Emma Robot – Automate Complex Workflows with AI

Policy Quoting & Application

Generating an initial quote for potential policyholders, collecting necessary personal or business data, and submitting a formal application. This process often sets the tone for the customer’s experience with an insurer.

Collect Customer Information

Prospective clients share data—like name, address, vehicle/home details, or business operations—through online forms, phone calls, or paper applications. Manual data entry can lead to typos and missed fields. Emma uses OCR and form recognition in solutions like Guidewire, Duck Creek, or Salesforce to capture these details, ensuring accuracy and saving staff from re-keying.

Risk Pre-Screening

Insurers often set basic eligibility or risk thresholds. Without automation, staff must consult guidelines or local regulations. Emma automatically checks these rules in underwriting software—e.g., Applied Epic or Vertafore AMS—flagging high-risk scenarios (e.g., certain ZIP codes for property insurance). This ensures agents know if a prospect meets minimum eligibility before further effort.

Quote Calculation

Traditional rating engines rely on multiple factors (credit score, claims history, coverage limits). Manually plugging data into rating tables is time-intensive. Emma pulls information from rating engines such as ISO or integrated modules in Guidewire PolicyCenter and instantly calculates a preliminary premium. This reduces errors and speeds up quote turnarounds.

Present & Adjust Quote

Agents often tweak coverage options or apply discounts. Emma references underwriting guidelines to suggest endorsements or highlight potential bundling options (e.g., multi-policy discounts). By automating these suggestions, insurers can increase cross-sells while ensuring compliance with company rules.

Application Submission

Once the client accepts the quote, all the data must be converted into a formal application. Emma auto-populates the required fields in the policy admin system—like Duck Creek or Socotra—and sends final documents for electronic signatures (e.g., via DocuSign or Adobe Sign). This eliminates the potential for last-minute form errors or missing signatures.

Underwriting & Risk Assessment

A deeper evaluation of applicant information to determine coverage eligibility, premiums, and terms. Underwriters consider data like loss history, credit scores, and specialized risk factors.

Step 1

Gather Supporting Documents

Applicants or brokers may provide driving records, property inspection reports, or health screenings. Manually retrieving these from emails and third-party sites is cumbersome. Emma uses OCR to parse any PDF attachments, storing relevant data (like prior losses or building materials) in underwriting solutions such as Majesco or Insurity.

Step 2

Run Risk Models & Scoring

Advanced insurers use predictive models to measure likelihood of claims. Manually re-entering data into such models is a big time sink. Emma taps into analytics tools (e.g., Tableau, DataRobot), feeds the applicant's data, and returns a risk score. This prevents underwriters from missing critical data points and speeds up approvals or declines.

Step 3

Verify Policy Guidelines

Certain coverage lines (flood, earthquake, specialized liability) require extra checks or reinsurance approvals. Emma checks internal guidelines in your policy admin system, verifying if the coverage aligns with appetite. This ensures underwriters quickly spot uninsurable risks or those needing external reinsurance.

Step 4

Identify Required Endorsements

If a property is in a wildfire zone, or a commercial client has unusual exposures, underwriters must add endorsements. Emma compares the risk data with policy form libraries in platforms like Duck Creek or Sapiens, recommending the correct riders. This consistency helps avoid coverage gaps or unintentional exposures.

Step 5

Underwriter Approval & Terms Finalization

Finally, an underwriter reviews the aggregated data. Emma routes the case—complete with all risk analysis, scoring, and recommended terms—via workflows in Guidewire Underwriting Management or Workday. The underwriter signs off, possibly adjusting coverage limits or deductibles, and Emma updates the policy record automatically.

Policy Issurance & Administration

Creating an official insurance contract once underwriting is done, then managing policy changes (endorsements, cancellations, or reinstatements) over the policy life cycle.

Draft Policy Documents

Final policy documents include coverage details, terms & conditions, and any endorsements. Manually assembling them can result in missing pages. Emma pulls relevant clauses from templates in DocuSign CLM or Adobe Experience Manager, merges coverage specifics, and compiles a final digital contract. This cuts human error and ensures each policy is complete.

E-Signature & Policy Delivery

Modern carriers often want a fully digital experience. Emma orchestrates e-sign requests using HelloSign or OneSpan, tracking recipient status and sending automated reminders. Once signed, Emma emails or securely uploads the final policy PDF to the customer portal, eliminating shipping costs and wait times.

Policy Amendments & Endorsements

Policyholders might request changes (e.g., adding a driver, increasing coverage). Agents typically fill out an endorsement form, but it's easy to miss key details. Emma scans the request—through email or web forms—and updates the policy system (e.g., Guidewire PolicyCenter, Sapiens). She triggers re-underwriting if the change significantly alters risk.

Mid-Term Cancellations & Reinstatements

If a policyholder cancels or misses payment, the system must reflect the new coverage status. Emma automatically identifies delinquent accounts, sends notices, and updates coverage terms in the admin system. This ensures compliance with state/regulatory guidelines on noticing periods and reduces manual follow-ups.

Policy Renewal

When renewal approaches, Emma checks claims history, premium payment records, and updated risk data. She might generate a new quote or route the policy to underwriting if there's a significant risk change. This automated renewal prep ensures timely notifications and less friction, increasing retention.

Claims Intake & FNOL (First Notice of Loss)

Capturing the initial incident report when a policyholder experiences a loss (e.g., auto accident, property damage). Getting accurate and complete info sets the stage for efficient claims handling.

Step 1

Multi-Channel Intake

Policyholders can report claims by phone, email, or online portal. Manually keying phone-call details or sorting emailed forms is inefficient. Emma listens for triggers (e.g., new email with 'Claim' in the subject) or integrates with call center logs in solutions like Five9 or Genesys, pulling essential details into the claims system (e.g., Guidewire ClaimCenter).

Step 2

Pre-Fill Policy & Loss Data

Once a claim is reported, staff might struggle to find the relevant policy. Emma automatically looks up the claimant's policy number, coverage details, and relevant endorsements, presenting them on one screen for the adjuster. This shaves minutes off each intake and reduces repeated questions to the policyholder.

Step 3

Loss Description & Documentation

Insurers ask for date/time of loss, location, and a narrative. Emma extracts these details from typed forms or call transcripts, then attaches photos or videos if the policyholder uploads them. This central repository in claims software like ClaimCenter, Duck Creek Claims, or Snapsheet ensures no vital info is lost in the shuffle.

Step 4

Triage & Segmentation

Claims can be simple (broken windshield) or complex (massive property damage). Emma applies business rules—like claim type, severity, coverage lines—to route it to the correct claim unit or manager. Low-severity claims might go through fast-track settlement, while higher severity claims get specialized attention.

Step 5

Initial Acknowledgment

Many jurisdictions require insurers to acknowledge claims within specific timeframes. Emma automatically generates an acknowledgment email or letter, referencing the claim number, assigned adjuster, and next steps. This timely response fosters trust and compliance with regulatory guidelines.

Claims Processing & Settlement

From the first notice to final payment, claims handlers must verify coverage, investigate facts, determine liability, and calculate payment. Efficient claims handling can be a major competitive advantage for insurers.

Adjusters confirm the policy is active, the loss type is covered, and no policy exclusions apply. Typically, this requires flipping between the policy doc and claims system. Emma retrieves the relevant coverage forms from Guidewire or Duck Creek and checks them against the claim details. If an exclusion or coverage limit is triggered, Emma flags it.

Gathering police reports, medical records, repair estimates, or third-party statements is time-consuming. Emma automates email or portal requests, using OCR to parse documents (e.g., PDFs, images) and attaching them to the digital claim file. This centralizes evidence and accelerates investigative steps.

Insurers must set aside enough money (reserves) to cover potential claim payouts. Manually setting reserves can lead to under- or overestimation. Emma references historical claim data or predictive models (in tools like Guidewire Predictive Analytics or IBM Watson) to suggest an initial reserve, which adjusters can refine as more info arrives.

Once liability and damages are clear, staff craft a settlement offer. Emma calculates typical settlement amounts based on prior claim patterns, coverage limits, and policy deductibles. Then, she drafts an offer letter or email. For straightforward cases (like a fender-bender below coverage limits), Emma can even auto-approve payouts, drastically reducing cycle time.

Once the policyholder or claimant agrees, the insurer issues payment. Manual payment processes risk delays or lost checks. Emma triggers direct deposit or check generation via Guidewire BillingCenter, Hyland OnBase, or an accounting system (e.g., SAP, Oracle NetSuite). She then updates the claim status to 'closed,' ensuring all final documents are filed properly.

Fraud Detection & Investigation

Identifying suspicious activity or potential fraud—like staged accidents, inflated claims, or misrepresented facts. Fraud can cost insurers millions annually, making prompt detection critical.

Fraud detection often involves scanning large datasets for anomalies—e.g., claimants with multiple suspicious claims. Manually combing records is unfeasible. Emma integrates with fraud analytics platforms (like FRISS, Shift Technology, or SAS Fraud Management) to spot red flags, such as repeated addresses or unrealistic claim timelines.

Insurers sometimes consult shared industry blacklists or public records. Emma automatically queries third-party sources (e.g., ISO ClaimSearch), merges the findings with internal claim files, and highlights mismatches or unusual patterns. This speeds up investigations that otherwise could stall while staff gather external data.

Certain triggers—like a freshly purchased policy followed by a big claim, or inconsistent statements—raise suspicion. Emma assigns a 'risk score' to each claim. If it crosses a threshold, Emma routes it to a specialized SIU (Special Investigations Unit) queue in claims systems like Duck Creek or Guidewire.

Investigations might require more thorough info, like recorded statements or security camera footage. Emma organizes these tasks, sending request emails to relevant parties, and storing the evidence in a secure drive integrated with the claim system. This streamlined approach helps SIU staff systematically build their case.

If fraud is confirmed, the insurer may deny the claim or pursue legal action. Emma generates the denial documentation or official referral packages (including all evidence) for law enforcement. Where no fraud is found, Emma marks the claim as cleared, returning it to standard processing. This ensures each case is resolved with minimal delays.

Premium Billing & Collections

Generating premium invoices, tracking payments (installments or lump sums), and addressing late or delinquent accounts. Smooth billing processes are crucial to maintaining steady cash flow.

Step 1

Invoice Generation

Premium billing schedules vary: monthly, quarterly, or annually. Creating these invoices manually—especially across thousands of policies—invites errors. Emma automates invoice creation in Guidewire BillingCenter, Duck Creek Billing, or standalone solutions like Sage 300, sending them via email or regular mail depending on client preferences.

Step 2

Payment Processing

Customers pay through credit cards, bank transfers, or direct debit. Emma integrates with payment gateways (e.g., Stripe, PayPal, Authorize.Net), automatically reconciling the incoming funds with the corresponding policy. This real-time matching reduces admin overhead and shortens the time spent balancing books.

Step 3

Delinquency Tracking & Grace Periods

If policyholders miss a payment, insurers usually have a grace period before cancellation. Emma identifies overdue invoices, sends reminder notices, and calculates late fees if applicable. She also triggers a cancellation workflow if no payment arrives by the grace period's end, ensuring compliance with state notice requirements.

Step 4

Refunds & Adjustments

Situations like mid-term cancellation or coverage changes may require partial refunds or premium adjustments. Emma calculates the prorated amounts, issues a refund or revised invoice, and updates the ledger automatically. This eliminates manual number-crunching and ensures consistent customer communication.

Step 5

Reporting & Cash Flow Insights

Finance teams need to see daily receipts, outstanding balances, and accounts at risk of cancellation. Emma compiles these stats into dashboards using tools like Power BI, Tableau, or built-in reporting in Guidewire. This helps management quickly spot trends and pivot strategies if too many accounts drift into delinquency.

Renewal & Retention

Encouraging policyholders to renew coverage at term-end. Maintaining high retention rates is crucial for an insurer’s profitability and growth.

Thousands of policies might have different expiration dates. Emma keeps a schedule for each, setting up timely 'renewal approaching' tasks in your CRM or policy admin system. This ensures no policy is lost due to oversight, saving the company from losing valuable customers.

For certain lines (e.g., commercial, high-value personal lines), a renewal might require updated underwriting checks. Emma checks for claims filed in the last term, changes in insured property or vehicles, and new risk data (e.g., new drivers in auto). If risk has significantly changed, Emma flags it for a quick underwriter review.

If a policy is straightforward (few claims, stable risk factors), Emma generates a renewal offer in systems like Duck Creek, Guidewire, or Sapiens, applying any updated rates or discounts. The policyholder receives an email or portal notification with easy acceptance steps (like e-sign or one-click renewal).

Renewal time is a great opportunity to discuss coverage gaps or bundle new policies. Emma references the policyholder's profile to suggest relevant add-ons (e.g., umbrella policy for high net-worth clients). This can happen through email campaigns or agent prompts, helping agents quickly identify cross-sell opportunities.

Management wants to see renewal retention by product line, region, or agent. Emma produces real-time renewal metrics, highlighting where retention lags. This data-driven approach helps insurers refine strategies—like targeted loyalty programs or improved agent training—to keep customers renewing year after year.

Regulatory Compliance & Reporting

Insurance is heavily regulated. Companies must file documents with state or federal authorities, maintain solvency ratios, and comply with consumer protection laws.

Identify Applicable Regulations

Each state or country has unique requirements—like rate filings, consumer disclosure forms, or electronic records mandates. Manually tracking updates from multiple regulators is complex. Emma scans regulatory bulletins (e.g., Department of Insurance sites) and flags any changes that affect rates, coverage forms, or disclosure statements.

Compliance Document Preparation

Some regulations require detailed data submissions (e.g., NAIC reporting in the U.S.). Emma automates data gathering from underwriting, claims, and finance systems, structuring it into standard formats (like SERFF for rate filings) or aggregator tools (e.g., Wolters Kluwer TeamMate). This short-circuits the manual 'copy-paste' workflow that can introduce mistakes.

Policy & Form Filings

New coverage forms or endorsements often need to be filed with regulators before use. Emma compares existing approved forms to proposed new text, highlighting changes for easy reference. She then packages everything for e-filing on official portals, keeping a digital archive of submission receipts for audit.

Market Conduct Exams

Regulators periodically audit insurers' claims handling, complaint management, and policy issuance. Emma compiles all relevant documents (call logs, complaint resolutions, claims data) from your systems, ensuring an organized submission. This drastically lowers the scramble that can occur when an exam notice arrives unannounced.

Ongoing Monitoring & Governance

Insurers often adopt internal controls—like requiring certain disclaimers in policy docs or overseeing agent licensing. Emma tracks compliance tasks, routing them to relevant managers in governance platforms like OneTrust or MetricStream, ensuring each step is completed and logged. This fosters a culture of continuous compliance.

Customer Service & Inquiries

Responding to policyholders’ questions—about coverage, premium due dates, claims status, or policy changes. High-quality service fosters trust and loyalty.

Step 1

Multi-Channel Support

Customers might call, email, chat, or message on social media. Manually pulling up each record is slow. Emma consolidates these interactions in a single interface (e.g., Salesforce Service Cloud, Zendesk, or Genesys Cloud). Agents immediately see the customer's policy details and prior contact history for more efficient responses.

Step 2

FAQ & Self-Service

Many queries—like 'When's my payment due?'—are repetitive. Emma automates quick replies, checking policy details for the payment schedule or coverage limits. This can take place via chatbots or automated email responses, letting staff focus on more complex inquiries.

Step 3

Request Routing & Escalation

Complex issues (like a disputed claim) might need escalation to specialized teams. Emma scans the inquiry content for keywords, then routes the ticket to the correct department. This ensures complicated questions aren't stuck with frontline reps who lack the expertise.

Step 4

Billing & Coverage Updates

Common service tasks include changing a billing address or coverage limit. Emma can handle these straightforward updates directly in the policy admin system—Guidewire, Duck Creek, or Applied TAM—once the customer's identity is verified. This self-service approach shortens wait times and improves the customer experience.

Step 5

Customer Satisfaction Surveys

Post-resolution, many insurers gather feedback. Emma sends a quick survey link via email or text, logs the response, and compiles results in dashboards like Qualtrics or SurveyMonkey. This data helps identify areas where agents excel or need further training—contributing to continuous service improvement.