PR-01Active
Conversational Agent
Conducts claim intake interview, asks discovery questions, collects supporting information
Intake claims across voice, chat, and document upload. Extract loss details, verify policy coverage, assess damage estimates, and route to adjusters — with fraud signal detection.
Insurance companies receive thousands of claims daily via forms, email, phone, and portals. Claim intake data is incomplete or inconsistent. Adjudicators manually review files, verify coverage, apply underwriting rules, and compute benefits—a slow, error-prone process. Denials are often appealed due to perceived unfairness. Fraud detection relies on manual flags and historical patterns. Policyholders expect instant decisions but typically wait 5-7 business days.
assistents claims agent collects claim information from policyholders via voice, chat, or online form, asking discovery questions to understand the loss or service request. The agent verifies coverage in real time, applies policy terms and underwriting rules, and computes benefits automatically. Document AI extracts supporting documents (medical records, repair estimates, police reports). Fraud risk is scored. Low-risk claims are auto-approved; complex cases escalate with full context. Real-time communication keeps claimants informed.
Conducts claim intake interview, asks discovery questions, collects supporting information
Analyzes supporting documents (medical, repair estimates, receipts), extracts claim-relevant data
Verifies coverage, applies underwriting rules, computes benefits, flags for escalation or approval
Claimant initiates claim via portal, phone, or form. Agent greets and begins intake interview.
Agent asks about loss/service, dates, involved parties, and damage or service details.
Agent requests supporting documents (medical records, repair estimates, receipts). Tracks submission.
Agent confirms policy is active, applies terms and exclusions, checks for coverage gaps.
Low-risk claims are auto-approved; claimant receives check or authorization. Complex claims escalate.
5 steps deploy to production in weeks
Schedule a personalized demo to see how assistents’s AI agents can solve this challenge for your organization.