Renewal Eligibility Assessor Agent
Evaluate and renew policies automatically using claims and risks
Description
Challenge:
Manual renewal assessment is time-consuming and prone to inconsistencies. Underwriters must evaluate claims history, premium compliance, updated risk factors, and product-specific rules. Mistakes or delays can lead to customer dissatisfaction, revenue loss, or regulatory non-compliance.
How It Works:
The Renewal Eligibility Assessor Agent consolidates historical claims, policyholder payment behavior, updated medical and occupational data, and policy-specific conditions to evaluate renewal eligibility. It applies adjusted premiums when risk changes and flags exceptions for manual review. The agent generates clear recommendations, audit logs, and exception alerts, ensuring compliance, operational efficiency, and improved retention.
Benefits:
80–90% automation in renewal decision-making
20–30% faster policy renewal cycles
Reduced lapse rates by 10–15% via proactive, risk-adjusted renewals
Portfolio profitability aligned with updated risk profiles
Transparent, audit-ready renewal decisions
Consistent application of business and regulatory rules
Reduced manual effort for underwriters, focusing attention on high-risk cases
Features
This agent ensures consistent, compliant, and transparent renewal decisions by evaluating claims, payment behavior, and updated risk profiles against product-specific rules and regulatory guidelines.
Features & Capabilities:
Policy Retrieval: Access policyholder details, policy terms, and renewal clauses
Claims Analysis: Evaluate historical claims frequency, severity, and loss ratios
Payment Compliance: Validate premium payments and arrears against grace periods
Risk Reassessment: Assess medical, occupational, and lifestyle updates
Renewal Rules Application: Apply product-specific, regulatory, and business rules
Premium Adjustment: Apply loadings or discounts based on updated risk
Exception Handling: Flag non-eligible or high-risk policies for manual review
Audit Logging: Maintain detailed justification and compliance trail
Operating Blueprint
Knowledge Sources:
Policy Terms & Conditions (renewal clauses, exclusions)
Claims History Database (frequency, severity, loss ratios)
Payment History Records (delinquency, arrears)
Underwriting Manuals (risk reassessment rules)
Regulatory Renewal Guidelines (mandatory protections, caps)
Business Rules:
Claims Frequency Rule: Policies exceeding set claims trigger reassessment
Loss Ratio Rule: Claims exceeding X% of premiums → loading or manual review
Payment Compliance Rule: Delinquent accounts beyond grace period = ineligible
Regulatory Protection Rule: Certain products cannot be denied renewal unless fraud is proven
Medical Update Rule: Updated disclosures required for renewal after age thresholds
Occupation Change Rule: Riskier occupations → premium loading
Grace Period Enforcement: Arrears cleared within grace period remain eligible
Customer Loyalty/Discount Rule: Apply loyalty discounts for consecutive renewals
Tool Workflow:
Retrieve policyholder and policy details
Analyze claims history and frequency
Validate payment compliance
Assess updated risk profile (medical, occupation, lifestyle)
Apply product-specific and regulatory renewal rules
Adjust premiums or loadings as required
Flag exceptions for manual underwriting
Generate renewal recommendation and audit log
Notify policyholder of decision
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