Triaje de siniestros
Triages the claim call in the first ten seconds, opens the folio immediately when it's urgent, and walks a full documented intake when it isn't — never renders a coverage decision itself.
THE CONTEXT
The hardest call of the relationship, stuck in a queue
The claim call comes in at the worst moment — someone is in the ER and the hospital wants a card guarantee — and it waits in the same queue as a balance inquiry. Reimbursement claims fare just as badly: a generic checklist produces incomplete files, and each round of missing paperwork adds weeks to the payout.
THE SOLUTION
Triaged in the first ten seconds, filed before the call ends
The agent classifies the call into one of three routes in the first turn and escalates immediately on any life-risk signal. It opens the claim file — with the authorization letter already triggered on the urgent route — without ever needing the policy number.
This is how a triage call actually goes.
Watch the agent confirm it isn't a medical emergency, open the folio without a policy number, and trigger the authorization letter.
KEY CAPABILITIES
A system built to triage first and file second
One closed question decides everything
Asks if the caller needs an ambulance right now — a question someone in crisis can actually answer — instead of asking them to describe or classify the emergency.
No policy number required
Looks the policyholder up by name and date of birth, because that's what someone calling from a hospital actually has on hand.
Authorization letter triggered live
Opens the claim file and fires the hospital authorization request in the same call, with a committed response time.
Never dictates coverage
Classifies, opens, and routes the case — whether a claim is payable is always decided by the claims desk, never by the agent.
Before / After
The claim call stops waiting in a queue and starts opening a folio in the first minute.
Life-risk calls escalate in the first turn, no queue
Folio opened and authorization letter triggered inside minutes
Checklist matched to the exact case, fewer missing-document cycles
FAQs
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