Sixfold Content

Life & Health underwriting is a constant balance between speed and quality: getting the right coverage to customers before they go somewhere else. One missed detail can change the whole quote. But the longer pricing takes, the greater the risk of applicant drop-off.

Accelerated underwriting helps with simpler cases that don't require additional evidence, but as recently reported by Gen Re, up to 88% of cases still need some type of human review.

Those cases still go through the same workflow: sorting through documents at initial review, going back to the advisor or broker when something's missing, and when the case is finally ready, reading through hundreds of pages of medical records like EHRs, APS, and lab results to piece together the full health picture before making a decision.

It's a lot of steps and a big manual workload that keeps underwriters from bringing in more premiums and getting back to customers faster with better coverage. That’s where Sixfold comes in; underwriting AI built to help at every step of the process, bringing together the details that matter to your team, and now with our new Narrative, a tailored initial analysis that simplifies triage and reduces the unnecessary back and forth, before the deeper analysis.

The First Look At a Case

At the initial review, underwriters are trying to answer one question: Do I have what I need to move this case forward? Most of the time, that means going through multiple documents just to find out, and when something's missing, at least 30 minutes are spent on a case they'll have to come back to later.

Our new Narrative capability for Life & Health is a focused, structured case summary tailored to what matters to your underwriting team, surfacing the information you want to see upfront to help underwriters with triage and to figure out next steps. Sixfold’s AI agents read through all the case documents, application, APS and labs, and pull together the relevant details into one structured view, so underwriters don't have to. Each narrative is configurable to your team's specific workflow, so what gets surfaced reflects what actually matters for your decisions.

Imagine a case where an applicant has hypertension or a history of elevated cholesterol. The underwriter immediately needs to know if they have all the information about blood pressure and what meds they're on. Does this applicant smoke? What is their family history? This is information they need before they even begin to assess the case.

The Narrative gives you exactly the information you need to know before you move on.

"We want to support underwriters at every point in their workflow. Sometimes that means a focused Narrative to help with triage and next steps. Sometimes that means a deep condition analysis across hundreds of pages. The point is, wherever an underwriter is in the process, Sixfold is there to help." 

— Noah Grosshandler, Product Manager at Sixfold

On the reinsurer side, it's a similar story. Underwriters are spending precious time just organizing loosely assembled submissions from cedents because most times the cases come in an inconsistent format, requiring additional questions before quoting, many of which wouldn't even be necessary if the information were clearly structured upfront.

With Narrative, these questions are answered upfront. Fewer emails back and forth with brokers and faster responses.

‍The Full Clinical Story: Conditions Analysis

After triaging and making sure a case is ready to quote, underwriters go back to the manual review of hundreds of pages of medical records, trying to spot that one detail that will change the whole quote. It's pretty much like detective work, finding how a medicine connects to a diagnosis and what the impact is on that patient, trying to piece together the full medical story. Assessing history, severity, and how well a diagnosis is managed. Meanwhile, customers are waiting for a response.

That's where Sixfold's in-depth Conditions Analysis comes in. When the case is ready for a full review, our Conditions Analysis connects all the medical pieces, bringing together medications, labs, procedures, and diagnoses under each condition so underwriters can see the full clinical picture without jumping between documents. It highlights what's relevant to your underwriting guidelines, shows how conditions have progressed over time, and surfaces the clinical data that matters most for your decisions.

One example is a case where an applicant is taking Spironolactone, a common medication used to control high blood pressure, but also prescribed for hormonal acne. An underwriter would have to go through lengthy pages of documentation to find what dosage they're on, how long they've been taking it, and what it's actually being prescribed for. And that's just one medication. For complex cases, underwriters are doing this across multiple conditions with years of medical history.

With our Conditions Analysis, underwriters can spend their time on decision-making rather than document review and data gathering. Customers get faster and better quotes. Guardian, for example, saw a 50% reduction in review time using Sixfold.

When Speed is What Matters

Some of our customers work with higher-volume lines like structured settlements and annuities and often process over 10,000 cases per year; they don’t always need an in-depth Condition Analysis to move a case to the next step.

There are fewer key risk details that influence the analysis, so they have been able to use Narrative to move forward on up to 70% of their cases, consulting our full Conditions Analysis only for the most complex ones. For some teams, Narrative handles most of the heavy lifting of manual review.

"One of our customers built Narrative into their workflow for initial case review. It helps their underwriters get up to speed quickly and know exactly what needs attention. When a case requires deeper analysis, they move to our full Conditions Analysis, but Narrative gives them that strong starting point." — Justin Sorce, Customer Success Manager at Sixfold

Confident Underwriting Decisions

Whether it's a quick initial review or a deep dive into a complex case, Sixfold is there to help your team get to a confident underwriting decision faster.

And it works where your team already works, whether that's in our UI, a workbench, or a policy admin system. Every insight ties back to the source documents, so underwriters can verify what they're seeing. Built for underwriting since day one. HIPAA and SOC 2 certified, with single-tenant environments to keep your data secure. Rigorous AI fairness testing to meet evolving regulatory standards and grounded in our Responsible AI principles.
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Interested in a hands-on demo? Reach out.

Underwriting judgment is one of the most valuable assets an insurer has, and one of the most fragile. Great underwriters develop a feel for risk that goes beyond guidelines, judgment built from thousands of decisions over a career. It's what shapes portfolio quality and shows up in loss ratios. But that judgment is unique to each individual underwriter. The underwriters around them don't have access to it, and when they retire or move on, it's gone. Meanwhile, the portfolio intelligence that should be informing every decision: how similar risks have performed, which broker relationships produce adverse selection, where losses concentrate—doesn't reach underwriters where and when they need it.

AI underwriting changes what’s possible here. Every submission processed leaves behind structured and unstructured traces that are sometimes not easily identified: risk factors extracted, reasoning paths, agent recommendations. When connected to the decisions and outcomes that follow, those traces form a learning loop, and Institutional Intelligence builds.

When this intelligence is properly put to use, your underwriting gets smarter. New underwriters ramp faster, operating on insights with expertise and portfolio context built in. Decisions become more consistent across the team, grounded in collective knowledge rather than individual memory. Expertise doesn't walk out the door when senior underwriters move on. The entire organization is upleveled with knowledge that used to live in silos.

What We’re Building

Strengthening Our Foundation

Sixfold's Underwriting Brain is at the center of everything we do. We’re deepening its expertise through specialty training and certification courses—building a sharper understanding of how underwriters work end-to-end and the nuances across lines of business. The Brain then captures carrier-specific guidelines and appetite with its patented appetite ingestion engine, refined over time through an underwriter feedback loop. Playbooks go further, encoding complex references, ontologies, and documented practices unique to your organization, so Sixfold doesn't just understand underwriting, it understands how you underwrite.

Building Institutional Intelligence

The Brain then builds Institutional Intelligence through a learning loop, the first phase of which is available today. Carriers can feed decision and outcome data back into Sixfold through enhanced case statuses and the Sixfold API. This data further shapes Sixfold’s understanding of your appetite and what wins business.

The learning loop expands as more data flows in. We're working closely with customers to build the data connections that matter most: broker performance, referral decisions, policy structure, losses. The goal is Institutional Intelligence that moves the metrics carriers actually manage to: winnability, portfolio performance, loss ratios. And because we deploy each customer in an isolated environment, the intelligence captured is yours alone.

Agentic self-learning comes next, identifying patterns across submissions, learning which signal combinations predict losses, the Brain self-refining its understanding of your desired portfolio over time. We're building toward self-learning deliberately, with the governance, performance monitoring, and controls enterprise insurers expect from Sixfold. 

Putting It To Work

A new agentic backend allows these layers of knowledge to be put to work. The Brain and the agents behind it build a research and assessment plan specific to each submission that comes in, reasoning through what information it needs and what actions it needs to take. Insights and recommendations are surfaced to underwriters, actions are taken, all grounded in the expertise and Institutional Intelligence that sits in the Brain. As Institutional Intelligence deepens, so does what Sixfold can do for your team.
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Current customers can begin feeding decision and outcome data into Sixfold today. Contact your Customer Success Manager to learn more.

Sixfold is actively conducting research sessions to help shape the future of our product. If you're interested in participating, reach out to us at hello@sixfold.ai.

Not yet a customer? Request a demo.

Since AI’s introduction in underwriting, it has been about surfacing information: flagging risks, highlighting important insights, and providing recommendations. But there's always been a gap between AI that knows what needs to be done and AI that actually does it.

Sixfold is building AI agents that close that gap: agents that work alongside underwriters to move cases forward autonomously. Referral Agent marks a shift in what Sixfold can do for your underwriting team, starting with one of the biggest bottlenecks we hear about from underwriters: referrals.

“We’re no longer just telling underwriters what to do; we’re helping them do it. This launch represents a major shift in how we drive efficiency and consistency in underwriting — turning “here's what you need to know’ into “here’s what we’ve already done about it”. The Referral Agent is just the beginning of that vision.”

- Alex Schmelkin, Founder and CEO of Sixfold

Where 40% of Cases Get Stuck

When we asked underwriters about their biggest workflow frustrations, referrals came up again and again. 

Every underwriter knows this routine: you spot a case that needs escalation, and suddenly you're building a package. Pull the rules. Cross-reference submission details. Write a detailed email explaining your reasoning. Make sure the approver, such as senior underwriter, has everything they need to make a decision.

It's necessary work, but it takes about an hour per case. With up to 40% of applications requiring escalation, underwriters can spend half their day packaging referrals instead of evaluating risk.

The ripple effects hurt everyone. Brokers wait days for responses while referrals sit in approval queues. Approvers get packages missing key details and have to circle back with questions. What should be a quick handoff becomes a multi-day process that slows everyone down.

AI That Completes the Loop

Referral Agent transforms how this process works. Instead of stopping at identification that a case needs referral, it handles the next steps as well. It executes referrals on its own: flags when a case needs escalation, assembles the complete referral package and drafts a ready-to-send email in your preferred tone.

The underwriter's role changes from package preparation to package review, freeing up time from admin work and letting them focus on more strategic decisions.

The repetitive process that used to take 60 minutes? It now takes 1 minute.

How it works

Sixfold knows the insurer’s unique risk appetite, applies what it’s learned, and clearly shows if and why a referral is required after case analysis is completed.

When the agent flags a case for escalation, it constructs a complete referral package in email form:  a business summary including the company's operational focus and a structured rationale section that walks through each referral guideline breach step-by-step, citing the exact percentages, dollar amounts, and policy thresholds that might have triggered the referral requirement.

With this launch, we’re making the underwriter’s inbox part of the workflow. Underwriters can just forward a broker’s email, with attachments, straight to Sixfold, and the risk assessment kicks off automatically. When it’s time to refer, a pre-drafted email is done, ready to be sent with a single click from the underwriter’s default email provider.

Benefits by Role

For Referrers ‍

- Always know when to refer
- No more repetitive referral tasks 
- Hours back every day for actual underwriting

For Approvers

- Every referral is standardized, making it easier to review
- With complete referral packages, you can decide faster - often same-day
- Automatic audit trail for compliance and training

For Insurers

- Referral guidelines are applied consistently across every team
- Quotes out faster → happier brokers → improved hit ratios
- A process that scales with every underwriter hired

The Broader Vision

‍Referral Agent is part of a shift in what Sixfold can do for your team. In 2024, Sixfold gave underwriters a brain that reads and assesses; now Sixfold equips them with a brain that acts: AI agents that move cases forward on their own.

Each Sixfold agent plugs into your existing workflow to solve a specific bottleneck. Backlog of referrals? Deploy Referral Agent. Team spending hours researching online? The Research Agent does it in minutes. Endless broker negotiations slowing you down? The Negotiation Agent (coming soon) handles it. Use them individually or stack them together,

“Every underwriter knows that sinking feeling of a growing referral queue. With the Referral Agent, that queue clears itself. It proves that AI can take action, not just give advice. It's the first of many agents that free underwriters from processor work so they can become portfolio strategists."

- Lana Jovanovic, Head of Product @Sixfold 

Experience It Live: Try Referral Agent at ITC Vegas in October. Forward an email, watch the risk assessment run, and generate a referral in real time. Book your ITC meeting with Sixfold, or schedule a digital demo.

Life & Health underwriters often have to go through hundreds of pages of medical documents to understand an applicant’s health profile, knowing that one missed detail could lead to the wrong coverage decision.

When we introduced our Life & Health Underwriting AI, we set out to give underwriters everything they need in one place: diagnoses, medications, and procedures pulled from applications and supporting documents, aligned to the insurer’s unique risk appetite. They no longer had to spend time manually going through medical documents. 

But after getting feedback from underwriters across global insurers, we realized something important: presenting information alone isn't enough. What they really need is the full health story, with all the pieces connected. For example, if a medication appears, they need to know the full context around it: how often it was prescribed and any related diagnoses or procedures.

That’s why we’re upgrading our Underwriting AI with Conditional Insights and Clinical Data, designed to reflect the way underwriters think about the overall health profile.

What’s New?

Conditions: From Medical Facts to the Full Story

Conditions completely change how Sixfold’s insights are presented to underwriters. 

Previously, all relevant data, like Personal Health, Medications, Procedures, and more, appeared as individual facts. While surfacing this information is essential, it didn’t show underwriters how it all connected.

The thing is, Life and Health underwriters don't analyze each fact in isolation; they think about how it fits into the bigger picture. What does this medication suggest? How severe is the condition? How does it all connect?

That’s why Sixfold now brings together all relevant information under a diagnosed condition, including:

• Medications and ongoing treatment
• Procedures and lab results
• The condition’s full history, with context and progression over time
  

For example, take Gastritis, an inflammation of the stomach lining that can cause pain, indigestion, and discomfort. An applicant might have been diagnosed with it a while ago, is taking medication such as Pantoprazole, and could have undergone procedures like Endoscopies five years ago.

Instead of treating these details as in isolation, Sixfold now recognizes they’re all part of the same conditions story. This mirrors exactly how an experienced underwriter would naturally connect the dots, seeing not just health facts, but the bigger picture of an applicant’s health history.

“This release has been a huge focus for our team, and the feedback from early users has been very positive. They’ve shared firsthand how impactful it is to have a single experience that brings together every aspect of an applicant’s medical history.” 

- Noah Grosshandler, Product Manager at Sixfold.

Want a closer look at how Conditions work? Join our live product demo on September 11th.

Core Clinical Data: Lab Insights and Historical Trends

Underwriters often have to go through dozens of lab results to answer: Does this applicant have an underlying condition? Are the results concerning? Could they worsen over time?

Core Clinical Data brings all of that information into one place, instantly. It pulls information found in lab results and medical records uploaded to Sixfold, presenting a pre-defined set of health indicators commonly tied to high-risk conditions such as: Vitals, Cardiovascular Health, and Hematology.

It gives underwriters instant and standardized insight: lab values, normal ranges, and historical progression, making it easier to assess the presence, progression, and severity of chronic conditions.

The impact? Core Clinical Data gives underwriters a snapshot of the applicant’s health at a glance, meaning time saved in reading lab reports that can be used to actually bind accounts. With immediate access to historical trends and key lab indicators, underwriters can make faster and more accurate decisions. 

How Guardian Cut Review Time in Half

Guardian, one of the largest life insurers in the U.S., faced a common challenge: manual case reviews slowed down underwriters and created bottlenecks in the underwriting process.

By adopting Sixfold for its Disability line, Guardian was able to automatically extract medical data, triage information faster, and speed up case assessments end-to-end.

The impact: a 50% reduction in review time, freeing underwriters from being stuck reviewing medical records and letting them focus on risk decisions. Read more about the results Guardian has seen here. 

Now, Guardian is expanding the program across more business lines, and you can see why! Join our Life & Health Product Demo on September 11th, where we’ll showcase how Sixfold works for life & health insurance underwriting. 

In commercial underwriting, submissions rarely contain everything underwriters need to properly assess risks. Critical information such as SEC filings, cyber incidents, litigation history, or executive misconduct aren't in the application, and finding that data falls on the underwriter.

The stakes are high: miss one key detail, and underwriters are suddenly pricing a completely different risk. The research to uncover this information means hours going through public sources such as news archives and databases.

All while brokers demand quotes fast in an increasingly competitive market.

Why We Built it

With Research Agent, underwriters have a research partner who finds the gaps in the submission, locates the missing pieces, and brings back the insights that matter for the decision. The agent does the external research work on the underwriter’s behalf.

By filling critical information gaps and applying research from the public web and connected third-party data sources into Sixfold’s overall risk assessment, underwriters are given a complete risk picture for more precise appraisal. Underwriters can view the exact origin of any piece of information, with clickable links that take them directly to the original source for verification or further detail.
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The result? Quotes go out faster, underwriters make more consistent calls, and decisions get made without wondering what might have been missed.

“Research Agent has been one of our most anticipated features, especially for customers in specialty lines where extensive research is needed to get a complete picture of the risk. We expect the agent to save them at least two hours per case.”

- Alex Schmelkin, Founder & CEO at Sixfold

When Research Makes Or Breaks The Quote

Sixfold’s Research Agent is designed to support commercial lines of business where external data is essential in risk evaluation and quoting. Lines of business we’re seeing the highest demand for include:‍

• General Liability - Public web research to capture OSHA violations, litigation history, and negative press coverage.
• Cyber - 3rd party cyber threat intelligence plus broader public web research for cyber breach disclosures and corporate litigation involving cybersecurity lapses.
• E&S Property - Public and/or 3rd party data on location and climate based risks (flood, wildfire, crime, etc.), permit history, and company mentions in the news.
• Directors & Officers (D&O) - News on executive misconduct, class-action lawsuits, SEC filings, and shareholder news.
• Healthcare & Life Sciences - Public records of malpractice lawsuits, regulatory actions, patient safety concerns, and news coverage related to clinical trials or product safety.

While Competitors Prep, You Price

Research Agent delivers wins across the board, immediate time savings for underwriters and competitive advantages insurers. 

“We’re seeing growing demand for research-heavy underwriting. With this launch, we accelerate the time to quote while elevating decision-making with richer context.”
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- Lana Jovanovic, Head of Product at Sixfold

Focus on what matters: Those hours gained back per case? That's time underwriters can spend on what they do best: making smart risk decisions, strengthening broker relationships, and building customer connections instead of drowning in research tasks.

Speed wins deals: Reduced manual research burden means underwriters can respond faster to brokers, increase their quote volume, and capture more bound premiums. For carriers competing on both responsiveness and quality, this means winning more of the right business.

Same quality, every time: Every underwriter now has access to the same thorough research process. No more inconsistency based on who's handling the case or how much time they have to dig. Better decisions, whether it's one case or a thousand.

Improved portfolio performance: Sixfold’s comprehensive risk assessment, now with the added capability of public web research and connected third-party data, equips underwriters with a deeper understanding of each risk.

Contact Sixfold to see the Research Agent in action.

No one became an underwriter because they love writing case documentation. But that’s where a huge amount of time goes today. Referral notes, peer review memos, audit documentation, written and rewritten, case after case. 

• A single case can take an hour, often several hours, to document.
• Multiply that across a typical team handling hundreds of submissions each week. The result is thousands of hours spent each year on documentation alone.
• Underwriters are doing this work while balancing dozens of other tasks: reviewing new submissions, responding to brokers, preparing quotes, and managing existing accounts.

80% Automation, 20% Judgment

Sixfold’s Narrative feature automates and standardizes how risk is communicated across the organization. It automatically generates a risk narrative that matches each insurer’s appetite, tone and format, while giving underwriters the flexibility to apply their own judgment where it matters.

See below for a quick product walkthrough from Shirley Shen, Senior Product Manager @Sixfold:

The Narrative feature is built to:

1. Align with the insurer’s unique risk appetite
2. Surface key facts and risk insights that matter most
3. Adhere to required documentation standards and formats

“Think of all the documents underwriters have to create for administrative purposes. Anything that requires them to synthesize the risk overall. Sixfold is doing 80% of that now: bringing together all the facts. Then the underwriter just adds the last 20%, the judgment call.” 
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- Laurence Brouillette, Head of Customers and Partnerships @Sixfold

Proven with Zurich’s North America Team

The Narrative feature was developed and validated through the 2024 Zurich Innovation Championship (ZIC).

Over a 6-week sprint with Zurich’s North America Middle Market team, Sixfold:

• Partnered with 16 underwriters and was used in 80%+ of their live submissions
• Processed nearly 4,000 pages of submission and web data
• Achieved an average of 60 minutes time savings per submission

Following this success, Narrative is now rolling out across Zurich’s U.S. offices.

"We launched with four Zurich Middle Market offices in January 2025 and are now expanding Sixfold to dozens more offices countrywide.”

- Amy Nelsen, Head of Underwriting Operations, U.S. Middle Market @Zurich North America

How Zurich gives underwriters time back with Sixfold — featured in The Insurer.

AI That Actually Gets Used

Narrative is a great starting point for insurers looking to bring AI into underwriting workflows today. It takes the repetitive parts of the job off underwriters’ hands without requiring them to change how they already work. 

“Sixfold streamlines the way underwriters receive information on new submissions, offering a holistic and simplified overview of a business’s operations and exposures right from the point of entry into our workflow.”

- Madison Chapman, Senior Middle Market Underwriter @Zurich North America

How Sixfold is transforming underwriting for Zurich’s U.S. Middle Market team.

When underwriters experience that impact immediately, with fewer hours spent writing up cases and fewer rounds of revisions, adoption happens easily. AI becomes part of the flow of work because it genuinely makes the day-to-day tasks so much easier.

Get in touch to see how Sixfold fits your underwriting workflow.