How-to · Insurance claims · Five Sigma · Oct 20, 2026
Let Five Sigma’s Clive agents prep a claim, and have the adjuster approve every coverage position, payment and message
Five Sigma’s Clive agents can draft coverage summaries, liability views, and replies, and Clive Claim Conductor can move a claim forward when a stage is complete. Every action switched to automatic is a decision made without an adjuster. This page shows how to set the guardrails, work the Cockpit queue, and keep coverage, payments, and messages with the adjuster. Terms: QA means a quality check done by a person.
Who this is for
Claims leaders, adjusters, and claims QA managers at P&C insurers, MGAs, third-party administrators (TPAs), and self-insured organizations. The job here is coverage positions, payments, and messages on property and general claims. For casualty medical summaries and reserve or attorney-referral approval — a different job — see CLARA DocIntel medical summary reserve check.
How to do it
This is a how-to, not a ranking of claims systems. Per the Five Sigma AI review, Clive covers intake, triage, coverage, liability, documents, communications, fraud signals, and QA; it runs in Five Sigma’s claims system or on top of an existing one. Clive Claim Conductor and the Adjuster’s Cockpit were unveiled on 28 September 2026, and we found no general-availability date. Five Sigma says insurers choose which actions run automatically by action, sub-organization, and line of business. The ground rule: the adjuster approves every coverage position, payment, and policyholder message.
1. Set Claim Conductor guardrails in writing
What it is: Before anything runs, the claims operations lead writes the short list of actions Conductor may take on its own. Payments, denials, and coverage letters stay with adjusters.
- Start with low-stakes actions: acknowledging claims, requesting standard documents, closing withdrawn claims.
- Keep payments, denials, and coverage letters off the automatic list.
- Set guardrails by action and line of business.
- Keep Clive Intake’s human check on until intake errors are measured.
- Send every Clive Risk flag to the SIU lead, not to a denial.
A claims operations lead at a travel insurer writes three automatic actions: acknowledge, request standard documents, close withdrawn claims. Everything else stops for an adjuster. She plans to sample thirty automatic actions after a month before adding anything.
Write every action Conductor may take automatically on one page. Payments and coverage letters are not on it.
2. Work one day of the Adjuster’s Cockpit queue
What it is: The Cockpit shows which claims are waiting for a person or blocked. For one day, the adjuster works every item, reading Clive’s recommendation, confidence, and explanation before executing, editing, or dismissing.
- Open every claim waiting for human input.
- Read the recommendation and the explanation, not only the confidence.
- Edit or dismiss anything that does not match the file.
- Note claims blocked more than two days and why.
- Log each dismissed recommendation with a one-line reason.
A team leader’s adjusters work one day of the Cockpit. Most blocked claims are waiting on documents from policyholders, so they send reminders from the queue. Ten dismissed recommendations are logged with reasons for the weekly review.
For one day, work every Cockpit item and log each dismissed recommendation with a reason.
3. Adjuster approves coverage, payments, and messages; QA a sample
What it is: The adjuster reads the policy wording behind every Clive Coverage summary, approves every payment, and reads every drafted reply. The claims QA manager samples files.
- Check each coverage summary against the policy wording, including endorsements and sub-limits.
- Approve every payment by hand.
- Read and edit every drafted reply before it reaches a policyholder or claimant.
- Have the QA manager compare Clive Inspection with a manual audit sample.
- Widen automation one action at a time, with evidence.
On ten new claims, Clive’s coverage summary is right on eight; one misses a newer endorsement and one reads a sub-limit as the full limit. The adjuster corrects both before any letter goes out, and the QA manager’s sample of fifty closed files catches two reserve explanations Clive accepted.
Before any coverage letter, payment, or reply goes out, have the adjuster read the policy wording or file behind it and approve it by name.
Pricing context (October 2026)
This how-to isn’t a price sheet. Per the Five Sigma AI review, Five Sigma does not publish prices. When we checked on Oct 20, 2026, fivesigma.ai/pricing redirected to a demo request. Treat it as quote-only and ask whether Clive agents are priced one by one or as a suite, and whether Conductor and the Cockpit are included. Dated October 2026.
Checked Oct 20, 2026 on the vendor’s own site: Five Sigma publishes no prices; fivesigma.ai/pricing redirected to a demo request on Five Sigma’s site. This page quotes no Five Sigma dollar figure; ask Five Sigma for a written quote and see our review for what is known.
Uncertainty: The only prices this site sells here are the optional $9 AI toolkit spreadsheet and $19 AI toolkit audit.
When this helps (honest take)
Useful when you want AI agents across intake, coverage, liability, and communications, and a named claims operations lead will decide what runs without a person.
Not useful when you only need fraud screening, you want casualty severity signals, or you want payments to run automatically from day one.
Related options (educational)
| Need | Where to look | Why |
|---|---|---|
| Clive agents, Conductor, and Cockpit | Five Sigma AI | Primary path; quote only |
| Casualty medical summaries and reserves | CLARA DocIntel medical summary reserve check | A different job |
| Fraud referral thresholds | FRISS referral thresholds | Related claims job |
| Where claims AI fits | Stack map: insurance ops | Broader map |
FAQ
What is Clive Claim Conductor?
Per our review, a feature unveiled 28 September 2026 that moves a claim forward when a stage is complete, within guardrails the insurer sets.
Can Clive run without an adjuster?
Five Sigma says insurers choose which actions run automatically. Keep coverage positions, payments, and messages with an adjuster.
How much does Five Sigma cost?
Five Sigma does not publish prices. Treat it as quote-only (checked Oct 20, 2026).
Optional next step
If you want a one-page toolkit map for the tools you already pay for, use the optional $9 AI toolkit spreadsheet. If you want a short review of seat waste and unused tools, use the optional $19 AI toolkit audit. Neither is required to follow this how-to.