Customer Communication & Status Update Agent
Keeps claimants informed in real time about their claim status, pending actions, and key milestones
Description
Challenge Claimants are often left in the dark after submitting a claim, leading to repeated calls, confusion over next steps, and delays due to missing documents. Without a consistent update mechanism, operations teams struggle to manage customer expectations while dealing with manual follow-ups. This agent solves that by delivering proactive, real-time updates across the claim journey—ensuring that every customer knows exactly what’s happening and what’s expected from them.
How It Works The agent continuously monitors the claims workflow engine for changes in status, SLA timers, or document requirements. Whenever a trigger is detected—like claim movement, document pending status, or escalation flags—it sends contextual messages to the claimant through their preferred channel. These updates are customized by claim type, urgency, and language, and always include actionable next steps. Whether it's an acknowledgement, a document reminder, or final outcome, the communication is timely, relevant, and logged for full traceability.
Benefits
Increases on-time document submission by up to 60%
Cuts inbound status enquiry calls by over 80%
Helps reduce claim abandonment by up to 35%
Delivers updates in under 5 seconds via SMS, email, push, or WhatsApp
Creates a full audit trail of every message sent
Features
This agent automates two-way communication between the claims engine and the claimant. It tracks the workflow stages, identifies what the customer needs to know, and instantly pushes personalized messages across channels. Templates are aligned with policy, urgency, language, and claim type.
Features & Capabilities:
Real-Time Claim Status Updates: Alerts claimants at every key stage (submitted, under review, approved, rejected)
Document Upload Reminders: Sends checklist-driven nudges for pending documents with direct upload links
SLA Escalation Alerts: Triggers reminders if timelines are breached or claim is idle too long
Language-Specific Templates: Delivers messages in the claimant’s preferred language
Omnichannel Delivery Engine: Sends via SMS, email, app push, or WhatsApp based on preference
Consent & Frequency Controls: Respects DND flags and avoids message spamming
Delivery & Engagement Logs: Tracks opens, clicks, delivery failures for every message
Template Repository Integration: Dynamically pulls communication templates by claim type, urgency, and region
Audit Logging: Stores all sent messages with metadata for compliance
Integration with Document Queue: Monitors what’s submitted and what’s missing in real time
Eligibility Logic
Decision Logic Flow:
The agent listens for workflow triggers and pending actions. Based on status changes, it pulls the right message template and sends it through the claimant’s preferred channel. Logic pathways are used to prioritize urgency, personalize language, and throttle communication volumes.
Key Logic Pathways Followed:
Trigger on Status Change: → Every status update sends a matching message unless muted by admin rule.
Document Reminder Rule: → If documents remain pending for over 48 hours, auto-send checklist reminder with upload link.
Preferred Channel Rule: → Respect claimant’s selected channel. Use fallback (email/SMS) if unavailable.
Escalation Notification Rule: → If claim remains idle > 3 days, alert both internal handler and claimant.
Language Personalization Rule: → Deliver updates in claimant’s language; use fallback if not available.
Throttle & Consent Check: → Cap non-urgent communication at 2 per day; skip if DND or consent not given.
