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Agentforce for Warranty Claims Adjudication

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Agentforce for Warranty Claims Adjudication

Help claim adjudicators process warranty claims faster and with more consistent decisions. The Warranty Claims Adjudication agent summarizes queue volume, ranks open claims, flags fraud risks, and drafts requests for information while adjudicators stay in control of every decision. This Agentforce Employee agent is built for claim adjudicators and warranty underwriters.

Required Editions

Available in: Lightning Experience
Available in: Enterprise, Performance, Unlimited, and Developer Editions with the Agentforce for Automotive add-on or included in Agentforce 1 Automotive Edition. Requires each user to have the Agentforce for Automotive add-on to access the action.
Note
Note Make sure you review the available resources for Einstein Generative AI and Agentforce before you implement Agentforce for your company as per your requirements.

How Adjudicators Use the Agent

Adjudicators use the agent from the Agentforce panel or Slack to review a warranty claim queue and investigate individual claims. The agent helps adjudicators:

  • Summarize queue volume, aging, and pending liability.
  • Rank open claims by value, age, and complexity.
  • Identify possible fraud indicators, such as duplicate serial numbers or repeated asset failures.
  • Find missing claim fields, coverages, and attachments.
  • Draft requests for information when a claim is incomplete.

How the Agent Uses Warranty Data

The agent uses account, asset, warranty term, asset warranty, claim, claim item, claim coverage, and claim coverage payment detail records. Warranty terms and asset warranties help the agent check warranty expiry. Claim assignments and claim history provide the context for queue summaries and claim review. A claim counts as open based on its claim status.

Adjudicators Stay in Control

The agent surfaces information and drafts responses, but it doesn't make claim decisions. Adjudicators review the supporting claim and warranty data before they approve, reject, or request more information for a claim.

Warranty Claims Adjudication is a different agent from Agentforce for Automotive Warranty Claims Assistance, which helps service reps summarize submitted claims and check warranty coverage.

 
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