AI agent · Insurance · Sort & route
Claim first notification
The first notice of a claim usually arrives incomplete, through whichever channel the policyholder or broker found first. The agent reads it, finds the policy, routes the claim and asks for what is missing while the claimant is still waiting for a reply.
Typical volumes for this process, not a client figure.
Emails and forms arrive in a shared inbox and get sorted by hand.
Sorted, routed, duplicates merged, missing documents requested automatically.
Where the time goes today
First notifications arrive in a shared inbox and through web forms, broker portals and call notes. Some are complete claim forms. Many are a short email with photos attached, a broker forwarding a client's message, or a second email about a loss already reported. A claims handler reads each one, looks up the policy, decides which line of business and team it belongs to, checks for an existing claim and registers it.
Sorting dominates the work. Policy numbers are missing or mistyped, the person writing is not the policyholder, and the same incident is reported by the insured, the broker and a third party. Missing facts, such as the date of loss, the location or an incident reference where one is required, are discovered late, often after the claim has reached an adjuster, who then writes back and waits.
Urgent claims, such as those involving injury, a home that cannot be lived in or a business unable to trade, need attention within hours. In a queue sorted by arrival time, they wait behind routine ones.
How the agent works
- Read the notificationThe agent reads the email, form or call note and its attachments, and extracts the policyholder, policy number, date and place of loss, type of incident, parties involved and any mention of injury.
- Find the policyIt locates the policy using the policy number if given, or name, address, vehicle or property details if not, and checks the policy was in force on the date of loss.
- Merge duplicatesIt compares the notification with open claims on the same policy and incident, and attaches it to the existing claim instead of registering a new one.
- Route by rulesIt applies your routing rules on line of business, claim type, likely severity and urgency signals, and assigns the claim to a team or adjuster with the reason recorded.
- Request what is missingAgainst the document list for that claim type, it identifies what is absent and sends the claimant or broker one request listing everything needed.
What stays with a person
The agent does not decide cover. Where the policy had lapsed, the loss looks outside the insured perils, or the facts suggest possible fraud, it routes the claim to a person with the reason stated; it neither accepts nor declines. Reserves, settlement offers and any statement to the claimant about whether they are covered remain with the adjuster.
Claims involving injury, a vulnerable customer or language suggesting distress go to a person straight away, whatever their routing would otherwise be. Your team defines what counts as an urgency signal and reviews that list as experience builds up.
What it reads, what it produces
| It reads | It produces |
|---|---|
| The claims inbox, web forms and broker submissions | A registered claim with the extracted facts and the policy linked |
| Attachments: photos, repair estimates, incident and police reports | Duplicate notifications attached to the original claim |
| The policy administration system | An assignment to a team or adjuster, with the routing reason |
| Open claims in the claims system | A single request to the claimant or broker listing missing documents |
| Your routing rules and document lists by claim type | A priority flag naming the signal that triggered it |
Controls that come with it
- The agent registers and routes claims; it never makes a cover decision or sends a declinature.
- Notifications it cannot match to a policy with confidence go to a person, not to a default queue.
- Injury, vulnerability and fraud indicators are routed to a person immediately.
- A senior handler checks a daily sample of routing and merge decisions.
- Merges and assignments can be reversed from the claim history, which records who or what made each change.
How you know it works
- Routing accuracy against past claims with known correct assignments
- Time from notification to a registered, assigned claim
- Duplicate claims registered, before and after go-live
- Adjuster requests for missing information after assignment
- Time to first contact on urgent claims
Is your process ready?
- Written rules: routing rules and document lists per claim type exist, and they are the ones handlers actually follow.
- Systems: the policy and claims systems can be queried and updated through an interface, and your vendor licence permits it.
- Cheap check: the adjuster who receives a claim can tell immediately whether it was routed correctly.
- Volume: a thousand or more notifications a week across channels repays the build; a small specialist book may not.
- Consistent process: handlers in different teams agree on what makes a claim urgent.
The five candidacy checks are explained, with an exam, in the free Module 01.
What goes wrong
- Routing rules that exist on paper but are overridden daily by experienced handlers, which the agent then follows too literally.
- Merging two genuinely separate incidents on the same policy because they happened close together.
- Requesting documents the claim type does not need, which irritates claimants and brokers.
- Broker submission formats that change without notice.
Questions we get
Does it handle notifications made by phone?
It works from text. If your call centre records a note or fills a structured form, the agent reads that like any other notification. If calls are recorded and transcribed, the transcript can be the input, with the same checks applied. It does not take calls itself, and the claimant still speaks to a call handler.
How does it decide a claim is urgent?
From signals your team defines: mention of injury, loss of a home, a vehicle that cannot be moved, a business unable to trade, a claimant who says they are struggling. Each signal is a written rule, and the claim record shows which one fired. Your team reviews missed and false signals regularly and adjusts the list.
What happens when a notification matches no policy?
It goes to a person with the searches the agent tried and the near matches it found, such as a similar name at a different address. It is not registered against a best guess. Many of these turn out to be a mistyped policy number or a claim sent to the wrong insurer, which a handler can settle quickly because the searching is already done.
Can it acknowledge the claim to the policyholder?
Yes, using acknowledgement templates your team approves, filled with the claim reference, the assigned team and the documents still needed. It does not tell the claimant whether they are covered or what they will receive. The wording of every template is yours, and changes go through whoever owns customer communications.
Want this agent on your process?
Tell us about your version of this process — volumes, systems, what goes wrong. A person answers with an approach and a price, usually within two working days, or tells you it is the wrong project.