The insurance industry is experiencing a quiet but powerful shift. Automation in claims processing is no longer about simple task completion – it’s about transforming how insurers operate, how they serve customers, and how they build trust in a digital-first world.
But with all the buzz around AI, one question often goes unasked: Do you really know your agent?
Let’s talk about what it means to “Know Your Agent”, and why it matters more than ever.
The transformation in claims and customer service Claims handling used to follow a predictable playbook: manual reviews, fixed workflows, and time-consuming communication between teams and systems. Today, things look different. Policyholders expect real-time service, a variety of touchpoints, and fast resolutions. Meanwhile, insurers face mounting pressure to lower operational costs, remain compliant, and manage complexity.
Claims automation has taken some weight off claims teams’ shoulders. Robotic Process Automation (RPA), business rules engines, and digital forms have modernized parts of the journey. However, many of these solutions are rigid, difficult to scale, and insensitive to nuance. They can’t adapt to unstructured data or make judgment calls when context matters.
This is where Agentic AI comes into play. With its ability to interpret, reason, and act, it offers insurers a new level of operational efficiency. But it also introduces a new challenge: How do you trust and govern an AI you don’t fully understand?
What does it mean to Know Your Agent? “Know Your Agent” (KYA) signals a new, more responsible approach to using AI in Insurance.
As AI Agents become more autonomous, insurers must retain visibility, control, and accountability. You wouldn’t hire a new team member without understanding their role, performance, or limits. The same should apply to digital agents.
To know your agent means:
You understand what the AI Agent does – and why. You can define thresholds for automation, escalation, and human-in-the-loop decisions. You have visibility into the AI Agent actions, performance metrics, and audit trails. You remain in control – ensuring compliance, safety, transparency, and alignment with business rules. In short, it’s about shifting from black-box automation to a glass-box standard. Especially in highly regulated environments, knowing your AI Agents is not just best practice, it’s essential.
What you can learn from your AI Agent At Simplifai, we believe AI should not only deliver results but also be accountable for every decision it makes. That’s why Simplifai’s AI Agents are developed with Know Your Agent principles in mind – ensuring that insurers can gain visibility into how automation works, where it adds value, and where human judgment is still needed.
Today, our Know Your Agent metrics can include:
Automation rates: the proportion of work processed automatically versus manually. Exception insights: reasons why certain cases require manual handling, such as missing claim information or validation issues. Classification outcomes: how claims are categorised and prioritised, whether by email content or attachments. Trend indicators: patterns over time that show improvements, recurring issues, or potential process optimisations. Claim volume : the total number of claims processed, giving a clear view of workload and throughput over time. Confidence score : an indicator of how certain the AI is in its decision, helping you assess performance and decide when human review is needed Our goal is simple: to help insurers understand their AI Agents, track efficiency, and continuously improve.
“Now more than ever, insurance companies must deploy AI technologies with transparency and trust, built to solve real-world problems. At Simplifai, we take responsibility to build customer confidence in AI. We hold ourselves to that standard.” – Artem Gonchakov, CEO at Simplifai
In claims automation, speed is only part of the story. What insurers really need is clarity, control, transparency and confidence in how decisions are made – and by whom.
With Simplifai’s AI Agents, you’re not just automating. You’re working with digital team members you can understand and trust. Because when you know your agent, you know your business is in good hands.
Meet our AI Agents
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