FNOL Claims Triage: New Claims Routed, Reserved and Assigned on Policy

After a storm, the notices come in faster than the coverage checks

Storm weekends bring first notices of loss in a burst. Each one needs a coverage check against the policy schedule, a disposition (approve, deny, pend for information or refer to special investigations), a handling track, an initial reserve from the reserve table and, for approved claims, an adjuster in the right region with room on their list. A notice that arrives after the reporting window carries a late-notice reason, which the supervisor may later waive.

Claims are in Salesforce, the policy schedule and reserve table are in Airtable, photos and loss statements land in Box, and policyholders and brokers write in to Gmail. The reserve report for finance is generated automatically and saved to Google Drive. When an endorsement turns up or the reserve table is revised, the change has to run through adjusters, reserves, tracks and regional totals, and some of it gets missed.

Who works in the room

The team made Myco the default agent in the intake room, since most messages there are new notices to triage. Questions about a reserve figure go to Ada, which owns the reserve checks, and anything a policyholder or broker will read goes to Fin. When Myco changes a claim's disposition, it mentions Ada in the thread with the claim and the proposed reserve, and Ada confirms the figure against the table before the supervisor approves.

From first notice to regional closeout

Coverage comes first, then the reserve, then the adjuster. For a storm batch, Myco splits the photos and statements across parallel helpers and gets one result back.

When the facts of a claim change

A broker emails that the policyholder added a water backup endorsement last spring, and it sits on the Airtable schedule under a separate line. Myco triages the claim again from the start: the denial falls away, the claim is approved, and it now needs a reserve from the water row of the table, a track and an adjuster. Ada checks the reserve, the supervisor approves the changes together, and Fin drafts the update to the broker on the same thread.

A late-notice waiver is narrower than it looks. When the supervisor waives late notice for claims from the storm, Myco removes that reason and walks each claim through the remaining rules. Some are approved. Others stay pending because photos are missing, or move to investigations. Reserve Table v2, issued midweek, applies only to claims that are approved or referred, and the regional totals are rebuilt from the records afterward.

What the checks catch

• A waived late notice treated as an approval, when the claim still has to pass every other rule
• Reserves recomputed under the new table for claims that are denied or pending
• A newly approved claim with no adjuster, or one recorded outside the team's conventions
• Amounts in the generated reserve report that do not match the table row for the claim's peril and severity
• Regional totals that still count a claim under its old disposition

What stays with people

• Approving every disposition, reserve and assignment before Salesforce changes
• Waiving late notice, and deciding referrals with special investigations
• Sending every email to a policyholder or broker, which Fin drafts in Gmail
• Signing the regional closeout

Integrations in this workflow

Kylon is not a claims administration system, and it does not replace the one you run. It works alongside Salesforce, Airtable, Box and the inbox, and carries the handoffs between them.

• Airtable
• Box
• Gmail
• Google Drive
• Salesforce
• Slack

• Salesforce holds the claim records with disposition, track, reserve and adjuster
• Airtable holds the policy schedule with perils and endorsements, and the reserve table
• Box holds photos, loss statements and estimates for each claim
• Gmail carries policyholder and broker emails, answered through drafts the claims service team sends
• Google Drive keeps the handling guidelines and the reserve report for finance
• Slack is where adjusters post field updates that Fin turns into drafts for policyholders

Where to start

Pick one region and one week of notices. Connect the Salesforce claim object and the Airtable schedule, point the room at the Box intake folder, and write the one rule that matters into the room guidelines: Myco proposes the disposition, reserve and adjuster for each claim, and the intake supervisor approves every one before it is recorded.

“A waived late notice now means one less reason, not an automatic yes.”

Set it up with your agent

Open a new Room, add your agent and paste this prompt. It connects the tools, builds the App with you and asks for your rules one step at a time, and nothing goes out until a person approves it.