Claim Management

AI-Powered Virtual Agents for Filing Claims, Claim Status, and More

The Ultimate Guide to AI Self-Service Without Compromise

What Are Virtual Agents for Claim Management?

AI-powered virtual agents use conversational AI to automate the routine conversations traditionally handled by live agents. With SmartAction’s Omni-Bot™ feature, organizations typically start in voice, where the ROI is the greatest, then scale the same experience to chat or text for a complete omnichannel self-service strategy.

Learn more about virtual agents and what they can do

While claim management processes are often detailed and complex, there are lots of opportunities to introduce AI automation that helps streamline experiences for both customers and your business. Offload routine calls and chats from customer service reps to AI-powered virtual agents. By seamlessly integrating with your CRM or ERP, virtual agents use natural language processing (NLP) to help customers begin filing a claim, check on claim status, review policy information, and much more - all the things live agents do.

Which Claim Management Calls & Chats Can be Automated Using Virtual Agents?

File a Claim

Claim Status

Claim Policy Info

Claim Follow-Up Notification

What is the Customer Experience Like with a Virtual Agent?
  • Scenario 1: Filing a Claim – Homeowner

    Last night, Brandon accidentally left a dry dish towel a little too close to the stove. The towel caught fire and burned the nearby kitchen cabinets and wall. Brandon needs to go through his homeowner’s insurance provider to have the cabinets replaced and the wall fixed. Brandon calls to start the typically unpleasant process of filing a claim, only to find that an AI-powered virtual agent is easy to use and very helpful.

  • Scenario 2: Policy Information

    Cindy bought a home three years ago at the bottom of the market. Since that time, the market has shot up, and her home is worth nearly double what she paid for it. However, because the value has changed so significantly, she wants to check on her homeowner’s insurance policy and make sure she’s insured to value. She’s able to locate a policy verification phone number online, and she gives a call to get the details. This routine inquiry is perfect for a well-designed virtual agent. Listen as Cindy goes through the process.

  • Scenario 3: Claim Status

    Nicole’s car is her pride and joy. She is conscious about maintenance and gets it washed every week. While visiting a friend, she parked on the street, and another driver swerved and hit her parked car. The car is already at the body shop, and her claim has been filed, but the insurance company’s decision seems to be taking a long time. Nicole gives her insurance a call to check on the status of her claim. See how a virtual agent offers assistance through human-centric design.

Which Claim Management Challenges Do Virtual Agents Help You Address?
Virtual Agents Bots
  • Effortless & personalized self-service for claim processes that don't require human judgment or critical thinking
  • Reduce live agent handle times
  • Focus live agents on most important calls & chats, such as First Notice of Loss (FNOL)
  • Seamless integration with contact center platform, CRM, ERP, and other systems
Sample Claim Management Conversation
  • Virtual Agent

    You’ve reached the American Insurance claim status line. Using caller ID, I see you have two claims open. Please tell me the claim number you’re calling about.

    The virtual agent is jacked-in to the customer data and matches caller ID to an account with open claims, offering a proactive greeting.

  • Customer

    Four one seven, nine six four, eight two one, zero zero two.

    Alphanumeric capture.

  • Virtual Agent

    Got it. Before we continue, I need to verify your account for security purposes. What are the last four digits of your social security number?

    Virtual agents ensure data security by following the same, automated process every time with no exceptions.

  • Customer

    Seven eight zero two.

  • Virtual Agent

    Do you want to hear your claim status for claim number four one seven, nine six four, eight two one, zero zero two?

    AI-powered virtual agent has short term memory to recall the claim number from earlier in the conversation.

  • Customer


  • Virtual Agent

    Your claim was filed on October ninth, twenty nineteen. The claim has been received and is pending review. We will contact you as soon as we have further information about the claim. Do you want to hear that again?

    Seamless integration to your CRM or claims management system allows for real-time updates.

  • Customer

    No but I want to hear the status of my other claim.

    Natural language intent capture.

  • Virtual Agent

    To confirm, you want to hear the claim status of claim number four one six, nine two seven, eight eight three, eight one zero?

    Virtual agent confirms the utterance when there is a low to medium confidence level about what was heard. If high confidence, the virtual agent will just move on to the proper response.

  • Customer


  • Virtual Agent

    Your claim was filed on October tenth, twenty nineteen. The claim has been accepted as of Monday, October twenty first, twenty nineteen. Reimbursement for the damage to your 2014 Dodge Caravan will be sent. Do you want to hear that again?

    The virtual agent reads out claim information exactly the way your live agents would. SmartAction works closely with you to determine what the conversation flow looks like.

  • Customer

    No thanks.

  • Virtual Agent

    Is there anything else for today?

    Virtual agents listen for up to a dozen intents in order to properly assist callers with effortless self-service.

  • Customer


    Fully contained call.

  • Virtual Agent

    Thanks for calling American Insurance. Have a great day.

Integrations – Claim Management

SmartAction integrates with every IVR, contact center platform, CRM, and claims management software.

Your IT team simply needs to expose APIs to the same data accessed by live agents. The SmartAction CX team will determine the best ways to connect to your data.


  • Salesforce
  • Oracle
  • NetSuite
  • Magento
  • Other Homegrown Systems

Contact Center/Telephony:

  • NICE inContact
  • Genesys
  • Avaya
  • Cisco
  • Mitel
  • Other Legacy Systems

For the most human-centric AI design and implementation, choose SmartAction’s virtual agent solution.

Why Automate Claim Management Calls & Chats with SmartAction?
PROVEN: Industry-leading conversational AI for omnichannel self-service
SmartAction started as an AI research company and now has more than a decade in AI development. The core AI technology supports omnichannel self-service across hundreds of use cases. SmartAction customers automate in voice first, where the ROI is the greatest, then scale the same CX to chat and text. SmartAction is the only AI-powered self-service solution for customer service to be named “Gartner Cool Vendor,” the only company recognized by Frost & Sullivan as “The Leader in Self-Service,” and is currently the top-rated and most reviewed Virtual Customer Assistant solution on Gartner Peer Insights.
EASY: Outsource voice & chat automation for a human-centric CX without compromise
SmartAction delivers its proprietary conversational AI as a service through a team of CX experts rather than DIY software licenses. SmartAction’s CX team works for you day-in and day-out to improve performance until reaching perfection. You only need to assist our CX team with conversation design, data integrations, and unique business rules to set the virtual agent’s “guardrails.” This is how we keep our brand promise of delivering self-service automation without sacrificing an ounce of CX. Learn about implementation.
LOW RISK: Start small in 6-8 weeks and grow over time
Getting started with SmartAction couldn’t be easier or more affordable, with no large CapEx investment or professional services fees. Rather than rip-and-replace existing telephony investments, SmartAction augments your IVR with conversational AI for a nominal one-time setup fee and simple, pay-as-you-go usage pricing. There are no charges for upgrades or fees for making changes - the full suite of services from SmartAction’s CX team is included in the per-minute usage price. Organizations can start as small as they want to see how well customers interact with the system and realize the immediate ROI.

Learn more about SmartAction’s obsession with LIFE LESS HARD™

#1 Rated AI-Powered Virtual Agents for Contact Centers

5 Star Reviews

Most contact centers have an over-reliance on live agents for even the most repetitive and rudimentary calls and chats. With cloud-based virtual agents, you can automate conversations your live agents are handling today without sacrificing an ounce of CX.

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