Insurance underwriting and claims are the two decisions that an insurer makes over and over. Underwriting is deciding whether to insure a risk, and what to charge for it. A claim is a customer's request for payment after a loss, and claims work is deciding how much to pay. This zone holds the software that records both decisions, and the data and AI models that help to make them.
At the centre is the insurance core system. It writes each policy, collects each premium, and records and pays each claim. Life insurers often run a separate core, because their policies last for decades. Their online applications and servicing run on digital life insurance distribution software.
The first decision is underwriting. Take, for example, a textile shop in Surat that applies for fire and flood cover. The underwriter is the insurer's employee who decides on the application. The underwriter opens it on an underwriter workbench, one screen that shows the application, its data and a suggested price. AI for insurance submissions has already read the shop's documents and filled in the form. Property risk data shows how often the area has flooded and how old the building is. For a car or a truck, usage-based insurance would add a score for how safely it is driven.
The second decision is the claim. Two monsoons later, water enters the shop and damages ₹6 lakh of stock. The owner reports the loss, and the core's claims system records it. AI claims estimation reads the photographs and drafts the cost of the damage. A claims employee or a surveyor checks the draft before the insurer pays. When a model drafts and a person approves, the arrangement is called human in the loop.
Two products in this zone sit slightly apart. A digital insurer is an insurer built as a software company, which runs all of these steps in its own app. A risk management information system (RMIS) is used by the insured company, not by the insurer. A large company uses it to keep its own policies and claims in one place.