Claim Status Voice Helpline for Policyholders

• Head of Customer Service
• Claims Contact Centre Manager
• Grievance Redressal Officer
• TPA Customer Care Lead

'Where is my claim?' is a question claims contact centres hear all day, from policyholders, family members and hospital insurance desks. Agents look up the claims system, decode internal status codes and read out pending documents, while callers with genuine complaints wait in the same queue.

We build an inbound voice agent for your claims helpline. It answers in the caller's language, verifies them against the registered mobile number and claim or policy details, and reads the live claim status from your claims or TPA system. Internal status codes are translated into plain explanations your team has approved. If documents are pending, it lists them simply and sends the deficiency letter and an upload link on WhatsApp. Settled claims get payment details after verification. Complaints, disputes about deductions and sensitive cases such as death claims go straight to a person with a call summary, and every interaction is logged as a ticket.

• Answers in Hindi, English and selected regional languages, detecting the caller's preference
• Verifies callers using the registered mobile and claim or policy details before sharing anything
• Reads live status from the claims or TPA system and explains it using approved templates
• Lists pending documents in plain language and sends the deficiency letter and upload link on WhatsApp
• Shares settlement amount, date and payment reference once the caller is verified
• Transfers complaints, disputes and bereavement calls to a person and logs them in your grievance system

1. 01Answer and detect languageThe agent greets the caller, identifies the preferred language and asks for the claim or policy number.
2. 02Verify the callerIdentity is checked against the registered mobile and policy details; unverified callers get general help only.
3. 03Fetch live statusClaim stage, pending items and payment details are pulled from the claims or TPA system.
4. 04Explain and send documentsStatus is explained in plain language, and pending-document lists or letters are sent on WhatsApp.
5. 05Route complaints and sensitive casesComplaints, disputes and bereavement calls go to a claims executive with a summary.
6. 06Log the interactionA ticket with transcript, intent and outcome is created in the CRM or grievance system.

1. Telephony
   • Toll-free number and IVR integration
   • Speech recognition and text-to-speech for Indian languages
2. Identity and data
   • Caller verification service
   • Claims or TPA system status API
   • Payment and deficiency letter lookup
3. Conversation
   • Dialogue manager with intent detection
   • Approved status explanation templates
   • Complaint and sensitive-case detector
4. Actions
   • WhatsApp Business messaging
   • Warm transfer with call summary
   • Ticket and grievance creation
5. Monitoring
   • Transcript store with personal data redaction
   • Call reason and confusion analytics

Claims executives take every complaint, dispute and bereavement call, and the grievance team owns complaint resolution. Supervisors review samples of automated calls and approve any change to the status explanation templates.

• Claims or TPA system API
• Toll-free and IVR platform
• WhatsApp Business API
• CRM or ticketing such as Salesforce Service Cloud or Freshdesk
• Grievance management system

• No claim information before verification
• Rejection and deduction reasons read only as recorded in the letter, with no speculation
• No promises on settlement dates beyond what the system shows
• Bereavement and distress detected early and handed to a person
• Personal and health data redacted from transcripts and logs

• Every complaint is logged and routed into your grievance process, so the helpline supports the redressal mechanism IRDAI requires rather than bypassing it.
• Health and identity data is shared only with verified callers, supporting DPDP Act 2023 obligations.

• Insurance

  Health Claim Document Extraction

  Turn hospital bills, discharge summaries and investigation reports into structured, checked claim data, with uncertain fields routed to an assessor instead of guessed.

• Insurance

  Pre-Authorisation Request Triage for TPAs

  Read incoming cashless requests, check completeness, policy terms and tariffs, and put a prioritised, source-linked summary in front of the TPA medical officer.

• Insurance

  Policy Renewal Voice Agent

  A multilingual voice agent that calls policyholders before renewal, explains premium and cover from approved content, sends a UPI payment link and hands complex requests to licensed staff.

• Telecom & Contact Centres

  Multilingual Inbound Voice Agent for L1 Support

  A voice agent that answers routine L1 calls in Hindi, Hinglish and regional languages, resolves what it safely can through your systems and hands the rest to an agent with full context.