COMMERCIAL CLAIMS AGENT · P&C INSURANCE

A business is waiting on this claim.
Close it in days, not quarters.

Fire, flood, business interruption or fleet: how quickly you close the claim decides whether your customer survives the year and whether they stay with you at renewal.

Review your build plan · 30 minGet the executive summary
Partnered with global leaders including:
Partnered with global leaders
90-dayaverage commercial claim cyclePayne Law / WifiTalents, OpsDog, C3
40%never reopen after a major disasterFEMA / SBA
67%cite claims efficiency as the top factorDeloitte 2024 Insurance Outlook
80%accuracy when extraction is done by handAgentech Insurance Automation Guide
THE REALITY TODAY

No single step takes three months,
but forty small ones do.

A customer is kept waiting due to a document someone has to chase, a clause that needs negotiating, an estimate sent back for review, an approval stuck in a queue over the weekend...
Each delay is defensible on its own, but together, they keep a business closed.

The first 48 hours arrive all at once

Photos and loss reports land alongside supplier invoices, handwritten inventories and emails in whatever language the site manager writes in, and somebody has to work through all of it before the claim can start moving.

Coverage stays an opinion until someone argues it

Commercial wordings are layered and frequently manuscripted, so two adjusters can read the same sub-limit and arrive at different answers. The gap between them comes out of your loss ratio.

Business interruption gets priced by instinct

Lost trading and standing costs are the hardest figures in the file, and they tend to be the ones estimated with the least evidence behind them. Once the number is set it is rarely revisited.

Every party waits on one signature

A single settlement has to reach the business owner, their restoration vendors and their lender. When one approval stalls, all of them start chasing your team instead of the process.

The customer is measuring you the whole time

Renewal gets decided during the claim rather than at the quote, and every week of silence is a week the broker can use to move the account somewhere else.

Nobody can reconstruct the decision later

Six months later, when a regulator or a broker asks why that sub-limit was applied, the reasoning usually lives in an adjuster's memory and an email thread nobody thought to keep.

The Custom Death Stack

Extraction from one vendor, rules from another, routing on top and a bridge holding it together. Five contracts that each move the claim a little further along, and not one of them closes it, which is why the cycle time never drops.

Reconciliation by spreadsheetsomeone owns this on Fridays
Integration scriptsbreak when a form changes
Case routingmoves work, adds no judgement
Rules engineneeds clean data it never gets
Document extractionreads text, understands nothing

Every layer was added to compensate for the one beneath it, and the adjuster is still the only part of the stack actually making a decision.

When every step doesn’t need a person,
solve it in under a week.

Autonomous operations for commercial claims means the sub-agents are not sitting beside the adjuster passing files back and forth. They run the claim themselves and show the clause behind every decision, escalating only what genuinely needs a person.

01

A layered policy, read the same way every time

Sub-limits, endorsements and manuscripted wording become executable rules rather than a judgement call, so coverage is decided the same way on the first claim as on the ten-thousandth.

Every coverage decision arrives with the clause it was traced to, ready for audit.
02

One settlement, every party paid in the same pass

The owner's payout, the repair invoices and the loan settlement are routed together rather than queueing behind one another for separate approvals.

Owner, vendors and lender are all notified on the same decision, so nobody is left chasing.
03

Autonomy that widens as it earns it

You choose where the sub-agents run unsupervised, and a claim type earns wider autonomy only once it has proved out against your own outcomes. High-value and unusual losses stay routed to your people by design.

You set the thresholds. The system does not take scope you have not given it.
04

Sits on the claims system you already run

Whether you run Guidewire, Duck Creek, SAP or something written in-house thirty years ago, the sub-agents connect through whichever route your system supports and write the outcome back so nobody has to re-key it.

No core replacement and no data migration. This is already running against mainframe-era systems in production.

7 sub-agents across 5 phases, running one claim from start to finish.

The seven sub-agents that run a commercial loss end to end, in the order they act.

SUB-AGENT

Intake Processing Agent

Takes in every document at once whatever the format or language, then works out what is missing and requests it before the claim moves on.

SUB-AGENT

Coverage Check Agent

Enforces the policy deterministically, so the same wording always returns the same answer, and shows the clause behind it.

SUB-AGENT

Liability Assessment Agent

Confirms the policy was in force at the time of loss and establishes liability.

SUB-AGENT

Damage Validation Agent

Checks the damage estimate against the evidence on file before it is accepted.

SUB-AGENT

Fraud Detection Agent

Runs alongside the fraud system you already have, clearing the claim against its signals in the same parallel pass rather than as a later review.

SUB-AGENT

Appraisal Decision Agent

Checks the photos and data for plausibility against your SOP thresholds, and calls an independent appraisal only when the loss runs high.

SUB-AGENT

Payment Agent

Issues the settlement and notifies the owner, the vendors and the lender together.

THE OPERATING MODEL

The same claim, run on a different operating model.

Before Otera
  • Documents opened and filed by a person before work starts
  • Coverage argued from the policy, differently by each adjuster
  • Checks run one after another, each waiting on the last
  • Reserves set early on thin evidence, rarely revisited
  • Owner, vendors and lender paid in separate approval cycles
  • Fraud reviewed late, once the file is nearly closed
  • Every claim supervised, whatever its size or risk
With Otera
  • Intake captures the full package and chases what is missing itself
  • Coverage decided deterministically, with the clause attached
  • Coverage, liability, damage and fraud cleared in parallel
  • Estimates validated against the evidence before they are accepted
  • All three parties settled together and notified at once
  • Fraud cleared inside the same assessment pass
  • High-value and unusual losses escalated, the rest run autonomously
Commercial claims
BUILD IT AND OWN IT

Build your platform.
Own everything it learns.

Your intelligence capital is the part of this operation only you have. Your team encodes it into decision logic that gets sharper with every correction.

Review your build plan · 30 min
Your contract wordings are encoded as logic
Your rules and exceptions remain yours to adjust
Your adjusters' calls stay formalized, not lost
Your Agentic Decision Graphs stay exportable and auditable
THE NEW REALITY

What autonomous claims looks like

Figures from live commercial claims operations and the research behind them.

90 → 5 days
Claim Cycle

A commercial fire loss settled in five days against a ninety-day industry average.

Every
Decision Traced to Its Clause

Every decision traced to the exact clause it relied on, ready for audit.

+40-50
NPS Points

What a ~30% cycle-time reduction delivers, alongside new business won on claims performance.

+30%
Satisfaction Lift

Claims settled within one week of first notice score 30% higher on customer satisfaction.

3
Parties, One Payment

Owner, restoration vendors and lender settled and notified in a single pass.

12 wk
To Production

Live autonomous claims processing, not a proof of concept.

Every enterprise asks these questions

"We have the people to build this ourselves. Why would we not?"
You should build. No vendor can fully encode how your business makes decisions, and you should never give up ownership of what makes those decisions yours.

The question is where to build from: raw components, tools on the market, or a platform already proven in production. Most teams use a mix of all three.

What matters is owning the intelligence that is unique to you: your contract wordings, rules, SOPs, and the judgment your best adjusters apply every day. Once formalized, it should remain yours, while the system applies it consistently, carries policy changes through every process, and lets you upgrade models without changing the decisions you have defined.

We use six criteria to assess this. Bring your plan to a 30-minute review, score it against them, and use the same framework for every option you are considering.
“Our wordings are layered and half of them are manuscripted. Can an agent really read them?”
That is the case it was built for. The Coverage Check Sub-Agent works from your actual documents, endorsements and sub-limits included, turning them into rules that execute the same way every time. It already handles reinsurance treaty wording, which is considerably harder than a commercial property policy.
“Business interruption is judgement, not data entry. Are you automating that too?”
Not blindly. The sub-agents validate the evidence against your standard operating thresholds and trigger an independent appraisal when the loss runs above them. Where BI genuinely turns on judgement, the claim escalates with the analysis already done and a recommendation attached, so your specialist reviews a complete file in minutes instead of assembling one from scratch.
“How do we keep control of the losses that actually matter?”
You define which claim types run unsupervised and what triggers escalation. High-value and anomalous losses are flagged into a review queue with a named reviewer. Autonomy expands per claim type only as that type proves out against your own outcomes.
“What happens to our adjusters?”
They stop opening post and start handling the difficult twenty percent, and blanket dual review gives way to exception-only review because a decision traced to a clause does not need a second pair of eyes to confirm it. The capacity this frees up does not have to stay in claims either, since the same adjusters can move onto new lines of business, and the cost taken out of the operation is what lets you price more competitively, which is where the topline growth and the room for product innovation come from.
“We already bought a platform for this once.”
Most of them added software around the work rather than changing who makes the decision, so the operation still ran on human judgement and the cycle time never moved. Nothing probabilistic can run an operation, whether that is a person making a judgement call or an AI making a best guess. What actually changes the economics is turning your own experts’ judgement into deterministic code that returns the same decision on the same inputs a thousand times out of a thousand, carries the exact clause behind it, and stays yours as you correct and extend it rather than leaving with a vendor or an employee. That is the thing worth testing in whatever you evaluate next, including us.
YOUR PERSPECTIVE

What this looks like from where you sit

The case for autonomous commercial claims reads differently depending on whether you own the loss ratio or the integration behind it.

Executive

COO / Chief Claims Officer

Owns whether autonomous operations get built to last.

  • Cycle time from ninety days to five
  • Renewal risk drops in a market where two thirds decide on claims handling
  • Interpretation variance stops leaking out of the loss ratio
  • Live in twelve weeks, not a multi-year transformation
  • Running today at the largest agentic deployment in the market
Operations

Head of Commercial Claims

Owns high-quality decisions, even on complex claims.

  • Seven sub-agents covering intake through payment
  • Fire, flood, BI, contents, fleet and liability losses
  • Coverage, liability, damage and fraud cleared in parallel
  • Exception-only review instead of blanket dual sign-off
  • Your thresholds decide what escalates and what does not
Technical

Head of Architecture

Owns decision logic that stays portable, through every upgrade.

  • Runs on top of Guidewire, Duck Creek, SAP or legacy
  • API, database or RPA bridge. No core system replacement
  • Policy wording compiled to deterministic rules, not a black box
  • Every decision traceable to the document and clause behind it
  • 100+ pre-built sub-agent templates to compose per line of business
Independent recognition — zero paid analyst relationships, all mentions organic