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VoiceOps: FNOL + Claim Status + Policy Q&A (24/7 Voice Automation)

Provide 24/7 voice-first service for First Notice of Loss (FNOL), claim status, and policy Q&A — grounded in approved sources, with sensitive or complex cases routed to humans with full context.

CORE PROMISE
AnswerVerifyCaptureCreate/UpdateHandoff

(Compliance-first, audit-ready)

Best For:
Insurance Carriers
TPAs
Brokers
Claims contact centers
After-hours intake teams

Common pain points we solve

Call volumes spike after accidents, storms, emergencies

Live agents not available 24/7 at scale

IVR menus frustrate callers

Manual FNOL intake is slow and inconsistent

Status calls flood contact centers

Policy questions answered inconsistently

Where this fits

Ideal starting scope for a pilot implementation

Teams Involved

  • Contact center
  • FNOL / Claims intake
  • Adjusters
  • Customer service
  • Compliance / QA

Channels

  • Phone line (public claims number or after-hours queue)

Ideal Pilot Scope

  • 1 line of business (motor / property / health)
  • 3 core intents: FNOL intake, claim status, policy Q&A
  • 1–2 integrations (claims system + CRM/ticketing)
  • Clear escalation rules & disclaimers

Inputs & Outputs

What goes in and what comes out

Inputs

  • Caller speech + keypad input

  • Policy/claim identifiers

  • Approved knowledge sources

    (policy docs, FAQs, regulatory scripts)

  • Optional:

    claims system/CRM data

Outputs

  • FNOL intake record

    (structured fields + summary)

  • Claim status response

    (system-of-record)

  • Policy Q&A response

    (approved-source grounded)

  • SMS/email confirmation

    (optional)

  • Ticket/claim created in platform

  • Escalation package for human

  • Dashboard metrics

    (containment, escalations, SLA impact)

  • Audit logs

    (transcript + actions + data accessed)

What the agent handles (Starter Intents)

FNOL (New Claim Intake)

  • Gather incident type, date/time, location
  • Capture parties involved & damage indicators
  • Capture contact details & callback
  • Create claim + route based on severity/LOB

Claim Status

  • "Is my claim assigned?"
  • "What's next?"
  • "Any documents pending?"
  • Must read from claims system (not model)
  • Optional SMS/email summary

Policy Q&A (Guardrailed)

  • "Do I have roadside assistance?"
  • "What's my deductible?" (only if authenticated)
  • "What documents do you need?"
  • Always cite policy section internally
  • Offer escalation if unclear

The Workflow

Step-by-step automation from intake to tracking

Step 1

Call Received

Incoming call handled after-hours or via primary queue.

Step 2

Consent & Disclosure

Recording consent and privacy notice provided where required.

Step 3

Identify Caller

Verify policy/claim number and caller identity (DOB/ZIP/OTP if needed).

Step 4

Understand Intent

Determine purpose: FNOL, claim status, or policy Q&A.

Step 5

Retrieve & Confirm Details

Fetch claim/policy info from systems and confirm critical fields (dates, location, vehicle/property details).

Step 6

Execute Action

Create claim intake case, update existing claim, or provide requested information/confirmation.

Step 7

Summarize & Route

Log transcript, structured summary, extracted fields, and route/escalate to human adjuster or agent if needed.

What ApexIQ Delivers

Intent set + call flow design

(FNOL, status, policy Q&A)

Compliance-first scripting

(disclosures, disclaimers, escalation language)

RAG knowledge layer

from approved policy docs/FAQs (no hallucinations)

Authentication flow design

tuned to insurance claims language

Integrations

claims system + CRM/ticketing + optional messaging

Action workflows

create intake case, update claim, request missing docs

Guardrails

confidence gating, strict rules for coverage topics

Analytics + monitoring

containment rate, escalation triggers, QA sampling

Handoff design

warm transfer with structured summary to human

Telephony & deployment (practical)

Telephony:Twilio/SIP/call queue integration with your existing provider
Routing:after-hours queue first, then extend to 24/7 or overflow handling
Fallback:"Say 'agent' anytime" + immediate transfer option
Recording:configure per jurisdiction/company policy
Background Overlay

Accuracy & Safety Controls

Built-in safeguards and quality measures

System-of-record priority (claim status only from claims system)

Confidence thresholds (low → escalate)

Answer-only-from-approved-sources (policy Q&A)

Red-flag detection (injury/fraud signals)

No legal/coverage advice & Authentication & role check

Full audit trail & PII masking + secure storage

Honest positioning

Reduces call load and speeds FNOL intake, but complex claims still require humans

AI handles routine volume and prepares clean handoffs.

Pilot Plan (2–4 Weeks)

A proven timeline to get you to production

W1Week 1

Scope + compliance alignment

  • choose LOB + allowed intents
  • define authentication requirements
  • approve policy docs and scripts for RAG & define escalation matrix + disclaimers
W2Week 2

Build call flows + knowledge

  • Implement FNOL data capture fields
  • Integrate policy/FAQ knowledge base
  • Set up telephony in test environment
W3Week 3

Integrate + controlled rollout

  • Connect claims system/CRM (API/export)
  • Run in after-hours or overflow mode
  • Tune based on call outcomes + QA review
W4Week 4

Expand + operationalize

  • Add claim status details and document request automation
  • Publish dashboards + runbooks
  • Establish governance: weekly QA sampling, doc refresh process

Pilot KPI Targets

FNOL capture completeness (required fields captured)
Claim setup time reduction (call → claim created)
Containment rate for routine status/policy queries
Reduction in live-agent volume (after-hours and overflow)
Escalation accuracy (right queue/adjuster) & call drop-off rate improvement
Compliance metrics: scripted disclosures, audit logs completeness

What We Need From You

Client checklist to kick off the pilot

1
Approved scripts/disclaimers + policy/FAQ documents
2
Line of business rules + FNOL required fields checklist
3
Claims system/CRM access method (API/export)
4
Authentication requirements and PII handling policy
5
Escalation matrix + human handoff process
6
QA reviewer + compliance owner for pilot governance

Want 24/7 FNOL intake and claim status coverage — without exploding call-center costs?

Book a consultation or request an assessment—we'll recommend the best first workflow to pilot.