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AI agent for insurance claims processors

Claim Intake Completeness Agent

Complete claim files within days of first notice

Document handlingAdministrationOperationsInsurance
See how it worksGet access
Claim Intake Completeness Agent: what goes in, what the agent does and what you get

What it does

Many claims stall in the first week because the file is incomplete, and claimants get frustrated by several separate requests. When a claim is opened, this agent identifies the claim type and lists the required documents, such as photos, police report, repair estimate, medical bills or proof of ownership. It reads what has arrived to confirm each document is the right one and legible. Illegible documents count as missing. It drafts one clear request listing everything missing, which the processor approves before sending. When new documents arrive, it checks again. If something is still missing after the reminder period, it drafts a second request. A claim reported after the policy's notice period is flagged for the adjuster. Once complete, it routes the file to the adjuster. Edge case: a document for a different vehicle or address is rejected even when it looks complete.

How it works

Follow the arrows from top to bottom. The orange dashed arrow is the loop: when a check fails, the agent goes back and tries again.

Start and resultWhat it doesA check on its own workWaits for your OKGoes back and retries
Yes, continueYes, continueApprovedNoNo 1 STARTS WHEN Claim opened 2 DOES Identify claim type and required documents 3 CHECKS THE RESULT Was the claim reported within the notice period? If not: flag late notice for the adjuster and continue.Back to step 2. 4 USES A TOOL Read uploaded documents 5 CHECKS THE RESULT Is every required document present, legible andmatching the claim? If not: draft one request listing all missing items.Back to step 4. 6 YOU APPROVE Processor approves claimant messages 7 DOES Send a second request after the reminder period ifstill incomplete 8 DOES Mark file complete and route to the adjuster 9 RESULT Complete claim file
Read the steps as a list
  1. Claim opened
  2. Identify claim type and required documents
  3. Was the claim reported within the notice period?If not: flag late notice for the adjuster and continue. Back to step 2.
  4. Read uploaded documents
  5. Is every required document present, legible and matching the claim?If not: draft one request listing all missing items. Back to step 4.
  6. Processor approves claimant messagesThe agent waits here for your OK.
  7. Send a second request after the reminder period if still incomplete
  8. Mark file complete and route to the adjuster
  9. Complete claim file

How it decides

Each claim type has a required list; a document only counts if it is legible and matches the claim.

  • One request listing everything missing
  • Illegible documents count as missing
  • Late notice is flagged

Make it yours

Every agent is a starting point. You choose these settings for your own situation.

  • Required lists by claim type
  • Reminder period
  • Message templates
  • Routing rules

What keeps you in control

It always asks you first

  • Messages to claimants

Hard limits

  • Never makes coverage decisions
  • Never contacts claimants without approval

It stops when

  • Done: file complete
  • Stop: claimant unresponsive after two requests, notify the adjuster

Set it up

We guide you through the set-up, step by step

Members get the full set-up guide for this agent. No technical skills needed: you copy, paste and upload.

10 minto set it up in your AI
5 AIsChatGPT, Claude, Copilot, Gemini, Grok
  • One set of instructions to paste into your AI, with the clicks for ChatGPT, Claude, Microsoft 365 Copilot, Gemini and Grok
  • The agent then walks you through connecting your own data, one source at a time
  • A downloadable copy with the flow chart, the rules and the full guide
Get access to this agent

An example run

What happensA car damage claim opened on June 2 had photos and a police reference, but the completeness check failed: the repair estimate was blurry and proof of ownership was missing. The agent drafted one request for both, and the processor approved it. Both arrived on June 5. The recheck passed, and the file went to the adjuster on day 4.

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