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AI Claims Report Setup Guide

Download the template here: AI Claims Report Template

The template records claims for six lines of business (motor, home building, home contents, personal liability, accident, mobile and electronics) with 30 claim types. Customers pick the line and claim type by click or describe the loss in their own words. An AI agent asks for all missing details, checks them for plausibility and creates a claims dossier that your claims team can usually process without follow-up questions.

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Modules that need your input carry a TODO annotation in the agent editor. Work through these annotations and the steps below before you go live.

Setting Up the Agent​

1. Load the Template​

Load the "AI Claims Report" (German: "KI-Schadensmeldung") template into your tenant. How to get templates

2. Set the Languages​

The template is available in German, English, French, Italian, Polish, Turkish and Ukrainian. Remove the languages you do not need in the Languages tab. Whatever language the conversation is held in, the fields sent to your claims team are always written in German. Handle languages in LoyJoy

3. Customize the Welcome​

Replace the sample insurer name ("Muster Versicherung" in German, "Sample Insurance" in English) with your company name and add the link to your privacy policy in the intro text. Welcome module in detail

4. Guided Entry​

The first Questionnaire module asks for the line of business and the claim type via buttons. Depending on the line, it also asks who is reporting (policyholder or injured third party, for motor and liability) and, for accident claims, for consent to process health data. With "Other / unsure", customers describe the loss freely and the AI agent assigns line and claim type itself.

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To remove a line of business you do not offer, delete its button here and the matching instruction in the AI agent (see step 5).

5. AI Agent​

The AI Agent module leads the conversation. Its behavior is defined by instructions:

  • 01 Rolle und Ton: role, tone and contact details. Enter your company name, your service hotline and your 24/7 emergency hotline here.
  • 02 Ablauf: conversation flow, from the description of the loss to the summary the customer confirms. Usually no changes needed.
  • 03 Regeln für alle Sparten: mandatory details for all lines, police report rules, injured third parties and requests to speak to a person.
  • 04 Gesundheitsdaten: handling of health data for accident claims.
  • Sparte Kfz, Wohngebäude, Hausrat, Haftpflicht, Unfall, Handy und Elektronik: mandatory and optional details, review notes and customer obligations per line. Delete the instructions of lines you do not offer.
  • 05 Grenzen und Felder: limits (no statements on coverage, liability or benefit amounts) and the fields the agent fills before it hands over.

After the customer confirms the summary, the agent stores all fields (for example schaden_datum, schaden_hergang, pruefhinweise, kunden_zusammenfassung) and leaves the AI agent. The review notes in pruefhinweise are meant for your claims team only and are never shown to the customer.

6. Photo Upload (Optional)​

After the conversation, customers can upload a photo of the damage (up to 2 MB). The photo is attached to the dossier for your claims team. Delete this Questionnaire module if you do not need it.

7. Contact Details​

The following modules ask for first and last name, date of birth (Date of birth module, minimum age 18), policy number (optional), email address and phone number (optional). Adjust or remove questions to match your process.

8. Review Form​

In the Form module, customers check the claim and contact details and can correct them before submitting.

9. Handover to Your Claims System (Optional)​

The API client module "Übergabe Schadensystem (optional)" sends all fields to your claims system. It is disabled by a condition by default. To use it:

  1. Set the URL, authentication and payload of your claims system.
  2. Map the claim number returned by your system to the variable schadennummer.
  3. Remove the condition on the module.

If you do not connect a claims system, delete the module.

10. Dossier to Your Claims Team​

The Send email module "Dossier an Sachb." sends the complete claim with review notes, photo and conversation history to your claims team. Enter the recipient address and the sender name, and replace the color #2949A0 in the email HTML with your brand color.

11. Confirmation to the Customer​

A second Send email module "Bestätigung an Kunden" sends the customer a confirmation with claim number and summary. Adjust the sender name, the company name in the closing line and the brand color.

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In the template, the AI agent generates a demo claim number. In production, take the real claim number from your claims system (see step 9).

12. Remove the Demo View​

A Simple message module shows test users how the claim arrives at the claims team, including the review notes. It is meant for demos only: delete it before you go live.

13. Goodbye​

Say goodbye to your users in a friendly manner. Goodbye module in detail

Testing​

Play through at least one case per line of business you offer, once via buttons and once in free text. Check the dossier email and the customer confirmation, then publish the agent. Publish an agent