Context-aware reasoning
Reads the assembled claim rather than a prompt template, so an agent's behaviour reflects your workflows, your fields and the specific state of the claim in front of it.
02 / Platform
One context layer.
Every agent reads it.
The agents are the visible part. Underneath them sits a single representation of the claim: the structured record from your system, the correspondence, the documents, the call history and the state of every outstanding request. Every agent works from it, and every agent writes to it.
This is the difference between automation that survives contact with a real book of claims and automation that demonstrates well and then quietly gets switched off.
A script can answer a question. Only a shared context can answer the same question twice, correctly, across two channels, a week apart.
01 / Context
What the agents actually read.
A claim is more than the row in your system of record. The context layer assembles the rest of it.
Most claims automation fails on the same point: it can see the fields and not the file. It knows a claim is open and a payment was issued, and it has no idea that the provider wrote three weeks ago to say the course of treatment changed.
The context layer closes that gap. It assembles the structured record, the correspondence thread, the documents, the call history and the open requests into one current view of the claim, and keeps it current as events happen rather than as a nightly export. Every agent reasons over that view.
It is not a second system of record, and it is not a data lake we ask you to migrate into. Your claims-management system remains the authority. The context layer reads from it, writes back to it, and is reconciled against it continuously.
- What it assembles
- Claim and policy fields from the system of record, party and contact records, inbound and outbound correspondence, every document attached to the claim, call recordings and transcripts, agent notes and actions, and the state of each outstanding request.
- How it stays current
- Real-time ingestion of events from your systems, plus write-back the moment an agent acts, so the view an agent reasons over reflects the claim as it stands rather than as it stood overnight.
- How documents enter it
- Any file attached to the claim is parsed, dated, typed and indexed, so a medical report from 2024 and an email from this morning are both addressable by the same question.
- What it is not
- A replacement system of record, a migration project, or a permanent copy of your book held outside your controls. Authority stays with your system and your access model.
02 / Capabilities
Six capabilities, working as one system.
The agents are assembled from these. Each is useful on its own, and each is sharper for the others being present.
Voice dialer
Handles inbound and outbound calls end to end: verification, conversation, extraction of what was said, and a written record attached to the claim.
Email automation
Turns inbox complexity into structured data and manages outbound correspondence with every party on the claim, including replies, requests and follow-ups.
Document parser
Turns any claim file into chronological, indexed, addressable data, including scans and handwriting, with the page and passage retained for citation.
Adjuster assistant
Retrieval, analysis and recommendation beside the adjuster, grounded in the file and cited to the source, never in place of their judgment.
Multilingual voice
The voice agents operate in more than one language, carrying the same claim context, the same disclosure and the same limits into each.
03 / Lifecycle
How a claim moves through it.
Four stages. The claim stays in your system throughout; what changes is how much of the work between the stages a person has to perform.
Capture
The loss arrives on whatever channel the reporter used. Audio is transcribed, documents are parsed, and the report is held together with its source.
Intake
Fields are extracted and validated, the policy is matched, duplicates are checked, and a complete claim is filed in the system of record with the original attached.
Engage
Inbound status is answered, outbound requests are worked and chased, and incoming correspondence is parsed, structured and written to the claim as it arrives.
Resolve
The adjuster works from an indexed file and a cited summary, with every agent action recorded beside the claim, and makes the decisions that are theirs to make.
Nothing in this sequence asks your team to work somewhere new. The claim is opened, updated and closed in the system they already use. The agents operate on the parts of each stage that are mechanical, and the file they leave behind is the one your team would have assembled by hand.
04 / Orchestration
Who does what, and when to stop.
Agents sharing one claim need rules about precedence, timing and handover. Those rules are explicit and they are yours.
01
Routing
Work reaches an agent by channel and by type: inbound calls by the number and the intent expressed, email by mailbox and thread, documents by the claim they are attached to, outbound tasks by the queue they sit in. What an agent is not configured for goes to a person rather than to a best guess.
02
Priority and timing
Outbound work runs on a cadence you set per task type, with quiet hours, attempt limits, retry intervals and a defined deadline at which the task leaves the agent and joins a human worklist.
03
Escalation thresholds
Every agent has explicit conditions under which it stops: low confidence in what it heard or read, a party asking for a person, a dispute or complaint, a regulatory question, a safety or fatality indicator, or any claim characteristic your team nominates. Thresholds are set with you and changed by you.
04
Handover
When an agent escalates, it hands over the context: who was on the call, what they asked, what was already said, what the agent established, and why it stopped. Nobody restarts a conversation from the beginning because a machine ran out of road.
Grounded, cited, or silent.
Anything the system states about a claim is drawn from that claim's record and carries a reference to where it came from. The adjuster can open the page and read the sentence for themselves.
Where the file does not support an answer, the system says the file does not support an answer. We would rather return a gap than fill one. In claims, an invented detail is not a rough edge, it is a liability.
05 / Configuration
What gets set up, and by whom.
Configuration is a working session with the people who run the queue, not a procurement exercise.
- Field mapping
- How each thing an agent captures lands in your schema, including code sets, jurisdictional fields and anything your organization treats as mandatory at filing.
- Permitted speech
- What an agent may say and ask on your behalf, per channel and per party type, including disclosure language and the limits on what can be disclosed to whom.
- Escalation rules
- The conditions under which each agent stops and hands over, the destination for each kind of handover, and the context that travels with it.
- Cadence and limits
- Attempt counts, retry intervals, quiet hours, voicemail behaviour and the deadline at which an outbound task becomes a human task.
- Write-back policy
- Which fields an agent may write, which it may only propose, and what note format your team wants on the claim for each kind of action.
- Access
- The credentials and scopes an agent operates under, issued by you, revocable by you, and no broader than the role you would give a person doing the same job.
06 / Measurement
How you know it is working.
An agent you cannot inspect is an agent you cannot trust with a claim.
01
Everything is reviewable
Calls are recorded and transcribed, emails are threaded, documents are retained with the passage an answer was drawn from, and every write-back is logged with the agent, the action and the time. Review is reading the record, not reconstructing it.
02
Sampling and correction
Teams typically review a sample of interactions per agent per week at the start, concentrated on escalations and on anything flagged low confidence. What the review finds becomes a configuration change, and the change is dated, so you can see what behaviour was in force on any given day.
03
Outcome tracking
The measures that matter are yours and they are operational: how much of a queue an agent carried, how often it escalated and why, how long an outstanding request took to close, and how many claims arrived complete enough to triage without a follow-up. We report against your numbers rather than ours.
Questions
What usually comes up next.
Do we have to replace our claims-management system?
No. The platform is built on the assumption that you will not, and that any vendor who asks you to is proposing a different project. Your system of record stays authoritative. MAVALLI reads it, writes to it, and reconciles against it.
What happens if your system is unavailable?
Claims work continues in your systems, because that is where it lives. Inbound calls fall back to your existing routing, and outbound tasks remain in the queue until they can be worked. No claim is held hostage inside the agent layer.
How does it handle a claim it has never seen a pattern for?
It escalates. An agent is configured for a defined set of tasks on a defined set of claim types, and anything outside that set is a handover with context rather than an attempt. We would rather an agent carry eighty percent of a queue reliably than ninety percent of it unpredictably.
Can we see and change what an agent is allowed to say?
Yes. Permitted speech, disclosure language, escalation thresholds and write-back scope are all configuration agreed with your team, and changes are versioned and dated so you can tell what was in force when any given call was handled.
Does it work on handwritten and scanned documents?
Yes. The document parser handles scans and handwriting alongside digital files, and anything it transcribes carries a confidence read. Low confidence on a field that matters is an escalation rather than a guess written to the claim.
Next step
See it against your own claims.
The useful conversation is a specific one. Bring a queue, a workflow and the systems it runs on, and we will tell you what fits.
Get in touch