Every insurer we work with has the same top contact driver: where is my claim. It is usually somewhere between a fifth and a third of all inbound volume, it is almost entirely answerable from data the insurer already holds, and it is nobody’s favourite work.
It is also the best possible first deployment, because success is unambiguous and the failure modes are mild.
Why customers ask five times
The claim moves through a process the customer cannot see. Between “we have your claim” and “we have paid you” there may be six internal states, several of which involve waiting on a third party, and none of which generate an outbound message.
So the customer calls. And because the answer they get is “it’s with the adjuster”, which does not tell them anything about time, they call again next week.
Answer with a date, not a state
Internal status names are meaningless outside the building. “In adjudication” is not an answer; “the adjuster has everything they need and you should hear a decision by Thursday” is.
That means the status answer needs three components:
- What has happened, in plain language.
- What happens next, and roughly when.
- Whether anything is waiting on the customer — this one first, if the answer is yes.
The third is the highest-value part. A meaningful share of stalled claims are stalled on a missing document that the customer does not know is missing.
When status answers began naming the outstanding document, one insurer saw the median time-to-document fall from nine days to two.
Then stop them having to ask
Once status is readable conversationally, the obvious next step is to stop waiting for the question. A notification on each meaningful state change — with the same three components — removes most of the remaining contacts.
Meaningful is doing work in that sentence. Customers do not want to hear about internal handoffs. They want to hear when something changed that affects them, and when something is needed from them.
What to escalate
Anything where the customer disputes the outcome, anything where the claim has been open substantially longer than the norm for its type, and anything where the customer’s tone suggests the process has become distressing. The first two are rules; the third is a judgement the assistant should make generously.
Why it is a good first project
Read-only, high volume, easy to measure, and it fails safely: the worst case is that the assistant says it cannot see the current status and passes to a person, which is exactly what the customer was going to get anyway. Meanwhile it forces the organisation to build the read path into the claims system that every later use case will need.
