specialist, carries shared policy context between agents, and coordinates hand-offs end to end.

Routing & hand-offShared contextEscalation paths
Layer 1Integration

Bidirectional connectors to your policy admin system, claims platform, Guidewire and CRM over the standards and APIs your systems already speak.

ACORD standardsGuidewire APIsWebhooks & APIs
Works with the systems you already run
Policy admin systemClaims platformGuidewire ClaimCenterGuidewire PolicyCenterDuck CreekSalesforce Financial Services CloudTwilioISO ClaimSearchLexisNexisVerisk

A knowledge layer that knows its limits

Iris answers policyholders, producers and adjusters from your approved policy forms and bulletins only. Every answer is cited — and a coverage question is always handed to a licensed professional, never ruled on.

Try a question

IrisPolicyholder view

Hi, I'm Iris. Ask me about your policy, a claim's status or your bill — I'll always cite my source.

Iris provides information only — never a binding coverage determination, claim denial or insurance advice. Anything that decides coverage is routed to a licensed adjuster or producer.

A knowledge layer that knows its limits — questions and answers

What's the status of my auto claim?
Your collision claim AU-48213 is open and assigned to adjuster Alan Reyes. The appraisal is scheduled for Thursday, June 11 at the network shop, and a rental has been authorized under your policy limit. You'll get a text the moment the estimate is approved. You can view the full timeline anytime in the claims portal.
¿Por qué subió mi prima este año?
Según su póliza y la presentación de tarifas de su estado, su prima de auto cambió por un ajuste de tarifa aprobado y un cambio en su historial de manejo. Le puedo mostrar el desglose línea por línea y sus opciones de renovación. Para revisar coberturas o un posible descuento, la conecto con un productor con licencia.
Is my basement flooding from the storm covered?
That's a coverage determination, so I won't decide it myself. I've opened a claim, attached your photos, and routed it to a licensed adjuster who will review your policy's water-damage and flood provisions and follow up with you. If this is an emergency, please call 911.

Governance, not just guardrails

The controls that let a carrier actually deploy agents — enforced in the system, not promised on a slide.

Licensed human in the loopEvery coverage decision — coverage confirmations, reserves, payments, denials and SIU referrals — waits for a licensed adjuster or producer to approve. No agent makes a coverage call on its own.
Complete audit trailEvery action, hand-off and data access is logged with a timestamp, the agent, the source and the approver — exportable for DOI market-conduct exams on demand.
State-DOI & NAIC-aligned by designState-specific disclosures, AI-interaction notices per the NAIC AI Model Bulletin, fair-claims-practices timelines, encryption in transit and at rest, and role-based permissions — compliance built in, not bolted on.
Grounded with sourcesAnswers come only from your approved policy forms, rate filings and bulletins, and cite them. No open-web guessing, no ungrounded coverage claims.
No vendor lock-inStandards-based connectors (ACORD, Guidewire APIs) and your data stays yours. Turn an agent off and your policy and claims systems keep running.

Live audit log

A sample of what every action looks like on the record.

21:20:14Outbound SMS (es) renewal outreach — policy AU-77410Logged
08:31:09Coverage-in-force verified — policy AU-48213Verified
08:32:47Policyholder PII accessed: FNOL file build (minimum necessary)PII
08:35:22Reserve recommendation staged — $4,180, awaiting sign-offPending
08:36:05Coverage & reserve approved by Alan Reyes, Licensed AdjusterApproved
13:18:40Fraud indicators (HO-90147) — SIU referral escalated to managerEscalated

What changes when agents own the busywork

Directional outcomes our pilots target — validated on your own data, never assumed.

24/7
Coverage, every channel
FNOL, quotes and policy questions answered around the clock, in English and Spanish — no after-hours hold music.
Minutes
From FNOL to file
Verification, loss narrative and document intake done while the policyholder is still on the line.
Earlier
Fraud & lapse flags
Indicators and renewal-lapse risk surfaced before payout or expiration — staged for SIU or a producer.
Hours back
For adjusters & producers
Less typing and chasing, more time on the coverage judgement and advisory work that needs a licensed human.

The problem, in numbers

  • Insurance fraud is estimated to cost Americans roughly $308 billion every year across all lines — the case for earlier, grounded fraud flags is large. Coalition Against Insurance Fraud, The Impact of Insurance Fraud on the U.S. Economy, 2022
  • Auto repair claim cycle times averaged about 23 days in 2023, and managing the wait is now central to claims satisfaction — faster intake and coordination matter. J.D. Power, 2023 U.S. Auto Claims Satisfaction Study
  • Individual life insurance policies lapse at roughly 5% per year, with a large share lapsing in the first few years — proactive renewal outreach is where retention is won. American Council of Life Insurers, Life Insurers Fact Book (NAIC / LIMRA data)

Figures above are external benchmarks and pilot targets, not guarantees — we validate every number on your own data before you rely on it. Monitoring agents are advisory: they alert and stage, a licensed adjuster or producer acts.

Start with one line of business. Prove it. Then scale.

We stand up a single workflow on your existing policy admin and claims platforms, show the audit trail and the outcomes, and expand only once your team trusts it.

01
Scope one workflow

Pick the highest-pain workflow — FNOL intake, renewals or fraud/lapse monitoring — and we map it to your systems.

02
Pilot in your environment

Agents run on your policy admin and claims platforms with a licensed human in the loop and a full audit trail, in weeks not quarters.

03
Measure, then expand

Review the outcomes on your own data, then roll the agent team out line by line of business.