Sold by: Kriv AI
Kriv AI delivers a 4-week fixed-fee focused fairness audit of agentic AI claims systems (triage, adjuster-assist, SIU/FWA, prior-auth, denial-reasoning, subrogation, litigation-likelihood, total-loss agents) with regulator-defensible documentation aligned to NAIC Model Bulletin on AI (Dec 4 2023, ~24 state adoptions), Colorado Reg 3 CCR 702-10 (Reg 10-1-1), Colorado SB 24-205, NYDFS Insurance Circular Letter No. 7 (2024), Texas TRAIGA HB 149 (eff. Jan 1 2026), California CDI bulletins, state Unfair Claims Settlement Practices Acts (UCSPA), NAIC Model Insurance Fraud Prevention Act, ACA §1557 (health payers), and CFPB-parallel fair-lending frameworks. Three tiers: $25K Foundation / $40K Standard / $60K Enterprise + $10K per additional LOB or jurisdiction. Natural follow-on to N10 + N16. AWS Select + Databricks + Anthropic CPN.
Overview
Class-action precedent has made algorithmic claims denial a board-level existential risk. NAIC Model Bulletin state adoption, Colorado's quantitative bias-testing obligation, NYDFS Circular 7, and Texas TRAIGA have made "fair by design" a state-DOI market-conduct exam question — not a marketing claim. Nothing on AWS Marketplace today delivers a focused, regulator-defensible, fixed-fee audit of agentic AI claims systems.
The NAIC Model Bulletin on AI (Dec 4, 2023) has been adopted in 20+ states, with claims adjudication, SIU fraud detection, and claims triage named as high-risk AI use cases. Colorado Reg 3 CCR 702-10 imposes algorithmic-discrimination testing + quantitative-assessment duties; CO SB 24-205 adds impact-assessment duties. NYDFS Circular Letter No. 7 (2024) governs external consumer data + AI claims decisioning. Texas TRAIGA HB 149 effective Jan 1, 2026. California CDI has its own bulletin. NAIC AI Systems Evaluation Tool in 12-state pilot. State UCSPAs + Fair Claims Settlement Practices Regulations + NAIC Model Insurance Fraud Prevention Act apply bad-faith + market-conduct exposure. Health payers also under ACA §1557, HIPAA, ONC HTI-1, CMS-0057-F. Cigna/EviCore (Oct 2023) + UnitedHealth/Optum nH Predict (Nov 2023) class-action filings made the enforcement surface concrete.
Existing AWS Marketplace listings don't fill this gap. Operational claims-automation SKUs are deployment platforms. Big-4 fairness audits run $150K–$500K+ over 3–6 months. Actuarial-firm audits (Milliman, Oliver Wyman, WTW) $100K–$400K as actuarial-opinion work. Boutique bias-audit firms (ORCAA, Parity, Solas, Fiddler, Warden) are NYC Local Law 144 hiring-focused or horizontal - not insurance-claims-specific. Kriv's N10 NAIC Assessment + N16 Insurance Claims Multi-Cloud are broader scope; N25 is the focused fair-claims agentic-AI audit that follows either or stands alone under state-DOI / class-action compression.
Methodology. Scope confirmation (in-scope systems - triage, adjuster-assist, SIU/FWA, prior-auth, denial-reasoning, subrogation, litigation-likelihood, total-loss). Data-lineage review (training-data provenance, inference flows, feature-engineering, proxy surface). Disparate-impact testing per system (AIR, four-fifths rule, statistical parity, equalized odds, calibration, Cohen's d, counterfactuals via Fairlearn / AIF360 / SageMaker Clarify / Google What-If). Protected-class handling + state-specific classes. Proxy-variable analysis (ZIP, credit-based scoring, language, surname, education, income). HITL effectiveness review. Adverse-action reasoning review (denial letters, coverage-dispute, SIU referral, prior-auth denials). Vendor-AI DD (Shift, FRISS, CCC, Cotality, Verisk, LexisNexis, MIB). NAIC scaffolding. State-DOI exam readiness package. Regulator-defensible audit report.
Week-by-week (4 weeks). W1 Scope + lineage + workshops + proxy plan. W2 Testing execution (disparate-impact; proxy; HITL; adverse-action reasoning). W3 Vendor DD + drafting (state-DOI readiness; NAIC scaffolding; audit report). W4 Readout + handover (audit report; state-DOI checklist; optional Fair Claims AI Governance Committee charter; board-briefing slide pack).
Three tiers. Foundation $25K (single LOB; up to 3 agentic systems; NAIC + 1-state overlay) for regional P&C $250M–$2B GWP, single-specialty insurtechs, digital health Series B–C. Standard $40K (up to 3 LOBs OR 8 agents; full NAIC + CO Reg 10-1-1 + NYDFS Circular 7 + TX TRAIGA + 5-state overlay; UCSPA mapping) for mid-sized P&C $2B–$5B, regional health payers. Enterprise $60K (carrier group with subsidiaries + reinsurance affiliate; systemic agents; all NAIC-adopted states; CFPB-parallel overlay; class-action-exposure signal memo; 90-day follow-up) for large regional/national P&C, top-25 health payers, top-25 life & annuity, reinsurers. Optional Additional LOB or Jurisdiction $10K each.
Important disclosures. Kriv is NOT a carrier, MGA, broker, producer, TPA, UR organization, or actuarial firm; underwrites no risk, adjusts no claims, issues no coverage determinations, makes no clinical decisions. Kriv performs no statutory model validation - Appointed Actuary retains sole authority. No filings with state DOIs, no rate/form signing, no DOI / court / tribunal / arbitration representation. No legal, regulatory, actuarial, or clinical advice. Findings are preliminary, NOT expert-witness testimony, NOT opinion of counsel, NOT actuarial opinion, NOT statutory audit. No "fair-by-design" certification exists, Customer's GC, Appointed Actuary, and outside counsel make all attestations. No guarantee of DOI exam outcome, litigation avoidance, enforcement mitigation, CMP avoidance, or reinsurance / cyber-insurance acceptance. Audit scope is focused, for broader scope route to N10 or N16. Anthropic CPN membership does not constitute endorsement.
Highlights
- First insurance-specific fair-claims agentic-AI audit on AWS Marketplace, regulator-defensible documentation aligned to NAIC Model Bulletin on AI (Dec 4 2023, ~24 state adoptions), Colorado Reg 3 CCR 702-10 (Reg 10-1-1), CO SB 24-205, NYDFS Insurance Circular Letter No. 7 (2024), Texas TRAIGA HB 149 (eff. Jan 1 2026), California CDI, state Unfair Claims Settlement Practices Acts, NAIC Model Insurance Fraud Prevention Act, ACA §1557 (health payers), and CFPB-parallel overlay.
- Disparate-impact testing per in-scope agentic system, Adverse-Impact Ratio (AIR), four-fifths rule, statistical parity, equalized odds, calibration, Cohen's d, counterfactual analysis via Fairlearn + AIF360 + SageMaker Clarify + Google What-If Tool.** In-scope systems: triage, adjuster-assist, SIU/FWA, prior-auth, denial-reasoning, subrogation, litigation-likelihood, total-loss agents. Protected-class + proxy-variable + human-in-the-loop + adverse-action reasoning + vendor-AI DD review.
- Natural follow-on to N10 NAIC Assessment + N16 Insurance Claims AI Multi-Cloud, transparent $25K / $40K / $60K fixed-fee, 4 weeks, + $10K per additional LOB or jurisdiction.** Foundation $25K (1 LOB, 3 agents, NAIC + 1-state) for regional P&C $250M–$2B GWP; Standard $40K (up to 3 LOBs OR 8 agents, full NAIC + CO + NYDFS + TRAIGA + 5 states, UCSPA mapping); Enterprise $60K (carrier group, systemic agents, all-states, CFPB-parallel, class-action-exposure signal memo, 90-day follow-up)
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Primary contact. info@kriv.ai · +1-732-433-5564 · https://kriv.ai/support
Response SLA. First response within 2 US business days (Mon–Fri 9 am – 6 pm ET, ex-US federal holidays). Active engagements: Engagement Lead within 4 business hours weekdays. State-DOI-inquiry or class-action-service-driven engagements compress to same business day (3–5-day kickoff).
Onboarding SLA. First customer contact within 2 US business days of buyer inquiry / private-offer acceptance. Kickoff within 1–2 weeks of SOW; 3–5 business days when state-DOI-inquiry, class-action-service, or market-conduct exam is active.
Escalation. (1) Engagement Lead (named in SOW) → (2) Practice Director (info@kriv.ai ) → (3) CEO Abhinav Dangri (info@kriv.ai ).
Communication. Dedicated Microsoft Teams channel; weekly 60-min video checkpoint; Friday written status. Customer SMEs 3–5 hrs/week (CCO-Claims, VP Claims Ops, Chief Actuary, Head of SIU, CIO, Chief Analytics, CCO/Market Conduct, GC, CMO for health payers).
Handoff. Word/Excel/PDF in customer secure share; disparate-impact results as Excel + Jupyter notebooks; protected-class + proxy analysis as Excel; audit report as Word + PDF; state-DOI checklist as PDF; board-briefing as PowerPoint.
Out of scope. Kriv is not a carrier / broker / MGA / TPA / UR organization / actuarial firm; adjusts no claims, makes no coverage determinations or clinical decisions. Performs no statutory model validation (Appointed Actuary retains authority); delivers audit findings + documentation only. No DOI filing, no rate/form signing, no regulator representation. Findings are preliminary, NOT expert-witness testimony, NOT opinion of counsel, NOT actuarial opinion, NOT statutory audit. Audit scope is focused, route to N10 or N16 for broader scope.
AWS-side billing. Cloud consumption costs separate.
Holiday coverage. Closed on US federal holidays.