Why Modernizing Insurance Platforms Falls Short Without AI at Its Core | SimpleSolve

Between natural disasters and shifting consumer trends, insurers are feeling the heat. Insurance companies aiming to remain competitive know that the opportunity cost of not modernizing their technology foundations is substantial. Modernizing core insurance platforms goes hand in hand with deeply embedded AI capabilities because intelligent insights can drive success or leave opportunities on the table.

Without full AI integration capabilities, insurers face slower processes, less precise risk modeling, and diminished customer satisfaction—challenges that will only grow as the industry continues to digitize and personalize its offerings.

The challenge with AI in the insurance industry is that while many core platforms in the market claim AI capabilities, not all use them equally well. Some deeply integrate AI, while others rely on selective integration, often using third-party tools to fill gaps.

Not All Modern Platforms Have the Same AI Maturity

Have you opened a bank account lately? What used to take weeks now gets done in just minutes, all because of technology. Honestly, I don’t think we’ve reached that kind of widespread efficiency in insurance yet. The momentum is definitely there, and we’re likely to see insurance closing that gap sooner rather than later.

Some insurers may be cautious about moving away from their tried-and-true legacy systems, but holding off on AI integration could mean more than just missing out on operational improvements, it could open up a strategic vulnerability. A 2023 Deloitte report highlighted that insurers failing to adopt AI at the core of their platforms risk falling behind in key performance areas like loss ratio, operational costs, and customer retention. 

However, as insurance carriers decide to transition to modern capabilities, it can be tricky to choose the best solution out there when it comes to AI in insurance.

While many insurance platforms claim to incorporate AI, their effectiveness hinges on how deeply AI is embedded and how intelligently it can handle real-time decision-making. A key distinction lies between platforms that offer surface-level AI enhancements—such as basic process automation or chatbots—and those that integrate AI-driven intelligence across the entire insurance lifecycle, from underwriting to claims processing, product customization, and fraud detection.

SimpleINSPIRE's next-generation platform empowers customers to fully leverage AI across their business processes driving sustainable growth. By seamlessly integrating advanced AI capabilities, our platform streamlines operations and unlocks valuable insights that enhance strategic decision-making.

Use Cases of Differing Capabilities in AI 

Let’s break down some real-world examples to show how AI in insurance is applied differently across platforms, with some making the most of its potential while others are still catching up.

Surface-Level AI Enhancements vs. Deep AI Integration

Many platforms boast about AI capabilities, but some are limited to surface-level automation, such as deploying chatbots for customer service or using AI tools for processing simple, repetitive tasks. While this improves efficiency in isolated areas, it doesn’t leverage AI to its full potential.

For example, some insurers deploy AI to automate first notice of loss (FNOL). Here, AI-driven chatbots can guide customers through claims reporting, automating the capture of initial information. However, in these cases, AI doesn't deeply influence underwriting decisions or risk analysis. The platform’s AI usage is more about convenience than decision-making intelligence. 

Insurers relying on these platforms may experience operational efficiency, but they lack the transformative power of AI to truly drive business growth.

Full AI Integration Across the Insurance Lifecycle

More advanced platforms, by contrast, leverage AI in a way that permeates the entire insurance ecosystem, from AI in underwriting to automated claims management and fraud detection. These systems do not merely automate tasks; they use AI to augment human intelligence in complex decision-making processes, enabling insurers to assess risks dynamically, price products accurately, and settle claims efficiently.

AI in Underwriting: Platforms with deep AI integration use machine learning to analyze massive datasets, including IoT data, telematics, social media, and historical claims, to assess risk profiles in real time. The advantage of this is that it gives underwriters the agency to make more accurate and data-driven decisions. For example, AI models may factor in real-time geospatial data, which can assess risk for natural disasters more effectively than traditional models that rely on static datasets. 

An AI underwriting Use Case in commercial insurance is dynamic risk pricing for fleet insurance. Rather than relying on periodic assessments of fleet behavior, these AI systems continuously analyze real-time telematics data, adjusting premiums based on driving behavior, routes taken, and vehicle maintenance schedules. This ensures more precise and fair pricing, which ultimately benefits both the insurer and the insured.

AI in Claims Processing: Advanced AI-powered platforms automatically process and triage claims based on their complexity. These systems use AI models that analyze visual evidence (like photos from car accidents) and cross-reference them with historical claims data. AI not only estimates repair costs with impressive accuracy but also flags potential fraud by analyzing patterns that might go unnoticed by human claims adjusters.

Use Case to Support AI in Claims Processing: In homeowners' insurance, AI can analyze high-resolution drone footage from disaster-hit areas to everyday incidents providing valuable support for insurance loss adjusters. This reduces the time to settle claims from weeks to days, vastly improving customer satisfaction.

AI for Fraud Detection: Insurance platform modernization that includes mature AI capabilities uses predictive analytics to identify patterns in claims submissions that suggest fraudulent behavior. These systems continuously learn from new data, allowing the AI models to refine their detection mechanisms. Fraudulent claims, which might slip through a system that relies on rule-based analytics, are caught by advanced platforms that can detect subtle anomalies in claims history or claimant behavior.

Automotive Insurance Use Case: In automotive insurance, AI models analyze everything from repair shop estimates to the claimant’s past insurance claims across different policies. Insurers using these platforms have seen significant reductions in fraudulent claims, directly improving profitability and reducing operational costs.

AI as an Enabler in Upselling and Cross-selling: AI isn't just transforming core functions like underwriting and claims processing—it also plays a key role in more customer-facing activities like upselling and cross-selling. Modern AI-powered platforms can analyze customer data and behavior to identify patterns that signal opportunities for additional coverage or services. For example, AI systems can recognize when a homeowner who has recently renovated might need increased coverage, or when a small business is growing and might benefit from additional liability insurance.

Tara, the Smart BOT is fully integrated with SimpleINSPIRE. This chatbot knows exactly where you are in the system and can be enhanced and trained to serve as your AI-driven assistant. She can trigger external data and Insurtech services, utilizing or displaying the results within SimpleINSPIRE. Tara also helps upsell during NB Quoting.

Incorporating AI across customer engagement is effective in boosting retention and increasing upsell opportunities. Platforms can dynamically adjust their messaging, suggesting additional products at the right time, whether through automated chatbots or personalized emails driven by AI algorithms.

Industry Use Case for Upselling: A platform with deep AI integration could identify that a policyholder’s recent car purchase puts them at a higher risk for costly repairs. The system might then suggest extended coverage or specific add-ons like vehicle protection plans, directly increasing the carrier’s profitability while meeting the policyholder’s needs.

The Next Frontier: Personalized Insurance Products

AI-powered platforms don't just improve underwriting or claims efficiency—they enable insurers to design highly personalized, on-demand products. Platforms with deep AI integration analyze customer behavior and lifestyle data to offer customized insurance products in real time.

For instance, some platforms use AI to launch usage-based insurance (UBI) models for auto insurance. These models depend on telematics data gathered from the vehicle, allowing premiums to be adjusted based on how safely the customer drives. AI continuously assesses driving behavior and adjusts the policyholder’s premium dynamically, ensuring a fairer, more individualized pricing model.

A leading P&C insurer in the property insurance sector uses an AI-powered platform that integrates IoT data from a smart home to adjust premiums dynamically. If the system detects that a homeowner has installed enhanced security features or regularly maintains their property (like ensuring a furnace is serviced on time), the AI system can lower the premium based on the reduced risk. On the flip side, if a water leak detector goes off repeatedly, indicating frequent plumbing issues, the platform might suggest policy adjustments or even upsell additional coverage for water damage.

This type of AI-driven personalization as it is expanded further will be a vital cog for P&C insurers, allowing them to move from static, one-size-fits-all policies to more adaptive and responsive offerings, which in turn improve customer satisfaction and retention.

In an industry driven by risk assessment, customer service, and operational efficiency, AI is no longer a “nice to have.” The maturity of AI within a platform directly impacts an insurer’s ability to optimize costs, innovate products, and enhance the customer experience.