OneShield Integration

Five things OneShield was never built to do

OneShield handles Policy administration, Claims management, Billing and does it well. These are the workflows that fall outside that scope — the ones that end up in inboxes and spreadsheets beside it. Regure runs them against the same book, or runs the whole operation where you would rather not keep two systems.

1. AI Subrogation Detection Agent

   The gap. Adjusters handling high claim volumes miss subrogation opportunities because manual review of every police report, incident narrative, and medical record for third-party fault indicators is impossible at scale. Industry estimates suggest 10-15% of subrogation opportunities are not pursued due to identification failures.

   What Regure does. Regure's AI reads every incoming claim document — police reports, FNOL narratives, witness statements, and incident photos — and flags subrogation indicators automatically. The agent identifies third-party involvement, potential product liability, and Workers' Comp employer negligence, routing identified opportunities to the subrogation unit with supporting evidence.

   ReadsPolice reportFNOL narrativeMedical examination reportContractor inspection reportWitness statements

2. AI Fraud Triage Agent

   The gap. Claims fraud costs the US insurance industry $80B annually. SIU teams cannot review every claim — manual referral rates of 1-3% mean the majority of fraudulent claims are paid without investigation. Document-level fraud signals (staged accident indicators, provider billing anomalies, claim inflation patterns) are invisible without AI analysis.

   What Regure does. Regure analyzes every claim document against a fraud signal library: medical provider billing history, accident scenario consistency, claimant claim frequency, contractor pricing benchmarks, and document metadata anomalies. Claims exceeding configurable risk thresholds are automatically routed to SIU with an evidence package.

   ReadsCMS-1500UB-04Police reportContractor invoiceFNOLIME report

3. Compliance Automation

   The gap. Core insurance platforms generate transaction records but not the structured evidence that regulators require. FCA Consumer Duty evidence, DORA ICT incident logs, SAMA Cyber Framework controls, and US state market conduct examination responses require additional compilation effort that falls on compliance teams.

   What Regure does. Regure sits between the core system's transaction data and the regulator's evidence requirements. Every document processed and decision made is automatically logged with cryptographic tamper-evidence. Regure generates structured evidence packages — FCA Consumer Duty outcome reports, DORA incident response logs, state examination responses — from operational data, eliminating manual compilation.

   ReadsClaims decision recordsCustomer communication logsFNOL to settlement timelinePricing justification documentsRegulatory correspondence

4. Renewal Intelligence

   The gap. Renewal teams in core systems see transaction history but lack the unstructured signal in claim narratives, broker communications, and loss survey reports that predict renewal outcomes. At-risk accounts are identified too late — typically at the 30-day mark when competitors have already presented alternatives.

   What Regure does. Regure enriches core system renewal data with signals extracted from document workflows: claim frequency patterns, broker communication sentiment, loss control recommendation compliance, and market submission activity. Accounts with early deterioration signals are flagged 90+ days out for proactive retention actions.

   ReadsLoss run reportsLoss control surveyRenewal applicationBroker correspondenceClaims development reports

5. Claims Leakage Prevention

   The gap. Claims leakage — overpayment, coverage misapplication, missed recoveries, and process failures — costs insurers 4-10% of total claims spend. Core systems track payments but can't identify where and why leakage occurs across the document-heavy claims process.

   What Regure does. Regure monitors every document touchpoint in the claims lifecycle against carrier-specific leakage indicators: contractor invoice vs. benchmark pricing, medical billing code consistency, reserve adequacy vs. document evidence, settlement authority adherence, and subrogation opportunity compliance. Leakage alerts are surfaced in real-time to supervisors.

   ReadsContractor invoiceProperty damage estimateMedical bills (CMS-1500, UB-04)Reserve documentationSettlement authorization

How the connection to OneShield is actually configured is decided in implementation against the version you run — see how configuration works. For the document machinery underneath all five, see document processing.