Insurance AI and Workflow Governance RFP Checklist
First notice got faster; what happens after it did not. Claims, pre-authorizations, assistance dispatch and beneficiary changes move by email, phone and re-keying, and who decided what against which policy terms has to be rebuilt for a market conduct exam.
Regulations
Regulations the platformmust enforce.
- state insurance departments and market conduct rules
- NAIC Model #668
- NAIC unfair claims settlement practices models and the state rules built on them
- NAIC privacy models
- GLBA
- HIPAA (health lines)
- NYDFS 500
- TCPA
- ESIGN
- UETA
Insurance requirements
10 requirementsfor insurance.
| ID | Requirement | Priority | Evidence to require |
|---|---|---|---|
| IN1 | At first notice, the request is typed (claim or assistance, injury or not, line of business) and sets the documents and consents required; only the questions that apply are asked | Must | Demo of an injury FNOL that cannot move without medical consent |
| IN2 | State unfair claims settlement clocks (acknowledgment, investigation, decision) run inside the claim and act when they run out | Must | Demo |
| IN3 | Documents chased from hospitals, repair shops, other insurers, passengers and families on a clock, and checked on arrival | Must | Demo of a third-party request to another insurer |
| IN4 | The record shows what the claimant was shown and consented to at first notice, not only what happened after the claim was entered | Must | Sample record from an FNOL |
| IN5 | Coverage is checked before a supplier is dispatched; a case closes only when the customer confirms the service | Should | Demo of assistance dispatch |
| IN6 | Life service changes (beneficiary, withdrawal, surrender) enforce identity and disclosures first, then documents and signatures by request type; each claimant completes their own part of a death claim | Must for life carriers | Demo |
| IN7 | Repair estimates, reimbursements and supplier invoices approved inside the platform, not by email | Must | Demo |
| IN8 | PHI masked by policy on health lines | Must for health lines | Demo |
| IN9 | Integrates with policy admin, claims and billing without replatforming, and with core systems integrated in weeks | Must | Production reference with integration timeline |
| IN10 | Handles CAT volume spikes without losing clocks or completeness | Should | Load evidence or production reference |
Swipe sideways for the priority and the evidence.
Add these to the 41 core requirements.
Proof test
Ask for it live,on your process.
Take it further
The spreadsheet,and what Callvu runs here.
Questions buyers ask: How do insurers get complete claims at first notice of loss? · How do insurers prove identity, disclosures and consent for beneficiary changes?
Take the checklist into your RFP.
The spreadsheet carries every requirement, the scoring and the proof test, ready to send to any vendor.