Claim Status Communicator Agent
Real-time multi-channel claim updates for better transparency
Description
Challenge:
Claimants and stakeholders often face uncertainty due to delayed updates or unclear communication during the claim lifecycle. Manual status updates are slow, inconsistent, and increase inbound support requests, impacting customer satisfaction and operational efficiency.
How It Works:
The Claim Status Communicator Agent continuously pulls live claim data, maps system-level updates to clear, customer-friendly messages, and sends notifications at key milestones—from FNOL acknowledgment to final payout. It supports multi-channel delivery via SMS, email, app push, or portal, highlights pending requirements, and provides dashboards for internal agents. All communications are logged for compliance and audit purposes.
Benefits:
Reduces inbound “status check” calls by 50–60%
Increases on-time document submissions by 80–90% through proactive alerts
Delivers notifications in under 2 minutes from system update
Maintains 95%+ delivery success across channels
Improves customer trust and satisfaction with transparent updates
Ensures regulatory compliance with communication timelines
Features
This agent keeps claimants, adjusters, and stakeholders informed with accurate, timely, and auditable claim updates, enhancing transparency and process efficiency.
Features & Capabilities:
Status Intake: Pulls real-time claim updates from management systems
Mapping: Translates technical status codes into milestone-based, customer-friendly messages
Message Generation: Creates clear, understandable notifications
Requirement Alerts: Flags missing documents or pending actions
Channel Routing: Delivers messages via SMS, email, app push, or chatbots
Dashboard Updates: Provides internal agents and adjusters with live claim status views
Audit Logging: Records all communication events for compliance tracking
Escalation Handling: Routes notifications to call centers if automated delivery fails
Operating Blueprint
Knowledge Sources:
Claims Lifecycle Workflow Repository
Communication Templates and Messaging Library
SLA & Milestone Tracking Data
Customer Contact Preferences
Regulatory Guidelines for Claim Communication
Business Rules:
Notify claimants within defined time of status changes
Escalate failed notifications after multiple attempts
Deliver messages via preferred channels, fallback if unavailable
Include pending requirements where relevant
Avoid redundant notifications within short intervals
Retain all communication logs for regulatory periods
Tool Workflow:
Status Intake: Fetch updates from claims management system
Mapping: Translate technical codes to milestones (e.g., “under review,” “approved”)
Message Generation: Convert into customer-friendly text
Requirement Check: Identify missing documents or steps
Channel Routing: Send via SMS, email, app, or chatbot
Dashboard Update: Display progress internally
Audit Logging: Capture all communications for compliance
Badges
Classification
Capabilities
