InsurTech Claims Portal — UK Commercial Lines MGA

Broker API-First Claims Architecture: REST API (OpenAPI 3.0) for broker systems to submit FNOL programmatically — eliminating email and fax FNOL from major broker systems. Webhook notifications: claim status changes pushed to broker systems in real-time. Broker portal: web UI for brokers without API capability. All claims visible to both broker and MGA with role-based views. FCA ICOBS and Consumer Duty Claims Compliance: ICOBS 8: claims handling requirements — prompt acknowledgement, keep claimant informed of progress, reasons for declinature in writing. Consumer Duty Consumer Understanding: decline letters reviewed for Flesch reading ease > 60 (plain English). Consumer Duty Consumer Support: complaint pathway clearly signposted in all claim communications. SLA monitoring: 5-day ICOBS acknowledgement target tracked per claim. Claims Triage and STP: Straight-Through Processing (STP) for low-value claims: property damage below £2,500 with no liability dispute, automated STP score above 85%, triggers automated reserve and fast-track settlement. STP rate target: 35% of claims. Non-STP: reserve suggestion from ML model (Python gradient boosting, trained on 3 years claim history), assigned to adjuster with relevant specialism. Solvency II UK Claims Data: Solvency II UK (UK SII): claims data must support QRT (Quantitative Reporting Template) S.19.01 (Non-Life Insurance Claims). Platform generates S.19.01 extract automatically at quarter-end. ORSA (Own Risk and Solvency Assessment) claims trend data: platform provides structured data export for actuarial modelling.