Claims Service Employee Assistance
Help your customer service representatives (CSRs) respond faster when clients report a loss or an incident with an AI agent to assist them. The agent guides CSRs through a structured first notice of loss (FNOL) workflow: identifying the client's account, selecting the relevant policy, collecting incident details, creating the claim, attaching participants and items, and drafting customer-facing emails.
Required Editions
| Available in: Lightning Experience |
| Available in: Enterprise, Performance, Unlimited, and Developer Editions with Agentforce Financial Services and Agentforce for Financial Services add-on, or included in Agentforce 1 Financial Services Edition. |
Use the Claims Service Employee Assistance template to create the AI agent for your CSRs. The template includes subagents and actions, which are powered by prebuilt flows and prompt templates.
Subagents
The Claims Service Employee Assistance agent uses a router that directs each CSR message to the appropriate subagent based on the current session state. Each subagent handles a specific phase of the FNOL workflow.
| Subagent | Description |
|---|---|
| Account Setup | Sets the account for the session. Gets the client's account from the session context or asks the CSR to provide an account name or Account ID. Shows the accounts that match the name or ID and asks the CSR to pick the client's account. |
| Policy Selection | Lists the account's active policies and open claims, asks the CSR to choose a policy, and fetches full policy details (participants, assets, coverages) for confirmation before the CSR files a claim. |
| FNOL Intake | Collects first-notice-of-loss details through structured intake questions specific to the policy's business line. Validates the loss date against the policy period. Optionally drafts a document-request email if supporting documents are required. |
| FNOL Review and Claim Creation | Displays prepared claim values (name, type, reason type, loss type) derived from intake answers for the CSR to review. Creates the claim record after CSR confirmation. |
| Claim Participants, Items, and Summary | Adds participants (drivers, witnesses, injured parties) and items (damaged property, vehicle parts) to the claim. Renders a running summary and optionally drafts a claim confirmation email for the client. |
| Record Lookup | Handles read-only record lookups at any point during the session. The CSR can ask about any account, policy, claim, or other record without losing session progress. |
| Off Topic | Handles greetings, session-end requests, off-topic messages, and prompt-injection attempts. Redirects the CSR back to the active workflow. |
Actions
The subagents run agent actions to complete a task or answer a query.
| Agent Action | Reference Action | Description |
|---|---|---|
| Get Insurance Policies | Flow: Get Insurance Policies | Gets the insurance policies for a client account, filtering policies by their status. |
| Get Insurance Claims | Flow: Get Insurance Claims | Gets the claims for a client account, optionally including closed claims. |
| Get Policy Participants | Flow: Get Policy Participants | Gets the participants related to a policy. |
| Get Policy Assets | Flow: Get Policy Assets | Gets the assets related to a policy. |
| Get Business Line Instructions | Flow: Get Insurance Business Line Instructions | Gets the FNOL intake instructions for an insurance business line based on the policy type. |
| Create Insurance Claim | Flow: Create Insurance Claim | Creates a claim record based on the policy, loss, and other FNOL details. |
| Create Claim Participant | Flow: Create Claim Participant | Creates a claim participant based on the account, insurance policy participant, and role details. |
| Create Claim Item | Flow: Create Claim Item | Creates a claim item record by using the insurance policy asset, coverage, category, and claim participant details. |
| Draft Documents Intake Email | Prompt Template: Draft Documents Intake Email | Drafts an email that requests supporting documents from the client. |
| Draft Claim Summary Email | Prompt Template: Draft Claim Creation Summary Email | Drafts a claim confirmation summary email for the client. |
The agent also uses these standard agent actions:
- Draft or Revise Email
- Get Record Details
- Identify Record by Name
- Query Records
Review the subagent instructions and reference actions. Test the agent in the builder, and customize the instructions, flows, and prompt templates to match your business needs.
- Considerations for Claims Service Employee Assistance
Before you set up an agent with the Claims Service Employee Assistance template, review these considerations. - Set Up the Claims Service Employee Assistance Agent
Use the Claims Service Employee Assistance template to create and configure an agent that helps your customer service representatives (CSRs) file insurance claims conversationally. - Start a Claim for a Client
When a client reports a loss or incident, use the Claims Service Employee Assistance agent to capture the required first-notice-of-loss (FNOL) details. The agent asks intake questions that are specific to the policy's business line and guides you through each step of the FNOL process. When you complete the intake and file a claim, claims adjusters have all the information that they require to start processing the claim.
