Capability · Insurance
Digital workflows for AI customer service.
A claim is the moment an insurer keeps its promise. Customers judge it on how fast, clear and fair it feels. We map the work behind every claim, case and call, build it into digital workflows, then put AI to work inside them, with people accountable for every decision.
At a glance
- For
- General insurers, statutory schemes, workers compensation and CTP, life and health
- What you get
- One model of how service works, digital workflows built from it, and AI customer service inside them
- Platforms
- Holocentric Connect, ServiceNow or Microsoft 365, and AI through Availe
- Time to value
- A first claims journey live in about 12 weeks, then scaled journey by journey
Insurers, workers compensation schemes and statutory insurers share the same pressure. Customers expect the speed of the best digital service they use anywhere. Regulators expect every claim, complaint and payment to be handled fairly, on time and on the record. And much of how the work actually gets done still lives in the heads of experienced staff.
AI can take a great deal of effort out of customer service. But it can only follow a process someone has written down, and it can only be trusted inside a workflow that keeps people accountable. That is where we start.
Why it matters
Every claim is a promise kept, or broken.
The moment of truth
Most customers only test their policy when something has gone wrong. How the claim is handled is the product they remember, and the reason they renew or leave.
Effort costs twice
Every question a portal or letter can't answer becomes a call, a follow-up or a complaint. Customers pay in time and frustration; insurers pay in handling cost.
Obligations on every step
Claims handling is a regulated financial service. Codes of practice, complaints handling rules and operational resilience standards such as CPS 230 all reach down into the process.
Knowledge walks out the door
When processes live in people's heads, new starters take months to become effective, and every restructure loses something. AI trained on undocumented work inherits the gaps.
AI can only follow a process someone has written down.
Map first
One connected model of how service really works.
Before anything is automated, we model the end-to-end process on Holocentric Connect, in BPMN 2.0, from the value chain down to the task a case manager performs on a Tuesday afternoon.
End to end, then down to the task
Hierarchical models from value chain to sub-process to task, so cross-team hand-offs, duplication and bottlenecks are visible.
Linked to obligations and risk
Each step carries the policies, obligations, risks and controls it satisfies, configured to frameworks such as CPS 230, ISO 9001 and the APQC Process Classification Framework.
Clear ownership
Swimlanes and role-based views show who does each step, and who owns keeping it current, with review dates and a full version history.
A living knowledge base
Every element carries its summary, inputs and outputs, documents and performance measures. The same model trains new staff and grounds the AI.
Standards-based and business-readable: models a claims team can understand, an auditor can trace, and a workflow team can build from. See our Holocentric capability (opens in a new window)
Digital workflows
From first notice to closed claim.
We turn the model into digital workflows across the customer journey, with AI assisting at each step and a person deciding wherever judgement or liability is involved.
Report
Lodge online, by phone or by chat, any hour. Details captured once and checked for completeness.
Triage
Each claim routed by type, complexity and risk to the right team, with urgent and vulnerable customers flagged.
Assess
Evidence gathered and summarised for the case manager, with the policy wording and similar past claims beside it.
Decide
A person makes every liability, decline and payment decision, with the reasons and sources recorded.
Support
Proactive status updates, appointment booking and plain-language letters, in the customer's preferred language.
Close and learn
Resolution notes and knowledge articles drafted automatically, and complaint and failure patterns fed back into the model.
AI customer service
AI that does the reading, so people can do the caring.
Generative AI and agents work inside the workflow, never around it. They draw on the insurer's own approved knowledge, cite their sources, and hand over to a person whenever the matter needs judgement.
For customers
Answers, not search results
Self-service and virtual agents that answer from approved policy and claims knowledge, and say where the answer came from.
Where's my claim?
Plain-language status and next steps on demand, instead of a call into a queue.
In their language
Knowledge and letters translated on request, so every customer is served the same way.
Help at any hour
Book, reschedule or update details conversationally, any time, with a clear path to a person.
For case managers and contact centres
Up to speed in seconds
Summaries of a claim's case notes, calls and chats before the next conversation starts.
The next best step
Guidance drawn from the process model and policy, showing what this claim needs next and why.
First drafts, not blank pages
Draft letters, resolution notes and knowledge articles, reviewed and approved by the case manager.
Less after-call work
Post-call summaries written from the transcript, so the record is complete when the call ends.
On the platform you already run
ServiceNow Customer Service Management
Digital workflows, portals, case management and Now Assist generative AI for customers and agents.
Microsoft 365 and Power Platform
Copilot Studio agents and Power Automate workflows inside your own Microsoft tenant.
Your cloud, through Availe
Custom agents on AWS Bedrock, Azure AI Foundry, Google Vertex AI or Anthropic Claude, in your own cloud account.
Four tests we hold it to
Accountable
A person owns every decision that affects a customer's entitlement, and AI never declines a claim.
Explainable
Every answer and draft cites the policy, process or record it came from.
Fair
Vulnerable customers are recognised and routed to people, and outcomes are monitored for bias.
Bounded
Agents act only within the steps and permissions the process model allows, and every action is logged.
Our AI practice, Availe, designs, builds and governs these agents, including AI Control Tower governance on ServiceNow, and transfers the capability to your teams. Availe's capability statement (opens in a new tab)
How we deploy
Listen, map, model, transfer.
We deliver the talent, the methods and the tools, and leave your people able to run and improve the service themselves.
Listen
We learn from your teams' knowledge of requirements and operational realities, before proposing anything.
Map
We co-design a detailed map of the service landscape, aligned with your operational goals and obligations.
Model
We build the process models, digital workflows and AI assistance that meet your outcomes.
Transfer
Comprehensive training and knowledge transfer, so your staff sustain the capability.
From first workshop to live service in about 12 weeks
- Weeks 1–5
Clear scope
Early alignment on the first journey, owners and success measures, reducing delivery risk.
- Weeks 5–10
Configured environment
Models, workflows and integrations built and tested, enterprise-ready for deployment.
- Weeks 9–12
Confident staff
Role-specific, hands-on learning, so people are ready to use the new service.
- Week 12 on
Smooth go-live
Hypercare support, and ongoing process capture as the service grows.
What makes it work
- Key contacts available from the start, for timely onboarding and workshops
- Alignment with your broader process management and transformation plans
- Timely export of existing process content, so years of work are reused, not rebuilt
- A business owner for the service by go-live
Ways to start
Start where the effort is.
Four ways in, each scoped and valued on its own. Most insurers start with one journey and widen from there.
Journey mapping assessment
One claims or service journey modelled end to end, with obligations, hand-offs and pain points marked, and a costed plan for workflows and AI.
Tailored platform demonstration
Your own processes shown in a purpose-built Holocentric instance, so teams see the fit before anyone commits.
12-week deployment
The first journey modelled, built into digital workflows and live with hypercare, then scaled journey by journey.
AI uplift for existing workflows
AI customer service added to the workflow platform you already run, grounded in the process model and governed through Availe.
The outcome
Faster to competence. Cheaper to improve.
Results Holocentric clients report from modelling their processes on the platform.
- 25%less time for staff in new roles to become effective
- 30–60%lower process improvement cost and cycle time*
- Up to 50%less time spent developing task-level processes
*Forrester Total Economic Impact study, 2021. Figures published by Holocentric.
Where does your claims journey stall?
Start with one journey. We'll map it end to end, show where digital workflows and AI would take effort out, and give you a plan you can act on.