Scenario 06: SureGuard Insurance Group

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Domain Weight Guide:

Domain	Weight	Focus Areas
D1 System Architecture	MEDIUM	Licensing, platform selection, mobile, reporting
D2 Security	HEAVY	Agent/adjuster/underwriter sharing, policyholder self-service, compliance
D3 Data	MEDIUM	Policy/claims data sync, 850K policyholders, retention requirements
D4 Solution Architecture	MEDIUM	Declarative vs code, portal technology, quoting engine
D5 Integration	HEAVY	7+ systems — Guidewire, billing, ISO, LexisNexis, FileNet
D6 Dev Lifecycle	LIGHT	Environments, release strategy, testing

Project Overview

SureGuard Insurance Group is a mid-market property and casualty (P&C) insurer headquartered in Hartford, Connecticut. It writes personal and commercial lines insurance across 22 US states, distributing exclusively through 3,500 independent agents.

SureGuard employs 1,200 people across Hartford (740), a claims center in Columbus, OH (310), and an underwriting office in Chicago (150). Annual gross written premium is $2.1 billion (62% personal lines, 38% commercial). The policyholder base consists of 850,000 active policyholders holding 2.1 million active policies. The company processes ~180,000 claims/year, with adjusters averaging 520 open claims each.

The CEO has launched a “Digital First” initiative (24-month timeline). Phase 1 ($3.8M) covers agent experience and internal operations. Phase 2 ($2.4M, starting 10 months after Phase 1) covers policyholder self-service and advanced analytics. The VP of Distribution has stated that agent adoption is the single most important success metric — technology must make agents more productive, not bypass them.

Current Systems

Guidewire PolicyCenter (on-premise): System of record for 2.1M active policies. Full lifecycle management. Processes 14,000 endorsements/month and ~175,000 renewals/month in nightly batches. 8 years of history (~42M transactions). SOAP and REST APIs.

Guidewire ClaimCenter (on-premise): 180,000 new claims/year (peaks in Q1/Q3). 145 adjusters in 6 regional teams. Cat events: 5,000-8,000 claims in 48 hours. $890M in reserves. Integrates with external vendors. SOAP and REST APIs.

Custom Billing System (COBOL/DB2 mainframe, 15 years old): Premium billing, payments, installments, and commission calculations. 1.8M transactions/month. Batch (SFTP) and limited REST API. Only 2 developers understand the codebase, both within 5 years of retirement.

Agent Management System (.NET, 8 years old): 3,500 agents with profiles, licensing, territories (non-overlapping ZIP ranges by line), and tiering (Elite/Premier/Standard/Developing). NIPR integration. REST API.

External Data Services: ISO/ACORD rating tables (2-4 synchronous calls per quote, 800ms each). LexisNexis for CLUE reports, MVRs, and risk scores (1.2s response; results cannot be stored beyond 90 days, must be encrypted at rest/in transit). OFAC sanctions screening required before policy binding.

IBM FileNet: 28M documents (declarations, endorsements, claim photos, adjuster reports, medical records, correspondence). CMIS API integration with Guidewire. Contract committed through 2028.

Business Process Requirements

Agent Experience

Agents must quote, rate, and bind personal lines policies (home, auto) through a self-service portal without calling underwriting. Today 78% of quotes require a phone call, adding 2.3 days to the cycle.
Portal must present a unified view of each agent’s book of business: policies, claims, commissions, and production metrics in one interface.
Agents must receive real-time notifications for new claims, approaching renewals, past-due payments, and underwriting referrals.
Top 200 agents need mobile access for policy lookup, claim status, and FNOL initiation while visiting policyholders.
During catastrophe events, SureGuard must broadcast urgent communications to agents in affected territories.
Agent onboarding (currently 35 days) must be reduced to under 10 days through automated license verification, appointment filing, territory assignment, and portal provisioning.
Agents must submit endorsement requests through the portal (currently 14,000/month via phone).

Claims Operations

Digital FNOL submission for policyholders and agents. Currently 92% of FNOLs are by phone; target is 40% digital in year one.
Automated claim assignment based on type, location, adjuster territory, caseload, and expertise (current manual assignment: 4.2-hour average).
Field adjusters need mobile access to claim files with photo upload, statement recording, estimate creation, and status updates.
Catastrophe surge capacity: temporary adjuster reassignment across territories and onboarding of independent adjusters from a pre-approved vendor network.
Subrogation tracking — estimated $12M/year in recovery is missed due to no systematic process.
All claim communications must be logged for regulatory audit by state DOI examiners.

Underwriting

Underwriter workbench consolidating application details, risk scores, loss history, agent notes, inspection reports, and comparable policy data for the 42-member underwriting team.
Tiered authority with auto-escalation: staff up to $500K TIV, senior up to $2M, managers up to $10M, VP unlimited.
Commercial lines collaborative workflow tracking communications, document exchanges, and decisions between agent, underwriter, and loss control engineer.

Data Model and Migration

Unify policyholder data from PolicyCenter, billing, and agent management into a single customer record (currently 3 different IDs per policyholder).
Real-time or near-real-time policy sync with PolicyCenter — changes reflected within 15 minutes.
Claims data sync from ClaimCenter including status, adjuster, reserves (internal-only visibility), payments, and milestones.
Migrate 5 years of agent production history (~210,000 records) and all historical commission payments.
Product model must represent 6 lines of business with coverage types, endorsements, and state-specific variations (e.g., 34 coverage components for a single NY homeowners policy).
Retention requirements: policy records for life + 7 years, claims for 7 years post-closure, regulatory correspondence for 10 years. Agent territory definitions (~12,000 assignments) and 22 state-specific rating/compliance configurations must be maintainable without developers.

Accessibility and Visibility Requirements

Agents see only policies they wrote and related claims. Split-policy scenario: a policyholder with home through Agent A and auto through Agent B — each agent sees only their policy.
Agency principals (~1,800 agencies, avg 1.9 agents, range 1-28) see their agency’s combined book of business.
Adjusters see only claims in their territory unless temporarily reassigned during catastrophe events. Underwriters see only their authority level and assigned lines.
Phase 2 policyholder portal: policyholders see only their own policies, claims, and documents.
NAIC Insurance Data Security Model Law compliance (adopted in all 22 operating states): information security program, incident response, annual risk assessment, 72-hour commissioner notification.
LexisNexis data restricted to authorized underwriting personnel only (FCRA), never in agent/policyholder views, access logged for audit. Medical records (workers’ comp, personal injury) restricted to assigned adjuster, claims manager, and medical review staff with additional encryption.
Commission visibility: agents see only their own; principals see their agency’s agents; regional managers see territory totals only. State regulatory examiners get time-limited, audited read-only access to specific files under examination.

Reporting Requirements

Monthly portfolio analysis: loss ratios by line of business, state, agent tier, and policy vintage with drill-down to individual policies.
Quarterly state regulatory filings (complaint ratios, claims closure rates, demographics) in state-specified formats for all 22 states. Monthly agent performance scorecards (new business, retention, loss ratio, growth, peer ranking).
Real-time claims dashboards: open counts by territory, days to close, reserve adequacy, adjuster workload. Actuarial team needs 5 years of policy/claims data refreshable monthly for loss modeling.
CFO monthly financial dashboard: written/earned premium, loss/LAE ratios, combined ratio, investment income vs. plan and prior year.
Compliance audit trail for all PII, claim file, and LexisNexis data access. Annual NAIC data calls (currently 6 weeks to produce manually from multiple systems).

Development Lifecycle Requirements

12-person IT team (8 Hartford, 4 contractors) with ~6 FTEs allocated to the new platform. Monthly release cadence with 24-hour hotfix capability. All production deployments require IT Director + VP sign-off.
Regulatory changes (30-60 day DOI mandates) must deploy without a full release cycle. Dedicated integration testing environment connecting to Guidewire’s test instance.
Robust sandbox strategy: compliance training environment with anonymized production data, plus at least two parallel development workstreams. All production data in non-production environments must be anonymized per NAIC requirements.

Implicit Requirements

Before designing, consider: What does “3,500 agents seeing only their book” mean for sharing model complexity? What does the split-policy scenario imply for data model and sharing? How do 520 open claims per adjuster affect performance? What do 5,000-8,000 claims in 48 hours mean for surge capacity? What are the licensing implications of 3,500 agents + 850,000 policyholders + 1,200 internal users? What does 15-minute policy sync require? How does the COBOL system’s limited API affect integration? What does “LexisNexis 90-day retention” mean for data lifecycle? How do you architect around the FileNet contract through 2028?

Architect’s Checklist