# First Notice of Loss Prep Agent

Agent blueprint, validated with 8 team members · Task: Report new claims (first notice of loss) · Commercial Lines Service · readiness 81/100 · Ready for an agent

Reads the client's loss report in Outlook, matches the account and policy in Applied Epic, and prepares the claim record and the carrier portal entry. A CSR approves the prepared claim once, then a browser agent enters it in the carrier portal. The claim number is recorded in Epic and a reply to the client is drafted for approval.

**Trigger:** A client loss report arrives by email in the CSR's Outlook (calls are keyed in as a short note or forwarded summary).

**Inputs:** Client email or call note (who, what, when, where, injuries, police report number if any); Applied Epic account, policy number, contact details and deductible; Carrier for the policy (from the Epic policy record); Estimated loss amount, if the client gave one

**Done when:** The carrier's claim number is recorded in Applied Epic and sent to the client.

## Steps

1. Read the new loss report and extract the key facts (Microsoft Outlook, connector): Outlook trigger passes the email to the model, which pulls date of loss, description, injuries, police report number and contact.
2. Draft the loss description in the client's own words (Microsoft Outlook, ai): Who, what, when, where, plus the police report number if there is one. No coverage advice.
3. Find the client account and candidate policies (Applied Epic, api): Match on sender, name or policy number. If there is no single clear match, hand to the CSR.
4. Suggest claim type and flag injuries or near-deductible losses (Applied Epic, ai): Vehicles = Auto, building damage = Property, customer injuries = General liability. Anything else goes to the CSR.
5. Show the prepared claim to the CSR for review and approval (Applied Epic, person): The CSR checks policy, claim type, description and carrier, edits if needed, and approves. Nothing is saved or submitted before this.
6. Create the claim and the activity in Epic with status (Applied Epic, api): Writes claim type, loss description and claim status. Logs the client request as an activity.
7. Enter date of loss, description, policy number and contact in carrier portal (Carrier agent portals, ui automation): These portals have no API, so a browser agent works the screens with the approved data. It stops for a person if a screen doesn't match.
8. Phone the carrier the same day for injury claims (Carrier agent portals, person): The CSR makes the call in addition to the online report. The agent supplies the claim summary and a reminder.
9. Read the carrier claim number from the portal confirmation (Carrier agent portals, ui automation): Browser agent captures the number and the confirmation screen. If none appears, hand to the CSR.
10. Record the claim number and update claim status in Epic (Applied Epic, api): Runs after the CSR has confirmed the portal submission succeeded.
11. Draft the reply to the client with the claim number (Microsoft Outlook, ai): Short confirmation with the claim number and next steps. No coverage statements.
12. Review the reply and send it to the client (Microsoft Outlook, person): The CSR approves, then the reply is sent from Outlook. This closes the case.

## Approvals

- CSR approves the prepared claim (policy match, claim type, description, carrier) before anything is written to Epic or submitted to a carrier portal
- CSR confirms the portal submission and claim number before the Epic update
- CSR approves the reply to the client before it is sent
- CSR makes the same-day phone report on injury claims

## Prerequisites

- Applied Epic API access with a service account that can read accounts and policies and write claims and activities; confirm the API supports creating claims
- Power Automate and Microsoft 365 Copilot licences, including attended or desktop automation capacity
- Outlook connector on the shared or CSR mailboxes in scope
- A dedicated agent sign-in for each carrier portal (Travelers, The Hartford, Liberty Mutual), with multi-factor handled in a way the carriers permit
- Check each portal owner's terms on automated access before building
- Written same-day reporting and injury-phone-report rules, with the carrier phone numbers

## Risks

- Portal screens change without notice: monitor runs, alert on failures, and hand to a person whenever a screen doesn't match
- Carrier terms or MFA policies may restrict automated access to the portals
- A wrong policy match or claim type could reach a carrier, so the single approval screen must show these clearly
- The team disagrees on near-deductible and unusual cases, so the agent could mishandle a case if these rules are not settled
- Savings are modest (about 30-50% of 5.5 team hours a week, roughly 2 hours): exception review and portal maintenance could eat into this

## Measure after launch

- Median work time per claim (baseline 10.1 min) and team hours per week (baseline 5.5)
- Share of claims reported to the carrier the same day (baseline not measured; start tracking before launch)
- Share of claims handed to the CSR to finish by hand, by reason
- Claims where the Epic record and the carrier portal disagree (baseline 0% observed mismatch)

## Decisions

| Decide | Rule | Source |
| --- | --- | --- |
| Claim type | Choose by what happened: vehicles involved is Auto, damage to the building is Property, injuries to customers is General liability. Most of the team agree. Other types (e.g. workers' comp) are not described. | team |
| Reporting channel | Injury claims are reported to the carrier by phone the same day, in addition to the portal. All other claims go through the carrier's agent portal. | team |
| Whether to report a loss near the deductible | Unclear. A minority say to ask the client; most say to report every loss the same day even if the client is unsure. The agent flags these and does not decide. | team |
| Which carrier and portal to use | Not known yet: ask the team | unknown |
| Claim status value in Epic | Not known yet: ask the team | unknown |
| Which policy the loss falls under when several could apply | Not known yet: ask the team | unknown |

## Still to answer before building

- Where are the same-day reporting rule and other claim policies written down, and who owns them?
- What is the deadline and process for the injury phone report, and which carrier numbers are used?
- How is the carrier chosen for a claim, and does the carrier determine which portal is used?
- How are claim types beyond Auto, Property and GL chosen (e.g. workers' compensation)?
- How is the claim status in Epic chosen, and which values are used?
- For losses near the deductible: does the same-day rule apply, or does the CSR ask the client first, and what counts as near?
- Why do about a third of people give 'other' as the reason for retyping?
- How often do unusual cases really occur? About 7 in 10 said almost never and about 3 in 10 said often.

## Exceptions

- When The claim involves injuries (not separately measured; the team disagrees on how often unusual cases occur): Flag it at the review step. The CSR phones the carrier the same day as well as using the portal.
- When The loss is close to the deductible (described by a minority; conflicts with the same-day rule): Flag it for the CSR with the estimated loss and deductible. The agent does not decide whether to report.
- When The report is missing details (date, policy, contact, description): Hand to the CSR with what was found and a list of what is missing, with a draft question to the client.
- When No single account or policy match: Hand to the CSR with the candidate accounts and policies.
- When Claim type is not Auto, Property or GL (e.g. workers' comp), or the carrier is not one of the three portals: Hand to the CSR with the extracted facts. No rule is known for these.
- When The client asks a coverage question: Hand to licensed staff. The agent gives no coverage advice.

## Build with

- Power Automate: Outlook trigger, Epic API calls, approval flow, orchestration and run logging
- Microsoft 365 Copilot / Copilot Studio: Extracts facts, drafts the loss description, suggests claim type, drafts the client reply
- Power Automate desktop / browser agent in Microsoft Edge: Works the Travelers, The Hartford and Liberty Mutual portal screens
- Applied Epic API: Reads accounts and policies; writes claims, activities and claim numbers

## Effort and return

- Size L, about 5-8 weeks (Power Automate, Copilot Studio prompts, Applied Epic API, browser/UI automation, testing with CSRs)
- Team time on this task now: 6 h/week; expected back: 2-3 h/week

## Evidence

- 90% of cases follow the same steps (some skip a step)
- 6 team hours a week
- data is moved by hand from Applied Epic to Liberty Mutual Agent Portal (64% retyped)