Understanding the challenge
When a policyholder has a claim, every hour of silence erodes trust, and the insurer was losing hours it did not have. First notice of loss came in by phone and email at all hours, routine service questions about coverage, billing, and documents flooded the same queue, and reps spent their days on repetitive requests while genuine claims waited. "A customer whose basement just flooded should not sit in a hold queue," the insurer's VP of operations said. A basic chatbot had annoyed customers, the claims and service systems did not talk to the CRM, and reps re-keyed information across screens, so the insurer's biggest differentiator, service, was the thing straining most.
Our approach
The insurer did not need a chatbot standing between customers and help. It needed agents that handle the routine load and get real claims to a human fast, wired into the systems reps already used. We combined three of our services:
• AI agents at the core: a claims and service agent that takes first notice of loss, answers routine coverage, billing, and document questions, and hands anything requiring adjudication or judgment straight to a licensed adjuster.
• Workflow automation for claims intake: capturing the details, routing each claim to the right adjuster, and triggering the next steps so nothing sits in a queue.
• A Salesforce integration so the agent and the automations work from one live policyholder record and every interaction is logged, not re-keyed.
• Human approval and clear boundaries, so the agent handles service and intake while people own every claims decision.
Technical innovation
The agent takes action rather than deflecting: it opens the claim, collects the details, and answers approved service questions from the insurer's own policy information, escalating anything that touches adjudication to a licensed adjuster the moment it arises. The workflow layer routes each claim to the right person and keeps the claims, service, and Salesforce records in sync automatically, and because the agent draws only from approved sources, policyholders never get an invented answer about their coverage. Every step stays inside the boundaries the insurer set.
Outcome
First-response time on new claims and inquiries fell by 40%, so a policyholder in trouble reached help fast instead of sitting on hold, and adjusters spent their time on real claims instead of routine questions. Intake flowed straight to the right adjuster, every interaction synced to Salesforce, and the insurer strengthened the service reputation it competes on. "Our customers get answers right away now, and my adjusters focus on the claims that need a human," the VP of operations said.
