Claims Concierge
An advocacy layer that tracks claim status across carriers and proactively updates the insured, escalating to your team only when something stalls or an outcome needs interpretation.
[ capabilities ]
- —Proactive milestone notifications
- —Stall detection and escalation rules
- —Insured-facing claim timeline
[ core systems & integration architecture ]
Driven by claim events. Listens for milestone changes in the claims system and handles the outbound communication so your team doesn't field status calls.
Guidewire ClaimCenter
Event Stream / WebhookFNOL, reserve change, and closure events via the event broker
Duck Creek Claims
Native REST APIClaim status polling where events aren't exposed
Applied Epic
Native REST APIClaim activity logged against the client record
Notification layer
Embedded SidecarInsured-facing timeline via email and SMS
Sync model
Real-time on every claim milestone
Standards spoken
Time to connect
Weeks
Enterprise guardrails
- —No customer data used to train models — zero-retention inference only
- —OAuth 2.0 / mTLS against your existing identity provider
- —Field-level audit trail on every value written back
- —Coverage determinations are never communicated by the bot
[ mcp microservice interface ]
This module ships as an MCP microservice — claims-mcp. It consumes governed tools from the core-system adapters and publishes its own, so your assistant, orchestrator, or another module can call it directly. No credentials ever reach the model runtime, and every write lands in the human gate.
Consumes from core systems
- gw_get_claim_timeline
- gw_summarise_exposures
- epic_get_activity_history
Provides to other agents
summarise_claim_statusreadClient-ready status summary with no coverage opinion
flag_stalled_claimreadIdentify claims with no movement past threshold
stage_adjuster_activitywrite · human gateCreate a follow-up activity for the assigned adjuster
[ implementation playbook ]
How an agency actually stands Claims Concierge up — read-first, human-gated, and measured from day one.
Setup, in order
- 1
Connect read access to claims data — claim numbers, status, adjuster notes, and reserve movement where available.
- 2
Define the client-communication rules: what clients may be told at each claim stage, and what always requires a human call.
- 3
Set the monitoring cadence — most agencies start with daily status checks on open claims.
- 4
Configure the stale-claim threshold (e.g., no movement in 14 days) that triggers a follow-up action.
- 5
Pilot with one account team: the concierge drafts status updates, the account manager sends them.
- 6
Add the client-facing digest only after the internal workflow is trusted.
Agency use cases
Proactive claim status updates
Instead of the client calling to ask what's happening, the concierge drafts a plain-language status note every time the claim moves — the account manager approves and sends.
Stale-claim escalation
A claim with no adjuster activity in two weeks gets flagged with a drafted follow-up to the carrier, so claims don't quietly die in a queue.
FNOL first response
When a first notice of loss arrives, the concierge acknowledges the client immediately, confirms the details received, and stages the claim setup for the team.
The first win to aim for
Inbound 'what's happening with my claim?' calls drop measurably within the first month.
Guidance by agency role
Producers
Step in for severe, sensitive, or relationship-critical claims, using the timeline to call with context rather than replacing personal advocacy with automation.
Account managers
Review client updates, chase stale carrier activity, and ensure urgent changes or coverage questions move to a licensed human immediately.
Agency administrators
Define escalation thresholds and approved communication rules, audit message timing, and track stale claims plus inbound status calls by team.
[ built for ]
[ where this sits in the vendor market ]
We recommend buying first wherever the market already solves a problem well. Here is what you can buy instead of building this — and where this module earns its place beside what you buy.
Products that already cover this ground
Third-party claims administration at scale
Buy it when: Carriers and self-insured programs that need claims capacity.
Where it falls short: Agencies — the useful action is knowing how to escalate into it.