AI for insurance
Claim notes and broker submissions take hours to read. Where does AI help insurers and brokers?
Last updated
AI helps most where people read before they decide: triaging new claims by type and urgency, summarising long claim files for assessors, extracting broker submissions into underwriting systems, and flagging fraud signals for an investigator to review. Assessors and underwriters keep every decision. APRA expects human involvement in high-risk decisions, an inventory of AI use and visibility over AI suppliers, so build governance in from the first pilot.
Who this is for
This page is for claims managers, underwriting operations leads, risk and compliance teams and CIOs at insurers, underwriting agencies and broker networks with many offices, where claim files, reports and broker submissions arrive by email and portal and are read and keyed by hand.
It covers where AI fits in claims and intake, where a person must stay in charge, and what APRA and ASIC have said about AI governance.
Where AI helps and who decides
| Task | What AI does | Who decides |
|---|---|---|
| Claims intake triage | Reads the lodgement and attachments, extracts key facts, lists missing documents and suggests a complexity and queue | Claims team leader |
| Claim file summaries | Builds a dated chronology from notes, emails and reports, with each point linked to its source page | Assessor |
| Broker submission extraction | Reads emails, schedules and spreadsheets into underwriting fields and checks them against appetite guidelines | Underwriter |
| Fraud signals | Flags inconsistencies across documents with reasons | Investigator |
Claims intake triage
Read everything that arrives
Lodgements, emails, invoices, quotes and assessor reports are read as they land, and policy number, loss date, cause and amounts extracted.
Check completeness
Missing documents are listed so the request for information goes out on day one, not after an assessor opens the file.
Suggest the route
A suggested complexity and queue, with reasons, lets simple claims move quickly and complex ones reach senior assessors.
Flag vulnerability
Mentions of hardship, illness or family violence are flagged for a person to handle with care.
Claim file summaries
Chronology with sources
Every event in the summary links to the note, email or report page it came from, so the assessor can check it in one click.
Refreshed on new documents
When a new report arrives, the summary shows what changed since the assessor last read it.
No decisions
The summary describes the file. Liability, cover and settlement stay with the assessor.
Broker submission extraction
For insurers and agencies
AI reads submission emails, schedules of values and claims histories into underwriting fields, and flags risks outside appetite guidelines for the underwriter.
For brokers
AI pre-fills renewal submissions from last year's file and the client's updates, and highlights what changed for the account manager to confirm.
Exceptions shown
Fields the AI could not read with confidence are marked for a person instead of guessed.
Fraud signals as prompts for a person
Stated reasons for every flag
Each flag states what looks inconsistent, such as dates that do not match or the same invoice details on unrelated claims.
An investigator decides
A flag starts a review. It never declines or delays a claim by itself.
Watch for unfair patterns
Track flag rates and outcomes by customer group and product, and retire any signal that mostly flags honest customers.
What APRA and ASIC expect
APRA's letter to all regulated entities of 30 April 2026 says governance, risk management, assurance and operational resilience are not keeping pace with AI adoption. It expects an inventory of AI tooling and use cases, ownership across the AI lifecycle, human involvement for high-risk decisions, visibility over the AI supply chain including fourth parties, and credible fallback processes where AI supports critical operations. It notes that few entities continuously monitor for model drift or bias, and that existing prudential standards apply to AI risk.
Under CPS 230, insurers keep a register of material service providers, and an AI provider supporting claims may belong on it. CPS 234 requires an entity to assess the information security capability of any third party managing its information assets, test its controls, and notify APRA within 72 hours of a material information security incident.
ASIC's REP 798 reviewed 624 AI use cases at 23 licensees across banking, credit, insurance and advice, and found that not all licensees had adequate arrangements for managing AI risk, including oversight of models developed by third parties. Brokers are generally not APRA-regulated, but most hold an Australian financial services licence, so ASIC's findings are relevant to how they govern AI.
Keep it private and onshore
Claim files hold health and financial information. Run the AI in your own cloud environment in an Australian region, with read-only access to the claims and policy systems, no training on your data, and every extraction and suggestion logged against the user who accepted it. That log is the evidence APRA's inventory, monitoring and accountability expectations call for.
How Solve8 delivers it
Solve8 works in fixed-fee phases: discovery on one claim type or submission flow at one office with a measured baseline of handling time and rework, a shadow pilot on live files where your claims or underwriting lead sets the accuracy bar, a build into your claims system, Dynamics 365, Salesforce or Microsoft 365 on your infrastructure in Australia, then support or handover. A person approves every output. Workshops run on site and builds run remotely under your access controls, with risk and IT involved from discovery.
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Sources
APRA, Letter to industry on artificial intelligence (30 April 2026): https://www.apra.gov.au/apra-letter-to-industry-on-artificial-intelligence-ai
APRA, Operational risk management (CPS 230 and the material service provider register): https://www.apra.gov.au/operational-risk-management
APRA, CPS 234 Information Security: https://www.apra.gov.au/standards/cps-234
ASIC, REP 798 Beware the gap: Governance arrangements in the face of AI innovation: https://asic.gov.au/regulatory-resources/find-a-document/reports/rep-798-beware-the-gap-governance-arrangements-in-the-face-of-ai-innovation/
Questions
Can AI approve or decline insurance claims?
It should not. AI can read the file, check it against the policy wording, list what is missing and suggest a route, but cover, liability and settlement decisions stay with an assessor. APRA's April 2026 letter expects human involvement for high-risk decisions, and claim outcomes affect customers directly.
Is an AI vendor a material service provider under CPS 230?
It can be. If the vendor supports a critical operation such as claims handling, assess it against your CPS 230 criteria and add it to the material service provider register if it qualifies. Under CPS 234, also assess the vendor's information security capability and how its controls are tested.
Can AI check broker submissions against our underwriting guidelines?
Yes, as a first pass. AI extracts the risk details from the submission and attachments, compares them with written appetite rules and flags anything outside them with the reason. The underwriter reviews the flags and makes the decision. Guidelines that live only in underwriters' heads need writing down first.
How do we stop AI fraud flags treating honest customers unfairly?
Make every flag a prompt for an investigator with stated reasons, never an automatic decline. Track outcomes by product and customer group, and keep a log of each flag and decision so you can explain it to a customer or regulator.
Who can help an insurer or broker in Sydney or Melbourne build claims AI that keeps data in Australia?
Look for a firm that builds inside your own environment in Australia, documents data flows in your risk templates, and runs a shadow pilot before anything reaches customers. Solve8 runs workshops on site in Sydney, Melbourne and other Australian cities and New Zealand, and builds remotely under your access controls.
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Claim files and submissions piling up?
A 30-minute review with a senior consultant. You leave with a written one-page summary you can share internally.
Fixed-fee phases, agreed before we start. Stop after any phase.