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AI workforce orchestration · Use case

Prepare a clearer first notice of loss for your handlers

AI-assisted FNOL that gathers claim details, flags urgency for review, prepares evidence and proposes routing while handlers retain coverage, liability and settlement.

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An AI specialist and human owner coordinate a business request and its next action.
AI roles · Connected work · Your people
WHAT STARTS THE WORK

A customer reports a loss and the handler needs the available facts.

AI AGENTSWORKFLOW STEPSHUMAN DECISIONS4 roles, defined access6 stages, each with an owner1 decision owner1Identify policyPolicy verification worker2Capture the eventIntake worker3ClassifyTriage worker4Collect evidenceEvidence worker5RouteTriage worker6Keep informedIntake workerIntake workerPolicy verification workerEvidence workerTriage workerClaims handlerCONTROLS AROUND EVERY STAGE4 operating rules · 4 decision rules · 4 channels · records to verify

AI agents

  • Intake worker
  • Policy verification worker
  • Evidence worker
  • Triage worker

Human decisions

  • Claims handler

Workflow steps

  1. Identify policyPolicy verification worker
  2. Capture the eventIntake worker
  3. ClassifyTriage worker
  4. Collect evidenceEvidence worker
  5. RouteTriage worker
  6. Keep informedIntake worker

4 operating rules · 4 decision rules · 4 channels · records to verify

Illustrative design. Systems, permissions, human coverage and outcomes must be configured and validated for your deployment.
THE RESULT TO CHECK

An intake record and missing-information list for the licensed handler. Coverage, liability and settlement remain human decisions.

On this page

The operating problem

Incomplete first notice creates callbacks and repeated explanations, while missing evidence slows a handler's review. This blueprint helps gather the reported event, prepare a structured file and record a proposed route for review; your claims handler owns coverage and liability decisions.

  • Claimants repeat distressing details at each handoff because intake is not structured or shared.
  • Missing first-notice details can leave handlers chasing documents before they can decide the next step.
  • Peak events can stretch intake and handler availability; identify what the team can review before adding volume.

Example: a damaged parked vehicle

A fictional intake example to discuss with your claims team. It illustrates the proposed information flow, not a live product run, an emergency response or a coverage decision.

01

Gather the reported facts

The claimant reports finding damage to a parked vehicle. The proposed intake records their account, the reported time and location, and a policy reference. Information from the policy system is shown for handler review; a match does not establish cover.

02

Make missing information visible

The agreed checklist asks for photos of the damage. The prepared brief separates supplied details from documents still needed and suggests a motor-claims queue with its supporting information. It does not infer who is liable.

03

Confirm the handoff

The next step is to check that the claims system saved the intake and that a handler accepted it. A failed save or unanswered request stays pending for staff follow-up. Coverage, liability, reserves and settlement remain with the responsible handler.

Who handles the work

Example division of work between AI workers and your team.

AI worker

Intake worker

Uses agreed first-notice questions on the selected channel and in the selected language, recording what the claimant reports for handler review.

  • Event narrative capture
  • Uses approved intake guidance; coverage and liability questions remain with the handler
AI worker

Policy verification worker

Checks available policy data for a caller and date of loss, sending uncertain matches to human review.

  • Available policy details and uncertain matches
  • Reads available policy data; uncertain matches remain for human review
AI worker

Evidence worker

Prepares requests from the approved claim-type checklist and tracks supplied and missing documents for staff review.

  • Requested, received and missing evidence
  • Prepares approved evidence requests and records what remains outstanding
AI worker

Triage worker

Prepares a claim-type, severity and urgency recommendation with the available supporting signals.

  • Routing recommendation
  • Suggest only — routing is a recommendation with a rationale
Human owner

Claims handler

Reviews the prepared file and owns coverage, liability, reserving, settlement and fraud decisions.

  • Coverage, liability, reserving, settlement and fraud decisions
  • Full authority

How the work could flow

Use this sequence to agree the workflow and test each step before launch.

01Policy verification worker

Identify policy

Which available policy record matches the reported details, and what still needs a handler to check?

02Intake worker

Capture the event

Is anyone injured or at risk, or is urgent mitigation needed right now?

03Triage worker

Classify

What claim type and severity band does this fall into, and on what evidence?

04Evidence worker

Collect evidence

Which documents does this specific claim type require, and what is still outstanding?

05Triage worker

Route

Has the claims system saved the intake, and has the proposed handler accepted it? Keep failed saves and unanswered requests pending for staff follow-up.

06Intake worker

Keep informed

Is there a current, approved status update to share, and did the selected channel confirm delivery?

Decisions your team keeps

Proposed operating requirements to configure and verify, including what happens when a system or human handoff is unavailable.

  • Configure identified injury, emergency and safety concerns to stop routine intake and request the agreed human response; test recognition, acceptance and fallback handling.
  • Keep coverage statements out of worker outputs and test how coverage questions are routed to the claims handler.
  • Keep triage as a recommendation for handler review. Check that its supporting information is available and that staff can correct the proposed route.
  • Route potential fraud indicators for specialist review under the team's approved handling process; test visibility and claimant-facing behavior.
  • Coverage, liability, reserving and settlement decisions remain with a named claims handler.
  • Configure least-privilege access for sensitive personal and medical details, then test who can view, export and correct them.
  • Require routing recommendations to show the available supporting signals, then test what a handler can review and correct.
  • Configure emergency and safety handling to stop routine intake and follow the agreed priority human path; verify the fallback when no handler is available.

Systems & channels

Systems to connect

Scope these around the selected implementation.

  • Policy administration system
  • Claims management platform
  • Document & media store
  • CRM

Channels to evaluate

Select and validate the required provider pathways.

  • Voice
  • Web chat
  • WhatsApp
  • Email

What to measure

Pilot measurement definitions, not claimed customer results.

Fields captured on contact one

First-notice completeness

Measure how much of the required intake structure is available for handler review and track follow-up requests and missing fields.

Saved intake to handler acceptance

Time to accepted handoff

Track time from a saved intake to handler acceptance, plus failed saves, unanswered requests and corrected routes.

Rationale per claim

Explainable routing

Review whether routing suggestions retain the required supporting information, so a handler can understand and correct the proposed route.

A bounded rollout

01Stage 1

One claim type, one channel

Choose one repeatable claim type and one channel. Record current missing fields and follow-up requests, then have handlers review prepared test files within the team’s capacity.

02Stage 2

Add evidence chase and triage

Test evidence requests, saved intake records and handler acceptance. Include missing documents, failed saves and unavailable handlers before enabling the agreed actions.

03Stage 3

Review outcomes before expanding

Compare missing fields, repeated contacts, corrected routes and accepted handoffs with the baseline. Test the required volume and staff capacity again before adding a claim type or channel.

Questions about this workflow

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