# Insurance AI Operations Route Map

Use this map to select the smallest correct insurance workflow. It is educational operating guidance, not coverage, claims, underwriting, actuarial, legal, regulatory, medical, repair, fraud, security, or payment advice.

## Route card

```yaml
state_or_territory:
line_and_product:
carrier_or_plan:
role_and_authority:
license_or_appointment_context:
job_to_be_done:
consumer_or_party_affected:
approved_systems:
private_or_restricted_data_present:
decision_or_external_action_requested:
qualified_reviewer:
```

## Choose the current specialist route

| Job | Start here | AI-prepared artifact | Human authority retained |
|---|---|---|---|
| client intake, renewal/review preparation, source-linked education, follow-up drafts, and coverage-safe handoff | Insurance Agent AI Workflow | Insurance Client Review Preparation Desk | licensed explanation, recommendation, solicitation, quoting, binding, coverage, underwriting, claims, and send |
| claim/policy-service intake, identity gates, evidence inventory, document versions, missing-item/status drafts, security flags, and decision routing | Insurance Claims & Policy Clerk AI Workflow | Claims & Policy Service Evidence Desk | coverage, liability, eligibility, benefits, investigation, underwriting, policy transactions, claims, payment, and communication |

## Shared source card

```yaml
source_id:
authority_type: state_primary | federal_primary | carrier_procedure | policy_or_plan | approved_form | qualified_expert | consumer_or_third_party_statement
state_line_product_scope:
effective_date:
exact_fact_or_requirement:
document_version_and_hash:
conflicts_or_limits:
privacy_class:
reviewer:
state: unverified | verified_source | qualified_review | approved_for_exact_use
```

NAIC models, bulletins, charts, and implementation maps are research tools until the controlling state/territory source is verified.

## Shared authority matrix

Keep these roles distinct:

- claims/policy clerk;
- licensed producer/agent;
- adjuster/examiner/appraiser;
- underwriter;
- carrier or plan administrator;
- SIU/security/privacy;
- legal/compliance/regulator;
- medical, repair, engineering, or actuarial expert;
- payment or funding authority.

Queue delay does not transfer authority to AI or a different role.

## Shared AI boundary

AI may prepare:

- source, evidence, and document-version ledgers;
- completeness checks against approved lists;
- neutral drafts from verified facts and templates;
- discrepancy, duplicate, conflict, and missing-field flags;
- correspondence QA, privacy checks, and review queues;
- handoff, audit, and exact approval packets.

AI may not:

- interpret coverage or policy application;
- recommend products, limits, terms, price, premiums, or claims outcomes;
- decide risk, eligibility, liability, benefits, necessity, causation, value, fraud, settlement, or payment;
- solicit, quote, bind, issue, change, endorse, renew, nonrenew, rescind, or cancel without authorized human/carrier action;
- investigate, surveil, negotiate, send, file, write an account, release funds, deploy, or publish.

## Exact approval packet

Bind the state, line/product, carrier/plan, role, verified party, exact decision/action, source/document stack, evidence IDs, privacy class, payload and attachment hashes, authorized decision artifact, reviewer authority, expiration, and correction path.

Terminal state: `approval_ready`. There is no execution control.