# Billing Question Triage and Draft Agent

Agent blueprint, validated with 8 team members · Task: Resolve billing questions · Commercial Lines Service · readiness 61/100 · AI assist (a person acts)

Reads an incoming billing question in Outlook, pulls the account and installment details from Applied Epic, and drafts a reply. Where Epic doesn't answer, a browser agent looks up the carrier portal billing record. A person reviews and sends every reply and requests any refund or correction.

**Trigger:** A client email about an invoice, double charge or past-due notice arrives in the team's Outlook mailbox (channel assumed to be email; to be confirmed).

**Inputs:** Client email (sender, question, any invoice or policy number); Applied Epic account, policy, carrier and billing/installment details; Carrier on the policy (Liberty Mutual, The Hartford, Travelers); Carrier portal billing record for the invoice or policy number (when needed); Team billing knowledge base (KB)

**Done when:** The client knows what they owe, and any refund or correction has been requested from the carrier; the activity is logged in Applied Epic.

## Steps

1. Detect new billing email and capture sender and message text (Outlook, connector): Power Automate trigger on the shared mailbox; filter with AI classification to separate billing questions from other requests.
2. Extract client, invoice number, policy number and question type from the email (Outlook, ai): Question types: invoice explanation, double charge, past-due notice. Flag missing identifiers.
3. Find the client account and read policy, carrier and installment details (Applied Epic, api): Match on client name, policy or invoice number; return the carrier and billing records.
4. Decide whether Epic answers the question or the carrier record is needed (Applied Epic, ai): Rule is unclear from the team; start by sending any case where Epic shows no clear answer or a possible duplicate to the portal lookup.
5. Look up the carrier billing record using the invoice or policy number from Epic (Carrier agent portals, ui automation): Portals have no API (ui only). Browser agent works the Billing Center screens for Liberty Mutual, The Hartford or Travelers, read-only.
6. Compare Epic and carrier records and note any double charge or discrepancy (Applied Epic, ai): Summarize what each system shows; do not decide whose error it is.
7. Draft reply stating what was found in both systems and next steps (Outlook, ai): Save as a draft only. No coverage advice; flag anything that needs licensed staff.
8. Review findings, edit the draft and approve sending (Outlook, person): Account manager checks the draft and portal findings, and sends the reply.
9. If a double charge or error is confirmed, request refund or correction from the carrier (Carrier agent portals, person): Person decides and makes the request; method (portal, email or call) not yet defined.
10. Log the request and reply as an activity on the account (Applied Epic, api): Required for every client request. Runs after the person approves; the agent fills in the summary.

## Approvals

- Account manager approves and sends every client reply (the agent never sends unattended).
- Account manager decides whether a refund or correction is needed and requests it from the carrier.
- Account manager approves the activity log entry before it is written to Applied Epic.

## Prerequisites

- Applied Epic API access and a service account with read access to accounts and billing, and write access to activities
- Shared mailbox access and Outlook connector
- Microsoft 365 Copilot and Power Automate licenses (already held)
- Dedicated sign-in for the browser agent on each carrier portal, with multi-factor handled
- Check each carrier portal owner's terms on automated access (Liberty Mutual, The Hartford, Travelers)
- Copy of the team KB for billing questions, and sample reply wording from the team

## Risks

- Carrier portal screens change without notice; monitor runs and hand to a person when a screen doesn't match.
- Portal terms or MFA may restrict automated access, which would force the lookup back to a person.
- The draft could misstate whose error it is or imply coverage advice; mitigated by person review and wording limits.
- KB contents unknown, so the drafts may miss approval or refund rules.
- Only 15–30% time saved is expected, since checking and judgment stay with a person.

## Measure after launch

- Median work time per billing question (baseline 4.5 min across 147 cases a week)
- Team hours a week on billing questions (baseline 12.4)
- Share of replies sent with minimal edits to the draft
- Share of cases where Epic data was retyped into a portal (baseline 42–55% per transfer)

## Decisions

| Decide | Rule | Source |
| --- | --- | --- |
| Whether a carrier portal visit is needed | Open the carrier's agent portal when Applied Epic does not give the answer. The team gave no more precise trigger; the carrier on the policy picks which portal. | team |
| Which carrier portal to open | The carrier on the policy in Applied Epic (Liberty Mutual, The Hartford or Travelers). | team + data |
| Where to look first for carrier billing details | Team is split: Applied Epic first (43%), call or email the carrier (29%), or carrier portal (28%). Agent starts in Epic, and the team must confirm this. | team |
| Whether a refund or correction is needed | If the review shows a double charge or error, request a refund or correction from the carrier before closing. What counts as an error and how to request it is unclear. | team |
| How urgent leadership requests are handled | Not known yet: ask the team | unknown |
| Reply wording and structure | A reply stating what was found in both systems and what happens next. No fixed template exists. | team |

## Still to answer before building

- Which channel do billing questions arrive through: email, phone or something else?
- Exactly which cases need a carrier portal visit, and what is looked up there?
- What is the exceptional handling for urgent leadership requests?
- What does the team KB say about approvals, checks and who may request refunds or corrections?
- How is a refund or correction requested from the carrier (portal, email or call)?
- Are there other cases that don't fit the usual handling besides leadership urgency?
- Do the carrier portals permit automated access under their terms, and can a dedicated agent sign-in be set up?

## Exceptions

- When Epic gives the answer without a portal visit (about 60% of cases involve no portal; exact trigger unclear): Skip the portal lookup and draft from Epic data alone, noting the source.
- When Carrier portal lookup needed (about 36–40% of cases, split roughly Liberty Mutual 40%, The Hartford 36%, Travelers 28%): Browser agent retrieves the billing record by invoice or policy number; on any failure, hand to a person with what Epic showed.
- When Portal screen doesn't match what the agent expects, login fails or MFA prompts: Stop, hand the case to a person with the Epic findings and a link to the email.
- When Invoice or policy number missing or no matching account in Epic: Draft a request for the missing detail for the person to review; don't guess.
- When Urgent request from leadership (sometimes to often; handling not described): Not known. Until the team defines it, flag the case for a person and don't change the queue order.
- When Question involves coverage advice or who made the error: Hand to licensed staff or the account manager; the agent only summarizes the facts.

## Build with

- Power Automate: Mailbox trigger, orchestration, calls to Epic API, approval and logging flow
- Microsoft 365 Copilot / Copilot Studio: Classify the email, extract identifiers, compare records, draft the reply
- Outlook connector: Read the incoming email and save the draft reply
- Applied Epic API: Account, policy and billing lookup; activity logging
- Power Automate Desktop / browser agent: Read-only lookup of carrier portal billing screens

## Effort and return

- Size M, about 4-7 weeks (Power Automate, Copilot Studio, Applied Epic API, Browser or UI automation, Insurance billing process knowledge)
- Team time on this task now: 12 h/week; expected back: 2-4 h/week

## Evidence

- 35% of cases follow the same steps (some skip a step)
- 12 team hours a week
- data is moved by hand from Applied Epic to Liberty Mutual Agent Portal (45% retyped)
- 3% of cases redo steps
- 36% of cases need an extra lookup (an exception the agent must handle)