Occupation manual 003 / Insurance production
A conservative workflow for approved intake, source-linked policy facts, renewal difference flags, coverage-question preparation, escalation, and reviewed follow-up—without automating advice, underwriting, pricing, binding, or claims decisions.
Short answer: use AI like a preparation clerk. It may organize approved facts, extract exact fields with source references, flag differences without judging them, prepare questions, and draft a recap from reviewer-approved notes. Licensed and authorized humans retain coverage interpretation, recommendations, negotiation, underwriting, pricing, binding, claims, consumer treatment, and every customer-facing message.
NAIC materials describe AI use across the insurance lifecycle but warn that large language models may produce confident-sounding wrong information. Human review, source control, governance, and risk-proportionate controls remain central.
The NAIC Producer Licensing Model Act defines negotiation to include direct advice on substantive benefits, terms, or conditions. Model unfair-practice and claims standards also make invented policy, rate, coverage, and claim statements unacceptable workflow outputs.
Record jurisdiction, line of authority, licensed reviewer, system of record, approved AI tool, permitted data classes, retention rule, and authorized communication channel.
Use the approved channel and label each fact by source and verification status. AI may identify blanks; it may not decide whether the customer qualifies or needs a product.
Extract exact labels, dates, form numbers, shown limits, deductibles, premiums, and notices with the controlling document and page. Mark ambiguity “needs licensed review.”
Compare two human-supplied fact sheets. Report same, changed, or unclear—never better, worse, sufficient, covered, cheapest, approved, or recommended.
Turn changes and conflicts into questions for the licensed reviewer. Route underwriting, pricing, claims, cancellations, complaints, sensitive traits, security incidents, and legal issues to qualified owners.
Draft only from reviewer-approved notes. Record sources, license/role, approver, authorized channel, system-of-record action, retention handling, and open escalations.
| Job | Approved input | AI output | Human gate |
|---|---|---|---|
| Intake clerk | Minimal approved facts and blank fields | Structured card and missing-item list | Licensed/authorized staff validates source and purpose |
| Policy fact clerk | Authorized source documents in an approved system | Exact fields with page references | Licensed reviewer verifies against controlling language |
| Difference checker | Two source-linked, human-supplied fact sheets | Same/changed/unclear flags | Producer interprets meaning and client impact |
| Question-prep clerk | Verified differences and customer-stated changes | Neutral questions and escalation labels | Qualified owner investigates and decides |
| Follow-up drafter | Reviewer-approved notes and template | Draft with unresolved items clearly marked | Authorized human checks facts and sends |
A renewal comparison may show that a date, listed item, coverage label, shown limit, deductible, form number, premium, or carrier notice changed. That is a factual flag—not a conclusion that coverage is better, worse, sufficient, suitable, affordable, or recommended. The issued policy, endorsements, authorized carrier records, and licensed review control.
The workflow may record that a customer reported an incident, provide the carrier's approved contact route, organize customer-supplied documents, and draft a factual handoff. It must not say whether coverage applies, predict payment, assign fault, characterize fraud, value a loss, recommend omission of facts, or imply that the agent controls the claim outcome.
You are a preparation clerk, not an insurance producer, underwriter, adjuster, claims examiner, lawyer, or compliance officer. Organize the supplied approved facts into a source-linked table, missing/conflicting-item list, questions for the licensed reviewer, escalation flags, and source ledger. Do not recommend coverage, limits, deductibles, products, carriers, or customer actions. Do not determine eligibility, underwriting, pricing, bindability, claim coverage, fault, fraud, value, or payment. Do not infer missing facts or sensitive traits. Preserve exact source wording and mark every ambiguity “needs licensed review.”
Download the worksheet, test only with synthetic or expressly approved inputs, and obtain qualified insurance compliance review for the intended states, lines, carriers, systems, and roles.