Case Study
How Sella Delivers Scalable Credit Risk Explanations with Prometheux
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By Industry / Insurance

Trusted Agents for
Insurance

Price risk with confidence, pay honest claims sooner, keep the right customers and report with less effort. Prometheux runs AI on your insurance data and your own rules, in place across policy, claims, broker, finance and third-party systems, so underwriters, handlers, actuaries and assistants get the same answer every time, with the evidence behind it.

Proven in production

What holds insurers back

The Data Is There.
The Answers Aren't.

Insurers hold decades of policy, claims and customer data, and the expertise to use it. But it is spread across brands, core systems and spreadsheets, and AI that can't explain itself never gets past the pilot. Prometheux puts your data and your rules to work together, in place.

Claims and fraud data today
With Prometheux
Policy, claims, broker and finance data sit in separate systems and brands
Data is processed in place, where it already lives: no copy into another platform, nothing to keep in sync
AI pilots give different answers to the same question, so they never reach production
Same input, same result, every run, with agents calling rules your teams approved
Quotes, claim decisions and reported figures are hard to explain to a customer, auditor or regulator
Every result cites the rules that fired and the source rows behind it
Modernising means a long, risky migration off legacy core systems
Start on the systems you have, mainframe extracts included, and modernise one use case at a time
Appetite, pricing and claims know-how lives in spreadsheets and a few experts' heads
That know-how becomes readable, versioned rules reused by every team, tool and agent
Language-model costs grow with every question asked
Rules answer the routine questions; language models are kept for the language work, so token spend stays under control
Use case menu

Where Insurance Teams
Start

Pick the business area you own. Each use case runs as rules on your own data, in place, with the evidence behind every answer.

Underwriting & Pricing

Write the risks you want, at the price your rules set, with a reason for every quote.

01Appetite and Eligibility Checks
Does this risk fit appetite and product eligibility, which rule declines or refers it, and what would change the answer?Context as Code →
02Every Premium Explained
Which rating factors, loadings and discounts produced this premium, and why did it move at renewal? Traced to the rating tables in place.Data Lineage →
03Referrals by Authority
Which quotes exceed an underwriter's authority or need referral, and on which condition, the same way on every quote?Deterministic AI →
04One View of the Risk
Bring claims history, property and vehicle details and the third-party data you already license into one view of each risk, without copying it.Cross-Database Processing →
05Loss Ratio Trends by Segment
Which segments are drifting on loss ratio or mix, measured on the definitions your actuaries agreed? Python steps flag the trend; rules explain it.Semantic Layer →

Claims

Pay honest claims sooner, stop leakage and spot fraud, with the rows behind every decision.

01Fast-Track With Reasons
Which new claims meet every fast-track condition, and for each one routed to a handler, which condition failed and on which record? Run on a schedule or as claims arrive.Agentic Workflows →
02Is This Loss Covered?
Given the wording, its endorsements and exclusions, does this loss fall inside cover? Start with one wording, codified once and checked the same way on every claim.Context as Code →
03Fraud Signals at First Notice
Which new claims fire fraud indicators across policy, claims and payment systems? Each flag lists its signals and the records behind them.Deterministic AI →
04Leakage on Paid Claims
Which payments break your settlement rules: duplicates, payments above limit or reserve, an excess not applied?In-Place Data Processing →
05Claim Files Summarised
Language-model steps summarise handler notes and documents, labelled as non-deterministic, while the decision stays in the rules.Neurosymbolic AI →
06Provider and Clinic Networks
Which providers, clinics and claimants are linked through shared addresses, referrals or bank details, and which claims run through them?Entity Resolution →

Distribution & Customers

Know each customer and channel once, across brands and systems, and act on rules you can explain.

01Customer 360 Across Brands
Which policyholders hold products under several brands or systems, so service, renewal and complaints treat them as one customer?Entity Resolution →
02Cover Gaps at Renewal
Which customers qualify for a cover they don't hold under your product rules, with the reason behind each suggestion?Context as Code →
03Customers at Risk of Lapse
Which policyholders show the patterns that tend to come before a lapse or cancellation? Python steps spot the trend; rules decide who gets a retention offer, and why.Agentic Workflows →
04Broker and Channel Performance
How do written premium, retention and loss ratio compare by broker and channel, defined once and used by every report?Semantic Layer →
05Renewal Pricing Consistency
Are renewing customers priced in line with new customers of the same risk under your pricing rules, and which policies differ, and why?Data Lineage →
06Service Agents With Evidence
Assistants answer policy, cover and claim-status questions by calling deterministic rules over MCP, with the evidence behind each reply.AI Agents →

Risk, Capital & Reporting

Roll losses and recoveries up through the book, and report figures you can stand behind.

01Reinsurance Recoveries by Treaty
Which losses fall into which treaty layers, and how much is recoverable per treaty and reinsurer across programmes?Recursion →
02One Definition per Date
Written, effective and posted dates mean different things. Define each once as a rule, and every report, dashboard and agent uses the same answer.Semantic Layer →
03Returns Checked Before Submission
Which fields in a Solvency II, IFRS 17 or finance return break one of your controls, and which upstream record caused it? Controls run in parallel, with a drill-down to the row.Deterministic AI →
04Reserving and Capital Inputs
Feed reserving and capital models with claims and exposure figures computed once, the same way every run, with lineage to the source.Data Lineage →
05Legacy Data, No Big Migration
Read policy and claims history from legacy systems and extracts where they sit, and move workloads only when you choose.Data Modernization →
Where connected data matters

The Questions Other
Tools Can't Answer

Fraud

Rings Across Many Claims

Which claimants are linked, at any number of hops, through shared phones, bank accounts, addresses, vehicles or repairers, and how much has each ring been paid? A recursive walk with totals at every step.

Parties

One Party, Many Records

Is this applicant already a policyholder, claimant, broker contact or declined risk under another brand or system? Every match cites its rule. See entity resolution.

Exposure

Accumulation Through the Book

How much insured value sits in each flood zone or catastrophe region, rolled up through locations, policies, programmes and treaties, and which policies drive it? Rerun on a schedule or when data changes.

Reporting

Every Figure to Its Row

Which claims, policies and rules sit behind this reported figure, across every system it came from? Lineage from the number back to the source rows, so it can be checked and replayed.

Architecture

One Rules Layer
Across the Book

Typical fraud and claims platforms ingest your core-system data into their own store and score it there. Prometheux sits between your policy, claims and payment data and the people, tools and agents that act on it, and runs the rules where the data already lives.

Analytics

Underwriting, claims, fraud and finance dashboards, graph and BI

Integrations

Back into the databases behind policy, claims, CRM, finance and case systems

Agents

Underwriting, claims and service agents, deterministic answers

Models

Define the ontology, read answers, and power analytics, integrations and agents

Your insurance data

Policy, claims, party, broker, payment, reinsurance and finance data, connected in place. Nothing to migrate.

  • Insurance Operations

    • Appetite, pricing, claims triage, fraud rings, accumulation and reporting on one set of rules
    • Agents call deterministic rules over MCP and API, with the evidence behind every answer
    • Results written back to the databases behind policy, claims and case systems, on a schedule or when data changes
  • The Insurance Rules Engine

    • One model of parties, policies, risks, claims and treaties across brands and systems, instead of one per tool
    • Recursion with aggregation and graph algorithms: claimants linked at any depth, exposure per region, recoveries per treaty
    • Same input, same output, with lineage to the rules and source rows
  • Cloud Agnostic

    • Run in Prometheux cloud, your cloud or on-premises, under your own controls
    • Scale horizontally on clusters as portfolios and claim histories grow, with optional GPU acceleration
    • 1-click deployment anywhere: EKS, AKS, GKE, Databricks Clusters, Snowpark Containers
  • Insurance-Data Agnostic

    • Read and write policy, claims, broker, reinsurance and finance data in any database, format and schema
    • Connect warehouses, lakes, core-system databases, mainframe extracts, files and APIs across clouds and on-premises
    • No new data store to migrate into and keep in sync
Layer by layer

Same Layers.
Better Built.

Map a typical insurance analytics or decision platform to Prometheux and the difference is where the work happens: in place, in rules you own, with an answer you can check.

Typical insurance platform
Prometheux
Data: core-system and third-party data loaded into the vendor's platform
Data: policy, claims, broker, payment and bureau data read and written in place; no new store
Parties: entity resolution inside the vendor's model
Parties: resolution rules you can read, each match citing its rule and records
Logic: appetite, rating and referral rules configured inside vendor workflows
Logic: your appetite, pricing, claims and treaty rules as versioned rules your team owns
Analytics: model scores with a rationale attached
Analytics: deterministic rules, graph algorithms and Python steps, with lineage on each result
Networks: link analysis to a set depth
Networks: recursion with aggregation at every hop: linked claimants, exposure per region, recoveries per treaty
Scope: separate modules for underwriting, pricing, claims and fraud
Scope: one set of rules reused across underwriting, pricing, claims, fraud, reinsurance and reporting
AI interface: the vendor's own agents
AI interface: your agents call deterministic rules over MCP and see how each answer was reached
Deployment: the vendor's platform
Deployment: Prometheux cloud, your cloud, your own Kubernetes, or inside Snowflake and Databricks
Why insurers choose it

Your Rules.
Every Flag Explained.

Fraud, claims and underwriting logic stays with the insurer, in rules your teams can read, version and change. Each result carries the evidence an investigator, handler or regulator needs, and runs where your data already is.

Owned, Not Vendor-Bound

Your claims, fraud and underwriting rules are plain text in your version control, not inside a vendor's model.

Deterministic and Explained

The same claim gives the same flag, with the rules and source rows behind it, ready for review, complaint or audit.

Built for Portfolio Scale

Rules run as distributed, parallel jobs, with optional GPU acceleration, over full claim histories. See high-performance engine.

Portable by Design

Run in Prometheux cloud, your cloud, your own Kubernetes or on-premises, or inside Snowflake and Databricks. See on-premises.

What this means for you ⟶

Bring one use case

Find the ring, not just the claim. Pay honest claims faster, with reasons. Give agents rules you can stand behind.

How insurers start

One Use Case.
Then the Book.

01

Connect in Place

Point Prometheux at the systems behind one flow: policy, claims, broker, payment or finance data for one line of business. The data is processed where it lives; nothing is copied.

02

Codify the Knowledge

Your underwriters, handlers, actuaries and investigators, our forward deployed engineers and the AI assistant turn appetite guides, wordings, referral criteria and know-how into readable rules in days, not months.

03

Run One Use Case

An appetite check, fast-track triage, a ring search or an accumulation roll-up, on live data, for teams and agents alike.

04

Expand Line by Line

Each new line of business or team reuses the rules and connections already in place, so you add logic without rebuilding it for every tool.

FAQ

Questions,
Answered

Do we have to replace our policy, claims or rating systems?

No. Keep them. Prometheux reads from your core systems, rating tables and existing scores, adds cross-system and network reasoning, and writes results back to the databases behind the policy, claims and case tools your teams already use.

Will querying in place slow down our production policy and claims systems?

You choose where rules read from: the production database, a replica, or the warehouse or lake you already load. Rules run on a schedule, when data changes or on demand, and reruns reuse results whose inputs haven't changed.

Can an agent or language model decide a quote or a claim?

Decisions stay in the rules: same data, same result, with the evidence attached. Agents call those rules over MCP or the API with the same access rights as the user they act for, and language-model steps such as summarising a file are labelled as non-deterministic.

How is sensitive policyholder data protected?

Data is read in place under your existing access controls, credentials stay in saved connections, and you can run the platform in your own cloud or on-premises. Prometheux is SOC 2 Type II certified.

What does it cost, and how do we prove the value?

It depends on your data and use cases, so we measure it on yours rather than quote a generic figure. Most insurers start with one use case on one line of business, agree the measure of success up front, then add use cases on the same rules and connections.

Bring One Insurance
Use Case.

An appetite check, fast-track triage, a ring search or an accumulation roll-up on your own data. Our forward deployed engineers will run it with you, in place, on your infrastructure.

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