Premium-Audit AI Agent (Workers' Comp & GL Exposure)

What this agent does

Assembles the workpaper, not the audit's conclusion

Payroll records arrive, and the agent pulls the governing bureau's rules for that state and class.

A policy expires, and the agent maps the exposure types the audit covers — payroll and sales.

Reason

Each record is reconciled against what was estimated at binding, not accepted as filed.

The bureau's classification and remuneration rules for that state and year are applied to the exposure.

Every developed-exposure figure is bound to the record it was reconciled from.

Decide

Findings that would move the experience mod are flagged, not folded into this year's number alone.

The assembled workpaper is routed to the premium-audit manager and the auditor for conclusion.

Out

The record, the reconciliation, the applied rules and the auditor's conclusion stay on the audit.

Execute write actions only inside the approval boundaries agreed during implementation.

→ Product statement

The agent gathers the records, reconciles them and computes the exposure; a qualified premium auditor concludes the audit, and the insured can see the basis.

Example workflow

One audit, records to conclusion

AgentHuman

1Audit records receivedPayroll ledger, sales journal, subcontractor certificates or policy declarations

2Exposure reconciledRecords matched to the estimated exposure, each figure with its source and its governing bureau

3Exposure computedDeveloped exposure, applied class codes, flagged findings and confidence

4Controls appliedBureau-rule checks, reconciliation checks, mod-impact flags and confidence threshold

No human action required

Stages 1 to 4 run unaided, and nothing is billed at any of them — the agent is computing, and the auditor's lane opens at the confidence gate.

5DecisionBranches at the confidence threshold

High confidence

Goes to the premium-audit manager and the auditor to conclude.

Low confidence

Adds a bureau-rule compliance read first.

Auditor review

The workpaper is held with its reconciliation, its flagged findings and the confidence.

Approve · Edit · Request more records

Approved — released to conclude▼

6Policy system updatedOnly where write access and approval policy allow it

7Outcome evaluatedReconciliation accuracy, flagged-finding outcomes, mod impact and post-conclusion corrections

Edits

Every edit made before conclusion is counted in the evaluation.

What should not run autonomously

Human approval stays in control

Outside the boundary — human approval required8 items

Concluding the audit or signing it as final.

Billing additional premium to the insured.

Applying a non-compliance or estimated-audit charge.

Assigning the final class code.

Automation boundaryAgent acts unaided

✓Collect the payroll, sales and unit records the audit requires.

✓Reconcile each record against what was estimated at binding.

✓Apply the governing bureau's classification and remuneration rules.

✓Flag findings that would move the mod, and hold.

Any write happens inside the boundaries agreed at implementation, never ahead of conclusion.

Closing an insured's dispute of the audit.

Accepting a subcontractor's certificate as proof, unverified.

Deciding which bureau governs a state-and-line risk, unreviewed.

Changes to the bureau rule library or remuneration tables.

Example output

One class code in the workpaper, annotated

Everything the agent computes is attached to the record it was drawn from.

Exposure-computation output · single auditIllustrative example

Audit

Computed line

Stated exposure

Record type

Confidence

Attribution

General contractor, subcontractor exposure

The subcontractor's payroll is included because the certificate on file was never verified with the issuing carrier

Payroll register

Class 5606 remuneration schedule

89%

Auditor of record and licence ID

As receivedTaken from the payroll register and the certificate on file — nothing on this side is written by the agent.

Records used Payroll register Subcontractor COI Prior audit history

Why this findingThe certificate on file was never confirmed with the issuing carrier.

ActionApproveEditRequest more records

What the score decidesBelow the configured threshold before it reaches the approver.

Value

Where AI adds value

The same four claims, placed at the point in the workflow where each one applies.

Where the value landsValue 01 – 04

Every auditFrom the payroll and sales records

03Computation

Compute from the records

Draw on the reconciled records and the bureau's configured classification and remuneration rules.

01Approved path

One class code, several years

Routine reconciliation and exposure computation arrive already done.

02Human review

Point the auditor at what needs

Findings that would move the mod and unverified subcontractor exposure are flagged, so review starts where judgment is needed.

04Build an evidence trail

The exposure, the record it was drawn from and the auditor who concluded stay on the audit.

Integrations

Typical integrations

Five system groups connect to the same agent. Which of them are in scope is decided in discovery.

Policy & rating systemsGuidewire · Duck Creek
NCCI Scopes · bureau manuals

Payroll & wage dataADP · Paychex
State wage-report files

Subcontractor & COI recordsmyCOI · Certfocus
Certificate-tracking systems

Agent

Premium-audit & exposure computation

Reads the records
Computes the exposure
Holds for conclusion

Workpaper & correspondenceAudit management systems
Dispute & appeal tracking

Observability & evaluationOpenTelemetry · Langfuse
Supported monitoring/evaluation sources

Integration availability depends on the client's existing systems and API access.

Agent controls

Six layers between the model and the workpaper

The controls sit one inside the next. What they let through is named in the map below.

L6 · Outermost — last line of defenceInward → L1 · closest to the model

L6Rollback / safe modeFall back to record collection when evaluation or production signals degrade.Roll back

L5Version monitoringTrack model, prompt, bureau-rule and remuneration-table changes.Track

L4TraceabilityRecord the exposure, its reconciliation, the applied rules and the auditor's conclusion.Record

L3Auditor reviewHold the workpaper for the auditor; it governs release, not whether the reconciliation is right.Gate

L2Policy guardrailsTest the workpaper against the bureau's classification and remuneration rules; a failure returns it.Restrict

L1Confidence thresholdsRoute low-confidence findings to a bureau-rule read before the auditor sees them.Require review

Model coreWorkpaper assembled — developed exposure, applied class codes, flagged findings and confidence

L1 – L2Test whether the workpaper may proceed

L3Puts the conclusion in the auditor's hands

L4 – L5Keep the exposure and the record behind it

L6Reverts to record collection when signals degrade

How Nestack evaluates it

Evaluate the audit workflow — not only the final workpaper.

Coverage runs the whole depth of the workflow, and every layer is cut by slice.

Surface — the workpaper the insured sees

Depth of coverage ▼

E1Final-output evaluationDid every developed-exposure figure reconcile to its source record and the applied class code?

E2Step-level evaluationDid the agent use the right bureau, classification rules and remuneration tables for that state and year?

E3Tool evaluationDid it read and write the correct policy and the correct field?

E4Confidence calibrationDo low-confidence findings actually attract more auditor read-backs?

E5Slice evaluationHow does performance change across specific exposure types?

E6Business outcomeHow many workpapers needed an auditor correction or a post-conclusion revision?

Floor — the outcome the audit answers for

Failure modes

Where each failure originates in the agent

Seven failure modes, placed at the stage each one originates.

Agent lifecycleDirection of processing →

01 · Retrieval1 mode

PX-03

Outdated payroll caps

Executive-officer payroll is capped against last year's minimum and maximum figures.

Stage gathersPayroll records, prior audit history and bureau rules

02 · Reasoning2 modes

PX-04

Bureau conflated

An independent-bureau state is classified under NCCI's rules, or the reverse.

PX-06

Mod impact dropped

A classification fix is applied to this term but never flagged for the mod recalculation.

Stage proposesReconciled exposure, class code, confidence

03 · Tool / write2 modes

PX-02

Charge applied unchecked

A noncompliance charge posts without confirming that bureau currently allows one.

PX-05

Basis not retained

Only computed totals are kept, and the source payroll records are dropped.

Stage writesOnly where write access and approval policy allow it

04 · Output1 mode

PX-01

Certificate unverified

The subcontractor's certificate is accepted without confirming coverage with the issuing carrier.

Stage returnsThe workpaper the auditor concludes

05 · Change / Version1 mode

PX-07

Silent rule drift

A bureau-rule or remuneration-table update widens what the agent will apply unflagged.

Stage tracksModel, prompt, bureau rules and remuneration tables

Sev-1 · premium bills outside the boundary Sev-2 · a wrong finding reaches the workpaper Sev-3 · records degrade, goes to review

See the complete Insurance & Financial Services failure-mode catalogue →

Affected slices

One class code can hide where rework concentrates

A single class code's audit-rework rate can look acceptable in aggregate while a handful of exposure types carry most of the rework. Nestack reports the rework rate by slice, not only in total.

Slice performance — reported separately, not only in aggregateIllustrative example

Slice	Failure rate	Lift	Status
Policies with subcontractor exposure	7.7%	4.0×	Review
Multi-state payroll across bureaus	5.4%	2.8×	Review
Executive officers and owner payroll	3.6%	1.9×	Watch
Single-class, single-state payroll	1.9%	0.7×	Normal

Bar: audit-rework rate lift vs. the single-class baseline · scale 0–4.0× · tick at 2.0× 2 of 4 slices over threshold

Evidence-linked improvement

Every cycle leaves the class code better tested

A cycle ends when the misclassification is a case the next release has to catch. That suite is what the next audit assembled is measured against.

Improvement cycle · five stagesSwitchback — the path turns at Improve and returns at Learn

01Detect

Audit-rework rate rises in a class-code slice.

02Diagnose

The code that carried the wrong class for three years is traced back through the reconciliation until the cause narrows to one record.

03Improve

Version-stamp the correction and attach the audits that exposed it.

04Verify

The affected cases run again, and a fail stops the release.

05Learn

It becomes a permanent test, and the classification rules move with it.

Learn → DetectThe return edge. Detection next time runs against a suite one audit longer.

Typical build scope

Twelve workstreams across six weeks

The build scope read against the delivery timeline. Week structure follows the six-week plan — discovery, records, computation workflow, evaluation, integration, then production validation and handover.

Workstream Week 1Week 2Week 3Week 4Week 5Week 6

01Audit workflow discovery and scope and boundary definition.

02Policy and payroll-source assessment.

03Bureau and classification-rule mapping and rule mapping.

04Record ingestion and normalisation.

05Computation logic and record binding.

06Confidence scoring and finding routing.

07Auditor review workflow.

08Policy-system and bureau-data integration.

09Classification and payroll cases.

10Guardrails and conclusion controls.

11Audit-trail instrumentation.

12Deployment, documentation and Agent Care handover.

12 workstreams · 6 weeks · bar shows the weeks a workstream is active — several run in parallel Final scope and sequence confirmed in discovery

Engagement tiers

What each tier includes

Rows are the capabilities named in each tier's scope. Higher tiers include everything below them.

Capability✓ in scope · — not at this tier PilotOne state, one class ProductionProduction audit systems AdvancedMultiple states / bureaus

Introduced at Pilot

Computation to your bureau and rules✓✓✓

Auditor review✓✓✓

Classification-accuracy baseline✓✓✓

Introduced at Production

Reporting by class—✓✓

Auditor workflow in your systems—✓✓

Approved write-back—✓✓

Policy-system integration—✓✓

Introduced at Advanced

Multi-bureau rule complexity——✓

Multi-stage audit approvals——✓

High audit volume——✓

Multi-bureau audit controls——✓

Build price From $5,000 From $8,000 Custom quote

Final build priceConfirmed after discovery based on integrations, workflow complexity, audit volume, review controls and deployment requirements.

Separate from buildBuild pricing is separate from recurring Agent Care, which covers managed monitoring, evaluations, incidents and verified improvements after launch.

What we need from you

What you bring, and what we build with it

Each input maps to a piece of build scope and a week in the delivery timeline.

You bringWe build with it

01Your class-code list and bureau assignments → Bureau-rule ingestion and class-code mappingWeek 1

02Representative past audits, including disputes → Exposure-computation baseline and record-binding baselineWeek 2

03Your remuneration and classification rule tables → Bureau-rule and classification mappingWeek 1

04Access to relevant APIs, feeds or exports → Policy-system and bureau-data assessment, then integration setupWeek 2

05Audits you would not want billed → Bureau cases and the evaluation suiteWeek 4

06What no audit may assume → Confidence scoring, finding routing, guardrails and conclusion controlsWeek 3

07Named premium auditors to review workpapers → Auditor review workflow, then pilot and production validationWeeks 5–6

Nothing else is required Deployment, documentation and Agent Care handover are ours.

Delivery timeline

Four phases across six weeks

The bands follow the work as it actually falls, so week 5 holds evaluation and pilot at once.

Phase W1W2W3W4W5W6

Discovery W1

Build W2 – W3

Evaluate W4 – W5

Pilot & Launch W5 – W6

Week focus W1Audit workflow discovery, bureau mapping and the automation boundary W2Policy and payroll integration and the computation baseline W3Computation workflow, confidence logic and auditor-review controls W4Evaluation suite, bureau-rule checks and failure-mode testing W5Policy-system integration, pilot audits and targeted corrections W6One audit cycle run under the premium-audit lead, then Agent Care handover

Reading the bandA bar covers the weeks its work is named in, and nothing else. The week 5 overlap is real, not padding.

At the end of W6Once the cycle validates, monitoring moves to Agent Care.

DurationSix-week plan shown · typical delivery 4–6 weeks depending on scope confirmed in discovery.

Next step · Insurance AI agent

Build a premium-audit agent around your bureau rules and audit workflow.

Show us your class-code list, your states and a recent audit file. We'll assemble a sample workpaper against your own bureau rules as the next step, so you can see exactly what stays with the auditor.

Discuss this agent →

Nestack Agents · Premium-audit & exposure computationAGT-INS-19 · Agent Care available after launch