AI Claims Triage Agent
Route every claim instantly and accurately
Route every claim instantly and accurately
V7 Go’s agent automates the first step of the claims lifecycle. Delegate the task of reviewing new claim notices, and the agent will classify, prioritize, and route them to the correct handler based on expert-designed rules.
Why V7 Go
Why V7 Go
Automated FNOL Ingestion
The agent monitors and processes new claims from any channel, including email inboxes, customer portals, or system APIs. It extracts key data from any FNOL format, structured or unstructured.
Automated FNOL Ingestion
The agent monitors and processes new claims from any channel, including email inboxes, customer portals, or system APIs. It extracts key data from any FNOL format, structured or unstructured.
Automated FNOL Ingestion
The agent monitors and processes new claims from any channel, including email inboxes, customer portals, or system APIs. It extracts key data from any FNOL format, structured or unstructured.
Severity and Complexity Scoring
Using a workflow guided by rules from senior adjusters, the agent analyzes the initial claim details to assign a severity and complexity score, distinguishing minor incidents from major potential losses.
Severity and Complexity Scoring
Using a workflow guided by rules from senior adjusters, the agent analyzes the initial claim details to assign a severity and complexity score, distinguishing minor incidents from major potential losses.
Severity and Complexity Scoring
Using a workflow guided by rules from senior adjusters, the agent analyzes the initial claim details to assign a severity and complexity score, distinguishing minor incidents from major potential losses.
Intelligent Claim Routing
Automatically route claims to the appropriate handling team. Simple, low-value claims can go to a fast-track unit, while complex commercial claims are escalated to senior adjusters, and potential fraud cases are sent to SIU.
Intelligent Claim Routing
Automatically route claims to the appropriate handling team. Simple, low-value claims can go to a fast-track unit, while complex commercial claims are escalated to senior adjusters, and potential fraud cases are sent to SIU.
Intelligent Claim Routing
Automatically route claims to the appropriate handling team. Simple, low-value claims can go to a fast-track unit, while complex commercial claims are escalated to senior adjusters, and potential fraud cases are sent to SIU.
Fast-Track Identification
Identify straightforward, low-cost claims that are ideal candidates for 'touchless' or fast-track processing. This accelerates settlement for the majority of claims and improves customer satisfaction.
Fast-Track Identification
Identify straightforward, low-cost claims that are ideal candidates for 'touchless' or fast-track processing. This accelerates settlement for the majority of claims and improves customer satisfaction.
Fast-Track Identification
Identify straightforward, low-cost claims that are ideal candidates for 'touchless' or fast-track processing. This accelerates settlement for the majority of claims and improves customer satisfaction.
Data Completeness Check
The agent verifies if the FNOL contains all the necessary initial information. If data is missing (e.g., policy number, date of loss), it can trigger an automated request to the sender or flag the file for an intake specialist.
Data Completeness Check
The agent verifies if the FNOL contains all the necessary initial information. If data is missing (e.g., policy number, date of loss), it can trigger an automated request to the sender or flag the file for an intake specialist.
Data Completeness Check
The agent verifies if the FNOL contains all the necessary initial information. If data is missing (e.g., policy number, date of loss), it can trigger an automated request to the sender or flag the file for an intake specialist.
Specialized Team Escalation
The agent is configured to recognize key terms that require specialist involvement. Mentions of litigation, specific injury types, or large-scale property damage can automatically trigger an escalation to the legal team or a dedicated expert.
Specialized Team Escalation
The agent is configured to recognize key terms that require specialist involvement. Mentions of litigation, specific injury types, or large-scale property damage can automatically trigger an escalation to the legal team or a dedicated expert.
Specialized Team Escalation
The agent is configured to recognize key terms that require specialist involvement. Mentions of litigation, specific injury types, or large-scale property damage can automatically trigger an escalation to the legal team or a dedicated expert.
Why V7 Go
Read FNOL forms, incident reports, and email notifications.
Extract policy data, incident details, and severity keywords.
Workflow
Workflow
Import your files
Guidewire
,
Duck Creek Claims
,
Salesforce
First Notice of Loss (FNOL) Forms
First Notice of Loss (FNOL) Forms
First Notice of Loss (FNOL) Forms
First Notice of Loss (FNOL) Forms
Email Claim Notifications
Email Claim Notifications
Email Claim Notifications
Email Claim Notifications
ACORD Forms
ACORD Forms
ACORD Forms
ACORD Forms
Police & Incident Reports
Police & Incident Reports
Police & Incident Reports
Police & Incident Reports
Customer Portal Submissions
Customer Portal Submissions
Customer Portal Submissions
Customer Portal Submissions
Voicemail Transcripts
Voicemail Transcripts
Voicemail Transcripts
Voicemail Transcripts
Policyholder & Claimant Information
Policyholder & Claimant Information
Policyholder & Claimant Information
Policyholder & Claimant Information
Policy Number and Type
Policy Number and Type
Policy Number and Type
Policy Number and Type
Date, Time, and Location of Loss
Date, Time, and Location of Loss
Date, Time, and Location of Loss
Date, Time, and Location of Loss
Brief Description of Incident
Brief Description of Incident
Brief Description of Incident
Brief Description of Incident
Keywords Indicating Severity (e.g., 'Injury', 'Fire')
Keywords Indicating Severity (e.g., 'Injury', 'Fire')
Keywords Indicating Severity (e.g., 'Injury', 'Fire')
Keywords Indicating Severity (e.g., 'Injury', 'Fire')
Keywords Indicating Fraud Potential
Keywords Indicating Fraud Potential
Keywords Indicating Fraud Potential
Keywords Indicating Fraud Potential
Estimated Loss Amount (if provided)
Estimated Loss Amount (if provided)
Estimated Loss Amount (if provided)
Estimated Loss Amount (if provided)
Contact Information
Contact Information
Contact Information
Contact Information
Vehicle or Property Details
Vehicle or Property Details
Vehicle or Property Details
Vehicle or Property Details
Third-Party Involvement
Third-Party Involvement
Third-Party Involvement
Third-Party Involvement
Time comparison
Time comparison
Time comparison
Time comparison
Traditional way
20-30 minutes per claim
20-30 minutes per claim
With V7 Go agents
1-2 minutes
1-2 minutes
Average time saved
95%
95%
V7 Go
V7 Go
V7 Go
V7 Go
AI-powered claims triage
for insurance operations
The first 24 hours of a claim are critical, yet most insurers are slowed by a manual triage process. Claims handlers manually read every incoming First Notice of Loss (FNOL) to determine severity, complexity, and the correct path for handling. This creates a bottleneck that delays response times, frustrates customers, and risks high-severity claims sitting unattended. V7 Go's Claims Triage Agent acts as an intelligent front door, instantly sorting and routing every new claim to ensure it gets to the right person, right away.
Claims Intake Teams
Automate the process of sorting and assigning new claims. Eliminate manual queue management and ensure adjusters receive a prioritized and properly assigned workload.
Claims Intake Teams
Automate the process of sorting and assigning new claims. Eliminate manual queue management and ensure adjusters receive a prioritized and properly assigned workload.
Claims Intake Teams
Automate the process of sorting and assigning new claims. Eliminate manual queue management and ensure adjusters receive a prioritized and properly assigned workload.
Claims Intake Teams
Automate the process of sorting and assigning new claims. Eliminate manual queue management and ensure adjusters receive a prioritized and properly assigned workload.
Claims Operations Managers
Improve operational efficiency and customer service KPIs. Ensure consistent application of business rules for claim assignment and prioritization, and get analytics on incoming claim types.
Claims Operations Managers
Improve operational efficiency and customer service KPIs. Ensure consistent application of business rules for claim assignment and prioritization, and get analytics on incoming claim types.
Claims Operations Managers
Improve operational efficiency and customer service KPIs. Ensure consistent application of business rules for claim assignment and prioritization, and get analytics on incoming claim types.
Claims Operations Managers
Improve operational efficiency and customer service KPIs. Ensure consistent application of business rules for claim assignment and prioritization, and get analytics on incoming claim types.
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Next steps
Ensure the most critical claims get attention first.
Delegate the task of sorting your claims queue to an expert AI agent.
You’ll hear back in less than 24 hours
Next steps
Ensure the most critical claims get attention first.
Delegate the task of sorting your claims queue to an expert AI agent.
You’ll hear back in less than 24 hours
Next steps
Ensure the most critical claims get attention first.
Delegate the task of sorting your claims queue to an expert AI agent.
You’ll hear back in less than 24 hours
Next steps
Ensure the most critical claims get attention first.
Delegate the task of sorting your claims queue to an expert AI agent.
FAQ
FAQ
FAQ
FAQ
Have questions?
Find answers.
How is this different from the full 'Claims Processing Agent'?
This Triage Agent focuses only on the very first step: sorting and routing. The full Claims Processing Agent handles the subsequent steps, like coverage verification and payment calculation. Using the Triage Agent first ensures the right person handles the rest of the process.
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How is this different from the full 'Claims Processing Agent'?
This Triage Agent focuses only on the very first step: sorting and routing. The full Claims Processing Agent handles the subsequent steps, like coverage verification and payment calculation. Using the Triage Agent first ensures the right person handles the rest of the process.
+
How is this different from the full 'Claims Processing Agent'?
This Triage Agent focuses only on the very first step: sorting and routing. The full Claims Processing Agent handles the subsequent steps, like coverage verification and payment calculation. Using the Triage Agent first ensures the right person handles the rest of the process.
+
How is this different from the full 'Claims Processing Agent'?
This Triage Agent focuses only on the very first step: sorting and routing. The full Claims Processing Agent handles the subsequent steps, like coverage verification and payment calculation. Using the Triage Agent first ensures the right person handles the rest of the process.
+
How does the agent determine the complexity of a claim?
The agent's workflow contains rules that look for keywords and data patterns. For example, a multi-vehicle incident with injury keywords is scored as more complex than a single-vehicle incident with only property damage. These rules are easily customized to match your business's definition of complexity.
+
How does the agent determine the complexity of a claim?
The agent's workflow contains rules that look for keywords and data patterns. For example, a multi-vehicle incident with injury keywords is scored as more complex than a single-vehicle incident with only property damage. These rules are easily customized to match your business's definition of complexity.
+
How does the agent determine the complexity of a claim?
The agent's workflow contains rules that look for keywords and data patterns. For example, a multi-vehicle incident with injury keywords is scored as more complex than a single-vehicle incident with only property damage. These rules are easily customized to match your business's definition of complexity.
+
How does the agent determine the complexity of a claim?
The agent's workflow contains rules that look for keywords and data patterns. For example, a multi-vehicle incident with injury keywords is scored as more complex than a single-vehicle incident with only property damage. These rules are easily customized to match your business's definition of complexity.
+
What happens to a claim after it's triaged?
The agent pushes the claim and its structured data into your primary claims management system (like Guidewire or Duck Creek). It can assign the claim to a specific adjuster or team queue, along with the triage summary, severity score, and a link to the original documents.
+
What happens to a claim after it's triaged?
The agent pushes the claim and its structured data into your primary claims management system (like Guidewire or Duck Creek). It can assign the claim to a specific adjuster or team queue, along with the triage summary, severity score, and a link to the original documents.
+
What happens to a claim after it's triaged?
The agent pushes the claim and its structured data into your primary claims management system (like Guidewire or Duck Creek). It can assign the claim to a specific adjuster or team queue, along with the triage summary, severity score, and a link to the original documents.
+
What happens to a claim after it's triaged?
The agent pushes the claim and its structured data into your primary claims management system (like Guidewire or Duck Creek). It can assign the claim to a specific adjuster or team queue, along with the triage summary, severity score, and a link to the original documents.
+
Can we customize the routing rules?
Yes. The routing logic is fully customizable in a no-code interface. You can set up rules based on policy type, claim value, geographic location, keywords, or the assigned complexity score, ensuring the agent routes claims exactly as your business requires.
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Can we customize the routing rules?
Yes. The routing logic is fully customizable in a no-code interface. You can set up rules based on policy type, claim value, geographic location, keywords, or the assigned complexity score, ensuring the agent routes claims exactly as your business requires.
+
Can we customize the routing rules?
Yes. The routing logic is fully customizable in a no-code interface. You can set up rules based on policy type, claim value, geographic location, keywords, or the assigned complexity score, ensuring the agent routes claims exactly as your business requires.
+
Can we customize the routing rules?
Yes. The routing logic is fully customizable in a no-code interface. You can set up rules based on policy type, claim value, geographic location, keywords, or the assigned complexity score, ensuring the agent routes claims exactly as your business requires.
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What happens if the initial FNOL is a blurry photo or a vague email?
V7 Go uses powerful document processing AI that can handle poor-quality images and unstructured text. It will extract whatever information is available and use it to make the best possible initial assessment. If critical data is unreadable or missing, it will flag the claim for manual review.
+
What happens if the initial FNOL is a blurry photo or a vague email?
V7 Go uses powerful document processing AI that can handle poor-quality images and unstructured text. It will extract whatever information is available and use it to make the best possible initial assessment. If critical data is unreadable or missing, it will flag the claim for manual review.
+
What happens if the initial FNOL is a blurry photo or a vague email?
V7 Go uses powerful document processing AI that can handle poor-quality images and unstructured text. It will extract whatever information is available and use it to make the best possible initial assessment. If critical data is unreadable or missing, it will flag the claim for manual review.
+
What happens if the initial FNOL is a blurry photo or a vague email?
V7 Go uses powerful document processing AI that can handle poor-quality images and unstructured text. It will extract whatever information is available and use it to make the best possible initial assessment. If critical data is unreadable or missing, it will flag the claim for manual review.
+
What's the main benefit of automating triage?
The main benefit is speed and consistency. It ensures high-severity claims get immediate attention, improves resource allocation by sending claims to the right skill level, and creates a better customer experience by acknowledging and beginning the claims process in minutes, not hours or days.
+
What's the main benefit of automating triage?
The main benefit is speed and consistency. It ensures high-severity claims get immediate attention, improves resource allocation by sending claims to the right skill level, and creates a better customer experience by acknowledging and beginning the claims process in minutes, not hours or days.
+
What's the main benefit of automating triage?
The main benefit is speed and consistency. It ensures high-severity claims get immediate attention, improves resource allocation by sending claims to the right skill level, and creates a better customer experience by acknowledging and beginning the claims process in minutes, not hours or days.
+
What's the main benefit of automating triage?
The main benefit is speed and consistency. It ensures high-severity claims get immediate attention, improves resource allocation by sending claims to the right skill level, and creates a better customer experience by acknowledging and beginning the claims process in minutes, not hours or days.
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