Keep referring dentists in the loop.
Referral updates get buried between systems.
Est. deploy 4–6 weeksSee the walkthrough
Client Communication · Insurance
Explain claim status without promising coverage.
Clients ask for updates across multiple inboxes.
For: Claims service managers and the team responsible for client communication in insurance.
01 · The outcome
What good looks like.
The team has a reviewed claim update citing the carrier source, with source evidence and an explicit approval before any external action. Track time from carrier update to reviewed client message against a baseline; do not assume automation improves it.
A connected workflow that uses carrier update, claim reference, and authorized recipient to draft a factual status summary that separates pending decisions from confirmed actions. It produces a reviewed claim update citing the carrier source.
Where AI helps, and where a person decides.
AI can draft a factual status summary that separates pending decisions from confirmed actions. It drafts and organizes; it does not authorize spending, commitments, clinical decisions or customer communication. The claims service manager verifies the source facts and approves the final action.
Claims service manager is accountable. People approve customer-facing, sensitive, financial, and legally binding actions.
- Claims service manager: Capture the source and scope
- Claims service manager: Review the proposed outcome
- Claims service manager: Release only the approved version
- Claims service manager: Check the result and exceptions
A named person approves customer-facing messages, spending, record changes and binding commitments before release. Pre-approved scripts are versioned; exceptions stop for review.
02 · The handoffs
How the work moves.
Every handoff has an owner. Select a step to open or close its detail.
Start when: A verified carrier status update arrives. Connect only carrier update, claim reference, and authorized recipient. The claims service manager confirms the request is authorized and in scope.
Ready when: The source reference, permissions and accountable owner are recorded.
Use the authorized records to draft a factual status summary that separates pending decisions from confirmed actions. Preserve the original language alongside the draft and label uncertain fields.
Ready when: Each proposed fact links back to a source, and missing information is visible.
Check a reviewed claim update citing the carrier source against the original records and current policy. Correct errors and escalate exceptions to the qualified specialist; do not auto-approve.
Ready when: Claims service manager has recorded approval or a reason to hold the item.
After explicit approval, save a reviewed claim update citing the carrier source in the system of record. Send only approved messages to verified recipients. Record the version and prevent duplicate delivery.
Ready when: The approved record is saved; any delivery is confirmed or placed in the retry queue.
Review time from carrier update to reviewed client message each week, sample completed records for quality, and resolve held items. Change the rules only after reviewing actual errors and staff feedback.
Ready when: Exceptions have owners, the metric has a baseline, and corrective actions are assigned.
Sample record.
$ david run --workflow=insurance-claim-update
ILLUSTRATIVE RECORD / NOT LIVE CUSTOMER DATA
- Example
- Illustrative only — not a real client record
- Reference
- INSURANCE-CLAIM-UPDATE-DEMO-001
- Trigger
- A verified carrier status update arrives.
- Owner
- Claims service manager
- Prepared output
- a reviewed claim update citing the carrier source
- Review status
- Awaiting human approval — no external action taken
- Missing information
- Owner to verify source completeness
- Measure
- Time from carrier update to reviewed client message
Start with your tools.
Connect Agency management system, Carrier portal, Microsoft 365 through approved APIs or controlled exports. Map record identifiers first; test permissions and field updates in a sandbox. Vendor names describe possible connections, not a guarantee of an available integration or license.
When things go wrong.
- A named person approves customer-facing messages, spending, record changes and binding commitments before release. Pre-approved scripts are versioned; exceptions stop for review.
- Use only authorized sources and role-based access. Keep an audit trail of source records, drafts, approvals and delivery status; deduplicate retries.
- If an integration fails, a source is missing or confidence is low, pause the action and assign the original request to the accountable owner.
- For financial or insurance work, a properly licensed professional approves recommendations, coverage, suitability and binding actions. Apply the firm's supervision, retention and advertising rules.
Try this week / no DAVID required
A useful first step.
This week, have your claims service manager time five examples of this work. Use redacted copies of carrier update, claim reference, and authorized recipient to make a reviewed claim update citing the carrier source manually, then list which fields required judgment.
What to measure.
- Time from carrier update to reviewed client message
- Minutes of human handling per completed item
- Drafts needing substantive correction
- Exceptions unresolved beyond the agreed review window
Estimate your time back.
20.8
$11,232
03 · More workflows to consider
Related workflows.
Route post-visit questions to the right person.
Clinical questions get mixed with billing requests.
Est. deploy 4–6 weeksSee the walkthrough
Send the right approved visit instructions.
Patients receive instructions for the wrong visit type.
Est. deploy 4–6 weeksSee the walkthrough
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