Sixfold Content

Over the past few years at Sixfold, we've helped more than 50 underwriting teams bring AI into their day-to-day work. From global carriers to innovative MGAs, teams ranging from five to 200 people across P&C, Life & Health, and specialty lines.

Different customers with different needs, but one common pattern: the teams that succeed with AI aren't the ones waiting for a perfect solution. They're the ones who start. They take the project out of the product roadmap and bring AI into how their team actually works, into the culture, the habits, the daily routine.

The goal is to take manual work off underwriters' plates so they have time to focus on complex decisions, bind more premium, and strengthen broker relationships. The secret is to simply start.

From our experience working with underwriters on a daily basis, one thing is clear: successful adoption doesn't come from trying to solve everything at once. It starts with one clear, impactful pain point.

Achieveing a successful start

1. ‍‍Pick a pain point that underwriters already feel every day. Something that eats up hours, like digging through pages of documents to find one relevant detail about a risk. When underwriters see real value, they'll use it and share the wins with their peers.
   ‍
2. Get leadership buy-in from leaders who understand why it matters, not leaders who add AI just to check a box. Leaders who actively support underwriters as they try something new make the difference.

And just as important: underwriters need to see what's in it for them. Concrete changes to their day-to-day work, not abstract efficiency gains.

“We focused on a use case underwriters actually asked for. And then accuracy became everything. If they can't trust the output, it doesn't matter how cool the technology is.”

─ Amy Nelsen, Head of UW Operations, Middle Market at Zurich North America

That's just the first step. We've put together a 5-stage guide that covers what comes next, from building trust, making it effortless to use, to spreading adoption across the team. 

Download the guide here

The bottleneck in life & health underwriting

Life & health underwriting is slowed by manual submission triage and the work of reading dense medical evidence for risk assessment. AI underwriting platforms now read and reason through an entire submission before an underwriter even opens it.

Every life and health submission arrives as a stack of unstructured information, like application data and medical records such as attending physician statements, lab results, and prescription histories, that can run to hundreds, even thousands of pages. Historically, underwriters spent the bulk of their time finding, reading, and organizing that evidence before they could make a single risk decision. That manual effort is the real constraint, not the decision-making process itself.

Sixfold changes that. Its AI agents read and reason across the full submission the way an experienced underwriter would, surfacing the relevant medical evidence aligned with the carrier's underwriting manual, flagging key risk factors, and delivering a clear health overview. All steps to support the underwriter's decision-making.

‍

Using medical software to read records and find key information faster

Medical evidence software exists because reading through the records is the most time-consuming part of a life & health case analysis. 

Sixfold processes attending physician statements, lab panels, and prescription data, extracts the clinically relevant findings, and ties them back to the risk factors that matter for the underwriting decision. Instead of skimming a 200-page record for a single relevant medical condition, the underwriter gets a structured, evidence-backed summary with a traceable source.

Because the system comes pre-trained with underwriting knowledge, it recognizes what matters most to a life or health risk from day one, rather than requiring months of configuration. It plugs into the underwriting workbench the team already uses, so the medical evidence summary appears within the existing workflow.

‍

Reducing time spent in manual submission triage with AI

Doing the initial review of a submission, checking if all the information is available to proceed or if it needs more data from brokers or agents, is where underwriting teams spend the most time on operational work. An AI platform automates triage by ingesting each submission as it arrives, assessing completeness, pulling and organizing the medical evidence, and producing a preliminary recommendation before a human review.

The result is that when underwriters start the case review, it's already prioritized, and the risk assessment is complete, ready for a final underwriting decision. Underwriters get to spend their time on judgment, complex risk cases, and broker relationships rather than on sorting and data entry. 

Across Sixfold customers, this contributes to a 50% reduction in turnaround time, hit ratios up 15% or more, and up to 30% more gross written premium per underwriter, because capacity is redirected from administrative triage to writing business.

‍

L&H Frequently Asked Questions

How do life and health insurers use medical-evidence software to speed up the underwriting process?

Life insurers use Sixfold's AI to automatically read and interpret medical records, attending physician statements, lab results, and prescription histories. It extracts relevant findings, links them to risk factors, and presents an evidence-based summary, so underwriters can focus on the decision rather than digging into information. It provides a risk assessment ready for decision-making, including recommendations on what to do next in a case.

Sixfold comes pre-trained with underwriting knowledge from day one. It integrates directly with existing underwriting workbenches, keeping the source evidence visible for every conclusion. Customers see processing times 50% to 97% faster as a result.

‍

How do underwriting teams reduce manual submission triage using AI platforms?

Underwriting teams reduce manual triage by having the AI platform ingest each submission on arrival, check completeness, organize the medical evidence, and automatically generate a risk assessment and next-step recommendations. Underwriters then start case review with cases that are already prioritized and pre-analyzed, focusing their time on risk judgment rather than sorting and data entry.

Having Sixfold help with triage, teams redirect capacity from administrative work to writing business. Sixfold customers report hit ratios up 15% or more and up to 30% more GWP per underwriter. Adoption stays high, over 90% of expected users, because the platform fits how underwriting actually works rather than forcing a new process.

‍

What are the top tools for automating life underwriting decisions?

The top tools for automating Life and Health underwriting decisions are purpose-built underwriting AI platforms that reason across a full submission, automated medical evidence and record summarization software, and integrations into the underwriting workbench. The strongest options combine all three: decisioning, evidence analysis, and workflow fit.

‍

About Sixfold

Sixfold is the first AI solution built specifically for insurance underwriting, in market since early 2023, and is live in production across 50 lines of business, including life & health lines. It has processed more than 1.5 million submissions globally and is used by more than 1,000 underwriters, from insurers like Guardian and New York Life.

‍

Sixfold was featured on the big screen at Open AI’s DevDay 2025, recognized for surpassing 100 billion tokens processed. To make it even better, Senior AI Engineer, Drew Das, was honored among global developers for his contributions.

This is a huge milestone for Sixfold, a reflection of the real impact our AI is making in underwriting. But what does 100 billion tokens actually mean in practice? We sat down with Drew to find out.

Can you start by explaining what exactly OpenAI recognized Sixfold for at Dev Day, and what it felt like to see your name up on the screen?

Seeing my name on stage felt like public validation of the engineering team’s hard work. Sixfold is operating at the frontier of large-scale AI in insurance underwriting. We’re not a pilot anymore; we’re in production.

It also hit home the responsibility that comes with it. Yes, we’ve built scale, but now we have to make sure what we produce is high quality and meaningfully used. Sixfold isn’t experimenting with LLMs; we’re running them reliably where accuracy, latency, and auditability really matter.

We’re not a pilot anymore; we’re in production.

What does “100 billion tokens” actually represent in Sixfold’s day-to-day work?

Each token is a fragment of understanding, a piece of text, data, or context that our models interpret and turn into something underwriters can act on.

It signals the volume of underwriting data, documents, broker submissions, and risk information that our platform analyzes and processes through generative AI workflows.

Hitting 100 billion means we’ve moved many workflows off manual underwriting review and into AI. When repetitive work is reduced, underwriters spend more time on relationships, strategy, and higher-value decisions. 

Hitting 100 billion means we’ve moved many workflows off manual underwriting review and into AI. When repetitive work is reduced, underwriters spend more time on relationships, strategy, and higher-value decisions. 

So… what’s next, another 100 billion tokens?

Token count is becoming table stakes. What matters now is how those tokens are applied and the outcomes they create. 

We’re focusing on deeper workflow integration, bringing AI agents that go beyond risk assessment to support decisions, automate workflows, and deliver real-time underwriting intelligence. Our Research Agent is a great example of that.

Considering the high-stakes nature of insurance, every risk insight and decision generated by Sixfold must be auditable and traceable. Our solution isn’t just built for scale, but for governance.

On the engineering side, what does it take to run something at that scale?

From an engineering perspective, scale brings complexity. We’re constantly balancing latency, cost, and accuracy.

Many AI projects stop at the “cool demo” stage, but we’re pushing through the messy engineering: hybrid search, re-ranking, prompt tuning, and evaluation,  all happening under the hood.

Scaling means better signals, more edge cases surfaced, and faster model learning. It’s a flywheel that keeps getting smarter.

Scaling means better signals, more edge cases surfaced, and faster model learning. It’s a flywheel that keeps getting smarter.

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.
‍

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.”
‍
- 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.