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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