Insurance
A claim is when your customer finds out whether the policy was real.
Insurance has two moments that decide whether a customer stays: the renewal they forget, and the claim they dread. Both are mostly document logistics wearing a suit. An agent handles the logistics on WhatsApp and stops dead at anything resembling a coverage decision.
The problem
Claim intake is a chase. Something has gone wrong for the customer, they are anxious, and your team asks for an FIR copy, then the bills, then a discharge summary, then a clearer photograph of the same bill — each one a phone call or an email into silence. Every extra day the file stays incomplete is a day the customer decides your product does not work. Renewals fail the opposite way: nothing dramatic happens at all. A premium notice goes out by post or SMS, nobody reads it, the policy lapses quietly, and the customer is uninsured until they discover it at the worst possible moment. Both problems are the same shape — a deadline, a document set, and no channel the customer actually checks. Meanwhile your licensed staff spend their week answering whether maternity is covered under a plan whose wording already says so.
What the agent does
Takes claim intake without the chase. It knows which documents a given claim type needs, asks for them one at a time, checks each arrival is legible and looks like the right document, and keeps following up on what is missing — without anyone remembering to.
Answers from your actual policy wordings. Coverage questions, waiting periods, exclusions, sum insured, what a rider includes — quoted from your own approved wordings rather than a general summary. If the wording does not answer it, the agent does not either.
Chases renewals before they lapse, not after. A reminder that arrives on the channel the customer reads, at a sensible interval before the due date, with the payment link in the same conversation. Lapse recovery is far harder than lapse prevention.
Never decides a claim. It collects, it acknowledges, it tells the customer what happens next and by when. Whether something is payable is a licensed decision and it goes to a licensed person, with the complete file attached.
What it plugs into
You keep the software you already run. The agent reads from and writes into it.
- Your policy administration system, so renewal dates and policy details are real
- Claims intake and document storage, so the file lands where your assessors already work
- Your approved policy wordings and product material — the only source it may quote
- Premium payment links, so a renewal can complete inside the conversation
How you know it’s working
Renewals completed before the lapse date
We agree that number before we build, measure it for the month before go-live, and report against it every month after. If it doesn’t move, the build was wrong and we say so.
When it hands over. Any question about whether a claim is payable, any coverage interpretation in a disputed case, any settlement amount, any grievance, and anything advice-shaped about which policy to buy. The agent's job ends at a complete file and an accurate quotation of your own wording — every judgement call is a licensed human's.
Same engine, other trades
Retail & D2C
Orders taken outside business hours
Real estate
Time to first reply on a new lead
Financial services
Applications that reach a complete document file without a staff call
Healthcare & clinics
Calls the front desk did not have to take
Education & coaching
Admission enquiries answered within a minute
Logistics & distribution
Status enquiries handled without a human
Manufacturing & distribution
Dealer orders placed without a phone call
More on what we build for insurance, or how we scope and run a WhatsApp agent build.
Tell us what’s slow.
Describe the job eating your team’s day. We’ll tell you straight whether an agent is the right fix — and if it isn’t, we’ll say so.
Frequently asked questions
- Can it tell a customer whether they are covered?
- It can read them what the policy wording says, which is often what they actually wanted. It cannot tell them whether a specific claim will be paid, and it is built to refuse that rather than attempt a careful answer. The distinction matters because a customer who is wrongly told they are covered makes decisions on it — proceeding with a treatment, declining another option — and the harm from that is real. Anything requiring judgement about their situation goes to a licensed person.
- What actually happens when someone reports a claim on WhatsApp?
- It acknowledges immediately, which matters more than people expect to someone who has just had an accident or a hospitalisation. Then it identifies the claim type, asks for the required documents one at a time rather than as a wall of text, checks each one is legible and appears to be the right document, and tells the customer what happens next and roughly when. The complete file goes to your assessor. At no point does it indicate an outcome.
- How do you send renewal reminders without becoming spam?
- By sending few and making each one useful. A reminder with the policy number, the due date and a working payment link is worth reading; four generic nudges are not, and they train the customer to ignore you. Message templates are also charged per send and WhatsApp penalises businesses people block, so the platform economics happen to align with restraint here. We set the schedule with you rather than defaulting to the maximum.
- Can it read our own policy wordings, not a generic summary?
- That is the point of grounding it. The agent answers from the documents you give it — your wordings, your product sheets, your riders — so a customer on an older variant gets that variant's terms rather than the current brochure's. Where the wording is genuinely ambiguous, it says the wording is unclear and routes to a person, which is the honest behaviour and also the one your compliance team will want.
- Does this work for a broker or agency, not just an insurer?
- Yes, and the renewal case is often stronger for a broker, because a lapsed policy is lost commission on a customer you already acquired. The difference is that a broker carries products from several insurers, so the agent has to identify which policy a customer holds before it quotes anything — otherwise it answers from the wrong wording. That identification step is the part we scope carefully.
- What about customers who are distressed or angry?
- It hands over quickly rather than trying to manage them. Detecting frustration and escalating is straightforward to build; being the right thing to talk to when someone has had a hospitalisation or a total loss is not. A claim is the least appropriate moment in the whole industry for software to insist on handling the conversation, so the agent is deliberately eager to step aside.