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.
Cases wait for information that already exists somewhere
Decisions depend on who handles the case
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.
Time to decision
Share of cases decided within SLA
Consistency of decisions across handlers
Goodwill cost per case
Questions
Common questions
Does the AI agent decide on complaints?
How does AI help with the 8D report?
Which metrics improve?
Where to go next
Service
Workflow Build
This workflow in production in 8 to 12 weeks, with its control set.
Service
Workflow Assessment
First check whether this workflow is the right first one for you.
Guide
Human in the loop AI: levels, release points and the EU AI Act
What human in the loop means for AI agents in operations, when human on the loop is enough, and how to widen release rights per case category on evidence from shadow mode. With a template and the rules from the EU AI Act, GDPR and German works council law.
Guide
8D report with AI: template, disciplines and who decides
An AI agent can prepare the gathering work in an 8D report: the problem description from complaint data, the evidence pack, similar past cases, deadline tracking and the customer letter. Containment, root cause and corrective action remain decisions for your quality engineers and the 8D team.
Guide
Complaint management process: steps, ISO 9001 duties and KPIs
Nine steps from intake to closure, the ISO 9001 clauses that apply, six KPIs with definitions, and a clear line between what an AI agent prepares and what people decide.
Next step
Strategy call
Clarify whether this workflow fits your priority.