Take first notice of loss on any channel, match it to the policy in force at the date of loss, capture the facts and route it — and state no coverage position.
Take the notice as it arrives — phone, portal, app, broker or email — and keep the words the notifier used.
02
Find the policy and the period in force at the date of loss, endorsements, lapse and cancellation included.
Reason
03
Capture what happened, when and where, the property or vehicle involved, and everyone else who was there.
04
Ask about injuries, third parties, witnesses and emergency services, and record the answers as given.
05
Raise total-loss, catastrophe, liability and vulnerability indicators, and check for a claim already open.
Decide
06
Where the policy matches and no indicator fires, the claim opens and routes to the queue that owns it.
07
Injury, distress, a policy that will not match or any question about cover goes to a person at once.
Out
08
Open the claim, timestamp the notice, send the acknowledgement you approved, and request what is missing.
09
Retain the channel, the words used, the policy version read, the indicators raised and the queue it went to.
→Product statement
The agent captures, checks the policy was in force and routes. It states no coverage position — not on the call, not in the portal, not in the acknowledgement — and anything that sounds like one belongs to a person.
Example workflow
One notice, end to end
AgentHuman
1Notice receivedA call, a portal or app submission, a broker notification or an email, with the channel and the time it arrived
2Policy matched at the date of lossCover, period, endorsements, lapse and cancellation as they stood, and whether more than one policy could respond
3Loss facts capturedWhat happened, when and where, the property or vehicle, third parties, injuries and emergency services attending
4Indicators checkedInjury, liability, total-loss, catastrophe, duplicate and vulnerability flags, and the documents still outstanding
No human action required
Stages 1 to 4 run without a person in the loop — the policy match, the loss facts and the indicator checks are finished before anything is opened. Nothing has been said about cover.
5DecisionSplits on whether the policy matched and no indicator needs a person
Policy matched, nothing flagged
Opens and routes to the owning queue.
Injury, distress or a coverage question
Goes to a person, on the spot.
Claims handler
Takes the notice while the notifier is still there where the channel allows, with the flags named and the policy as read. Anything about cover is theirs.
Open · Correct · Escalate
Handled — handed back▼
6Claim opened and routedTimestamped, acknowledged on your approved template, and sent to the queue that owns that claim type
7Outcome evaluatedPolicy-match accuracy, capture completeness, duplicates, escalation appropriateness and time to open, by channel and language
Handler changes
Every field a handler corrects after intake is counted, by channel.
What should not run autonomously
Human approval stays in control
Outside the boundary — human approval required8 items
Telling a claimant whether the loss is covered.
Denying, declining or closing a notified claim.
Advising on excess, limits or likely settlement.
Recording a reported loss as anything but a claim.
Automation boundaryAgent acts unaided
✓Match the policy and the period in force at the date of loss.
✓Capture the loss facts, parties and injuries as the notifier gives them.
✓Raise total-loss, catastrophe, duplicate and vulnerability indicators.
✓Open the claim, acknowledge on your template and route to the owning queue.
Write actions run only inside the approval boundaries agreed during implementation. Opening and routing a claim is one of them; saying anything about cover is not, on any tier.
Handling an injured, bereaved or distressed caller alone.
Taking a recorded statement about fault or liability.
Promising a repairer, hire car or benefit entitlement.
Changing routing rules, indicators or escalation triggers.
Example output
One notice of loss, annotated
Everything the agent records is attached to the channel and the policy version it came from.
FNOL output · single noticeIllustrative example
Channel
Policy at loss date
Reported
Routed to
Confidence
Coverage position
Out-of-hours call
In force, endorsed
Escape of water
Property — mitigation
93%
None — a handler's
As receivedThe notice as it was given, on the channel it arrived, with the time of receipt and the policy as it stood that day.
Checks clearedPolicy in force at lossNo open claim on fileNo injury reported
Why this queueFrom the peril, the indicators and your routing rules — not from any view about cover.
ActionOpenCorrectEscalate
What the score decidesWhether the capture may route unattended. It decides nothing about cover.
Value
Where AI adds value
The same four claims, placed at the point in the workflow where each one applies.
Where the value landsValue 01 – 04
Every notice of lossFrom phone, portal, app, broker and email
03Policy & period
Match the policy and period in force that day
Cover, period, endorsements, lapse and cancellation as they stood on the date of loss — read at intake and stamped with the version.
01Approved path
Capture it once, properly
The facts an adjuster will need are asked for while the notifier is still there, on every channel, so the file opens complete rather than half-built.
02Human review
Hand the hard notices over early
An injury, a death, a shaken caller or a policy that will not match reaches a person straight away — not after the claim has been opened against the wrong cover.
04Build an evidence trail
Retain the channel and the words used, the policy version read, the indicators raised, the acknowledgement sent and the queue it went to — on both paths.
Integrations
Typical integrations
Five system groups connect to the same agent. Which of them are in scope is decided in discovery.
Policy admin & claimsGuidewire · Duck Creek · Sapiens Majesco · Policy and claim APIs
Voice & messagingTelephony and IVR · chat, SMS and WhatsApp Transcription · call recording
Portal, app & brokerPolicyholder portal · mobile app Broker and MGA feeds · web forms
Agent
FNOL intake & routing
Captures the notice Matches the policy Routes the claim
A few channel and language cohorts carry most of the missing fields, and they are the cohorts least likely to complain about it. Routing built from channel, postcode or claim history stands in for who the claimant is. Nestack reports performance by slice, not only in total.
Slice performance — reported separately, not only in aggregateIllustrative example
Slice
Failure rate
Lift
Lift vs. threshold
Status
Non-native-speaker callers
6.6%
3.8×
Review
Out-of-hours phone notices
5.1%
2.9×
Review
Broker-notified losses
3.3%
1.9×
Watch
Repeat routine motor claims
1.2%
0.7×
Normal
Bar: missed-capture lift vs. routine motor-claim baseline · scale 0–4.0× · tick marks the 2.0× review threshold2 of 4 slices over threshold
Evidence-linked improvement
Every field the adjuster chased is a capture defect
The first thing an adjuster does with a thin file is telephone the claimant again. That second call is the measurement, and it belongs to the intake that caused it.
Improvement cycle · five stagesSwitchback — the path turns at Improve and returns at Learn
01Detect
A slice starts losing fields, duplicating notices or missing escalations.
02Diagnose
The question set, the policy match, the indicators or the channel — one of them.
03Improve
A question, a match rule or a routing rule changes — signed by the claims officer, dated and versioned.
04Verify
Replayed over held-back notices, and over every file an adjuster had to reopen.
05Learn
The chased field becomes a required capture, and a case the next release must pass.
Learn → DetectThe return edge. Every cycle also re-reads the escalation triggers — a distressed caller the agent kept to itself means the trigger was wrong, not the caller.
Typical build scope
Twelve workstreams across six weeks
The build scope read against the delivery timeline. Week structure follows the six-week plan — discovery, channels and policy matching, capture and escalation rules, evaluation, routing and live intake, then production validation and handover.
WorkstreamWeek 1Week 2Week 3Week 4Week 5Week 6
01Workflow discovery and automation-boundary definition.
02Channel inventory and intake-path mapping.
03Policy admin and claims API assessment.
04Policy-at-loss-date and in-force checks.
05Question sets and capture rules by claim type.
06Injury, third-party and liability capture.
07Total-loss, catastrophe and duplicate flags.
08Distress and vulnerability escalation triggers.
09Acknowledgement wording and notice sign-off.
10Capture and escalation evaluation.
11Routing rules, queue ownership and claim opening.
12Deployment, documentation and Agent Care handover.
12 workstreams · 6 weeks · bar shows the weeks a workstream is active — several run in parallelFinal scope and sequence confirmed in discovery
Engagement tiers
What each tier includes
Rows are the capabilities named in each tier's scope. Higher tiers include everything below them.
Capability✓ in scope · — not at this tierPilotOne channel, one claim typeProductionLive intake on one lineAdvancedAll channels / multi-line
Introduced at Pilot
Policy-at-loss-date matching✓✓✓
Structured loss capture✓✓✓
Escalation to a person✓✓✓
Shadow mode — captures, opens nothing✓✓✓
Baseline evaluation✓✓✓
Introduced at Production
Claim opening and acknowledgement—✓✓
Injury and third-party capture—✓✓
Duplicate and prior-claim checks—✓✓
Routing rules and queue ownership—✓✓
Introduced at Advanced
Catastrophe surge handling——✓
Multi-channel and enterprise controls——✓
Build priceFrom $5,000From $8,000Custom quote
Final build priceConfirmed after discovery based on the channels and lines in scope, the policy and claims systems involved, telephony and messaging integrations, notice volume, escalation and routing controls, and deployment requirements.
Separate from buildBuild pricing is separate from recurring Agent Care, which covers managed monitoring, evaluations, incidents and verified improvements after launch.
What we need from you
What you bring, and what we build with it
Each input maps to a piece of build scope and a week in the delivery timeline.
You bringWe build with it
01Every channel a loss can arrive on today→Workflow discovery, channel inventory and the automation boundaryWeek 1
02Access to policy admin and claims, endorsements included→Policy-at-loss-date matching and in-force checksWeek 2
03The fields your adjusters actually need, by claim type→Question sets, capture rules and the indicators that fireWeek 3
04Your policy on injury, distress and vulnerable customers→Escalation triggers and the route to a personWeek 3
05Your acknowledgement wording, and what may never be said→Notice templates and the no-coverage ruleWeek 4
06Recent notices, including the reopened and the duplicated→Evaluation suite, regression cases and failure-mode testingWeek 4
07Named handlers and the queue that owns each claim type→Routing rules, queue ownership and live intakeWeeks 5–6
Nothing else is requiredDeployment, documentation and Agent Care handover are ours.
Delivery timeline
Four phases across six weeks
Phases are drawn over the weeks they actually occupy. Nothing is opened in your claims system before week 6 — intake runs alongside your handlers until then.
PhaseW1W2W3W4W5W6
DiscoveryW1
BuildW2 – W3
EvaluateW4 – W5
Pilot & LaunchW5 – W6
Week focusW1Channels in scope, escalation policy and who owns each queueW2Policy-at-loss-date matching and in-force checksW3Capture rules, injury questions and escalation triggersW4Acknowledgement wording, evaluation suite and failure-mode testingW5Live notices captured alongside handlers, and compared field by fieldW6Claims opened and routed from the agent's capture, then handover
Reading the bandBars span only the weeks their work is named in. Week 5 is shadow running — the same notice is captured twice and the two files are compared.
At the end of W6Claims are opened and routed from the agent's capture, and every question about cover in that period went to a person.
DurationSix-week plan shown · typical delivery 4–6 weeks depending on scope confirmed in discovery.
Next step · Insurance AI agent
Fix the first five minutes of the claim.
Show us how a loss reaches you on each channel, what your adjusters have to chase afterwards, and your policy on injury and distress. We'll capture one notice end to end, agree the wording that may never appear in an acknowledgement, and mark every point where a person has to take the call.
