Solutions · Managing general agents
Claims management for MGAs under delegated authority
A lean team, consistent handling, and a file your capacity partner can audit without a fight.
In short
Hesper AI is an AI claims resolution platform used by managing general agents to run delegated claims with a small team. Its agents handle intake, evidence assembly, coverage analysis and recovery screening on every file, and write the sourced record a carrier partner expects to find in a claims audit. Your head of claims keeps the decisions and the authority.
Why does claims handling decide whether capacity renews?
Delegated authority is lent, not owned. The carrier behind the programme reviews how claims were handled, and the loss ratio it sees is the product of those decisions. Inconsistent handling, thin files, and missed recoveries all show up in the same place: the result the capacity partner underwrites next year.
Most MGA claims teams are small by design. The constraint is not judgment, it is hours.
What does a capacity partner's claims audit look for?
Consistency and evidence. Were claims handled the way the delegation agreement says, were coverage positions documented, were reserves supported, was the file complete when the payment went out, was recovery pursued where it existed.
Hesper writes that record as the claim runs. Every coverage position cites the policy language, every finding cites its source, and every recommendation is timestamped and attributed, so an audit reads the file rather than interviewing the team. The same record answers the MGA Act reporting triggers, which ask for a claim file copy when a claim may exceed the MGA settlement authority or stays open more than six months.
How does a small team run a whole book with it?
- Intake arrives complete: extracted from the notice and its attachments and created in your system.
- Clean claims resolve straight through, inside the limits you set, so the team's day goes to the ones that need judgment.
- Evidence is assembled before an adjuster opens the file, with contradictions and gaps already surfaced.
- Suspicious claims get an investigation-grade workup rather than waiting for capacity.
- Every file is screened for subrogation and salvage, which is where lean teams most often leave money behind.
Does this work if our claims are handled by a TPA?
Yes, and the questions are the same: consistency, evidence, recovery. Some MGAs run Hesper themselves for oversight of the delegated file; others deploy it with their TPA so the record is built once and both sides read it.
Hesper connects to the claims system already in use through its API, and can start on one line or one programme.
What does Hesper do, and what does your team decide?
| Hesper's agents | Your team |
|---|---|
| Builds the file and applies the programme's rules on every claim | Sets the rules and the authority limits |
| Documents coverage positions with the language cited | Makes the coverage and payment decisions |
| Screens every file for subrogation and salvage | Decides what to pursue |
| Writes the audit record as the claim runs | Faces the capacity partner's review |
What does the output look like?
- Programme
- Delegated claims authority from a carrier partner, small in-house claims team
- Handling
- Straight-through resolution for clean claims within the delegation's limits
- Coverage
- Positions documented against the policy form and endorsements, with the text quoted
- Recovery
- Every closed file screened for subrogation and salvage before closure
- Audit
- Sampled files show the evidence, the reasoning and the signer for each decision
Evidence cited
- Coverage position citing the endorsement that governed it
- Recovery opportunities ranked with the evidence behind each
- Straight-through decisions logged against the delegation's criteria
Recommended next action: Head of claims reviews exceptions; the audit pack assembles from the files themselves.
Frequently asked questions
What is claims automation for an MGA?
Software that runs the claim-handling work a delegated programme requires - intake, evidence, coverage analysis, recovery screening - so a small team can handle a whole book consistently, with a documented record for the carrier partner's audit.
Will our capacity partner accept AI-assisted claims handling?
What a carrier partner audits is whether decisions were consistent, documented and supported. An evidence-backed file makes that easier to show, not harder. Decisions stay with your team, and every recommendation records who signed it.
We are small. Is this sized for us?
It is a good fit for lean teams, because the constraint it removes is hours rather than judgment. Programmes typically start on one line and expand once the handling and audit results are visible.
Our TPA handles claims. Can we still use it?
Yes. Some MGAs run it for oversight of the delegated file, others deploy it alongside the TPA so the record is built once and both sides work from it.
How is claim data handled?
Encrypted in transit and at rest, retained for the subscription term unless you instruct otherwise in writing, and never used to train models. Hesper is SOC 2 Type I attested and GDPR-ready.
Where to go next
Book a demo for your delegated programme
A 30-minute walkthrough on your book: handling, documentation, and what an audit would find.
Book a demo