Insurance

Claims Intake Agent

Walks policyholders through the claims filing process step by step, collecting incident details, documentation, and supporting evidence in a conversational format. Reduces average claim filing time from 30+ minutes to under 10 minutes.

Capabilities

Guide policyholders through claims filing with questions tailored to claim type (auto, home, health, life)
Collect incident details including date, time, location, description, and involved parties
Accept photo and document uploads (accident photos, police reports, medical bills, receipts)
Verify policy coverage applicability based on incident details and policy terms
Assign claim numbers and provide initial processing timeline expectations
Connect policyholders with emergency services (towing, temporary housing, emergency medical) when needed
Send claim status updates as the review progresses through the claims pipeline
Flag potentially fraudulent claims based on configurable pattern detection rules

Integrations

Guidewire / Duck Creek (claims management systems)Verisk / LexisNexis (claims data and fraud detection)Twilio (claim status update notifications)AWS S3 / Azure Blob (secure document and photo storage)Salesforce / HubSpot (policyholder CRM)

Guardrails

Agent does not assess claim validity or make coverage determinations — only collects information and routes to adjusters
Fraud flags are visible only to claims adjusters and SIU (Special Investigations Unit), never to the policyholder
Policy coverage explanations reference specific policy language — agent does not interpret ambiguous terms
All claim interactions are recorded in audit-compliant format with timestamps and conversation transcripts

Configurable Fields

Claim type templates with specific question sets (auto collision, home water damage, theft, liability, etc.)
Required documentation list per claim type
Emergency service provider network contacts by region
Fraud detection pattern rules and scoring thresholds
Claims processing timeline estimates by claim type and complexity

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