Fair, consistent decisions across every claim and policy
One control layer to oversee underwriting, claims and customer decisions against policy and state and federal requirements, whether the work is done by people or by AI.
Discover the Prisma platformWhy insurers need decision governance
An insurer's business is a series of decisions: whom to insure and at what price, which claim to pay and how fast, how to treat a customer who complains. They are made at high volume, by people and increasingly by AI, and each must follow policy, fit the law of the state it is made in, and treat similar customers alike. Decision governance oversees those decisions against policy and regulation and improves how they are made.
Why one control layer beats many point tools
An insurer in many states faces many versions of the same questions, and each business unit proves compliance in its own way. One layer gives one standard for people and AI, recorded in one form, so consistency is visible across lines of business and states.
Oversight, intervention and remediation, together
Prisma evaluates each decision against your policy and the rules that apply, detecting violations and ambiguity and recording the reasoning. When one falls short, it intervenes, applying consequences and feedback to the person or the AI behind it. Remediation turns that into better behavior, so performance improves and stabilizes over time, and the evidence of every judgment is kept.
One control layer across the decisions that matter
How Prisma helps insurers with the requirements each regulator sets.
State insurance departments
Unfair discrimination in underwriting and ratingUnderwriting
Unfair claims settlement practices and complaint handling, with time limitsDisputes
Unfair trade practices and market conduct, including customer conversationsContact center
Rules on external consumer data and algorithms, for example Colorado SB21-169 for life insurersUnderwritingAI agents
- NAIC
National Association of Insurance Commissioners
Model bulletin on the use of AI systems by insurers: a written program for the responsible use of AIAI agentsUnderwriting
Model act on unfair claims settlement practicesDisputes
- NYDFS
New York State Department of Financial Services
Insurance Circular Letter No. 7 (2024): AI and external consumer data in underwriting and pricingUnderwritingAI agents
- FinCEN
Financial Crimes Enforcement Network
- OFAC
Office of Foreign Assets Control
Sanctions screening of customers and beneficiariesKYC/KYB
International supervisors
- EEOC
Equal Employment Opportunity Commission
Title VII, the ADEA and the ADA apply to hiring and HR decisions, including those made with AI toolsHiring
Frequently asked questions
Decision governance is the oversight of the decisions an insurer makes, by people or by AI, against its policies and the rules that apply. It steps in when a decision falls short and feeds what it finds back so that behavior improves.
Mainly the states. Each state's insurance department licenses insurers and supervises solvency, market conduct, rates and forms. The NAIC develops model laws that states adopt but is not itself a regulator. FinCEN applies anti-money-laundering rules to insurers that sell covered products.
A written program for the responsible use of AI, covering governance, risk management, internal controls and the oversight of third-party AI and data. Many states have adopted it, and the details depend on the state.
Insurance laws prohibit treating similar risks differently without a justified reason, and they restrict the use of certain factors. Regulators have also looked closely at how AI and external consumer data are used. Reviewing every decision makes inconsistent outcomes visible.
Underwriting decision oversight, then claims disputes, customer conversations, onboarding, AI governance and anti-discrimination monitoring.
No. They keep doing their work. Prisma evaluates the decisions that come out of them, and out of the people and AI using them, intervenes when one falls short of policy, and keeps the evidence. The insurer keeps every underwriting and claims decision.
As an SDK that runs inside your own environment, with Palqee's managed cloud and interface available if you need them. Forward Deployed Governance Engineers embed with your team from day one.