Seamless, AI-Driven Claims Processing
Claims management and processing are taxing procedures for both insurers and policyholders. The need for conversational, AI-powered intervention has never been so evident.
Our RPA-enabled Claims Processing Bots handle end-to-end insurance claims with self-serve options for policyholders to submit paperwork. Once processed, the claim is ready for an agent to finalize.
The same three nodes, drawn out in full
Submit paperwork, processed, agent to finalize — that is the shape of every claim. Between those three nodes a real claim moves through five states, and the bot owns four of them. The one marked in solid ink is the one that still belongs to a person.
- Bot-owned states
- 04
- Human-owned states
- 01
- Settlement decisions by bot
- 00
- FNOLBot · 00:00
First notice of loss
The bot answers, confirms policy number and date of loss, and opens a claim reference before the caller hangs up.
rail node 01 · submit paperwork
- DOCSBot · + 3 min
Document capture
A WhatsApp thread carries the checklist. Each upload is acknowledged by name, and the bot calls back for anything still missing.
rail node 01 · submit paperwork
- TRIAGEBot · + 12 min
Triage & validation
Coverage, policy status and duplicate checks run against the core system. Clean claims route to fast-track; flagged ones route to investigation.
rail node 02 · processed
- ADJUSTHuman · + 1 day
Adjuster review
The adjuster opens a claim that is already complete — documents attached, fields populated, exceptions annotated.
rail node 03 · agent to finalize
- SETTLEBot · + 4 days
Settlement & follow-up
The bot confirms the payout figure, reads back the bank account on file, and calls again once the transfer lands.
rail node 03 · agent to finalize
“Where is my claim?”
It is the single most common call a claims line takes, and the least rewarding one for an agent to answer. The bot answers it from the live claim state — and uses the call to unblock whatever is holding the claim up.
Abridged transcript · caller verified on the registered mobile
- BOTVocallabs claims line. May I have your claim reference, or the mobile number on the policy?
- CALLERI don’t have the reference. It’s the car claim, from last Tuesday.
- SYSTEMlookup · mobile ending 4417 → 1 open claim · MTR-88213 · state TRIAGE
- BOTFound it — motor claim MTR-88213, registered Tuesday the ninth. Where is my claim: it cleared document check this morning and is with validation now.
- CALLERSo what’s left? Do you need anything from me?
- BOTOne item. The repair estimate from the garage came through unsigned. If you send the signed copy, the claim moves to an adjuster today instead of Thursday.
- CALLERSend me the link and I’ll do it now.
- SYSTEMsms + whatsapp dispatched · upload slot: ESTIMATE_SIGNED · claim held at TRIAGE
- BOTSent to the number you’re calling from. Once it uploads I’ll text you the adjuster’s name, and I’ll call you when the settlement figure is approved.
What it does to cycle time
Claims rarely stall in the adjuster’s queue. They stall waiting for a document nobody chased, or a caller who could not get an answer. Measured on one insurer’s motor book, over the first ninety days:
| Measure | Before | With the bot | Why |
|---|---|---|---|
| Time to register a claim | 2 days | 4 min | FNOL captured on the first call |
| Document chase cycles | 3.4 | 1.1 | Checklist acknowledged per item |
| Claims complete at adjuster | 41% | 94% | Nothing routes half-filled |
| Average settlement cycle | 19 days | 6 days | Fast-track on clean claims |
| “Where is my claim” calls to agents | 100% | 12% | Status answered by voice, any hour |
68%
Cut in settlement cycle
94%
Claims complete at adjuster
24/7
Status answered by voice
The paperwork, chased item by item
Self-serve only works if the policyholder knows exactly what is missing. The bot holds an open checklist against the claim, names each item as it arrives, and calls back about the ones that have not.
- Policy number or registered mobileRead back digit by digit and confirmed against the core system
- Date, time and place of lossCaptured in speech, normalised to the claim record
- Photographs of the damageWhatsApp upload, count acknowledged aloud on the next call
- FIR or incident report, where applicableFlagged mandatory for theft and third-party motor claims
- Repair estimate or hospital billChecked for signature and totals before it is accepted
- Bank account for the payoutRead back in full and re-confirmed before settlement
What sits between a claim and a payout
Speed is only worth having if it does not widen the leakage. Verification and fraud-detection run on every claim the bot touches, and the decision itself never leaves your team.
- Caller verification
- Policy number, date of birth and the registered mobile must agree before any claim detail is spoken aloud.
- Duplicate detection
- The same loss event filed twice — across channels or across policies — is held and surfaced to a reviewer.
- Velocity flags
- Unusual claim frequency on a policy, or a burst from one garage or clinic, marks the claim for investigation.
- Document integrity
- Uploads are checked for edits, mismatched dates and totals that do not reconcile with the stated loss.
- No autonomous payout
- The bot never approves a settlement. It prepares, confirms and follows up; a human adjuster signs.
- Full call record
- Recording, transcript, uploads and state changes are written to the claim file for audit and regulatory review.
Books it is running on
- 01
Motor
Own-damage and third-party. Registration, garage, estimate and survey dates collected on the first call; cashless network garages confirmed by voice.
FNOL · SURVEY · ESTIMATE · SETTLE
- 02
Health
Cashless pre-authorisation and reimbursement. The bot chases discharge summaries and bills, and reads the approved amount back before the hospital is paid.
PRE-AUTH · BILLS · QUERY · SETTLE
- 03
Property
Fire, flood and burglary on home and shop policies. Loss photographs, the incident report and the surveyor visit are all scheduled from one conversation.
FNOL · SURVEY · REPORT · SETTLE
