Use case
Claims and complaints
From complaint to reasoned decision: evidence assembled, checked against contract and rules, resolution proposed with reasoning. A person decides.
01The problem
What the work looks like today
A complaint or damage claim means collecting evidence from emails, photos, delivery documents and contracts, checking it against policy and liability, and deciding. Cases sit for weeks because collecting takes longer than deciding.
02Failure modes
Where time and quality are lost
Three patterns we see in almost every operation of this kind.
- 01
Cases wait for information that already exists somewhere
- 02
Decisions depend on who handles the case
- 03
Goodwill is granted without a record of why
03The agent
What the agent does, step by step
Assembles the case file: order, delivery, correspondence, photos, contract terms. Checks the claim against the applicable rules and past decisions, quantifies the exposure and proposes a resolution with reasoning. Missing evidence is requested from the customer in a drafted message.
04Human checkpoint
Where a person decides
A claims or quality specialist decides every case above a threshold. Below it, the agent's proposal is released with one click. Refusals always go to a person.
05Control set
What is enforced and logged
Every decision records the evidence considered and the rule applied. Thresholds for auto-release are set by finance and reviewed monthly. Payments are never triggered by the agent.
06Measurement
What the monthly report shows
Four numbers, against the baseline from the assessment.
- 01
Time to decision
- 02
Share of cases decided within SLA
- 03
Consistency of decisions across handlers
- 04
Goodwill cost per case