Avallon

Product Introduction

1. Avallon is an AI-powered claims operations automation platform designed for insurance carriers, MGAs (Managing General Agents), and TPAs (Third-Party Administrators). It transforms manual, complex claims workflows into automated resolutions using agentic AI systems that interact with stakeholders and process data autonomously. The platform handles tasks such as claim intake, status updates, third-party communications, and data analysis without human intervention.
2. The core value of Avallon lies in its ability to reduce operational costs by up to 60% while increasing adjuster productivity through end-to-end automation of claims workflows. It achieves this by deploying context-aware AI agents that integrate directly with existing claims management systems (CMS), communication channels, and data repositories.

Main Features

1. Claim Intaker: Automates the capture of new losses via phone, email, or file upload, eliminating manual data entry by directly filing claims into CMS platforms. The AI validates claimant information, cross-references policy details, and flags inconsistencies in real time.
2. Case Status Receptionist: Answers inbound status request calls using real-time claim data and provides contextual updates to claimants. The system integrates with IVR (Interactive Voice Response) systems to route complex queries to human adjusters only when necessary.
3. Third-party Reacher: Automates outbound calls to employers, healthcare providers, and injured workers to gather updates, using natural language processing (NLP) to log responses directly into case files. The dialer system retries unanswered contacts and prioritizes urgent cases based on predefined rules.
4. Avallon Copilot: Analyzes claim histories, cites relevant policy clauses, and recommends actions such as approvals, denials, or escalations. It pulls structured data from documents, emails, and CMS databases to generate audit-ready reports with source citations.

Problems Solved

1. Manual Workflow Inefficiency: Avallon addresses the time-consuming nature of claims processing, where adjusters spend 40-50% of their time on administrative tasks like data entry and status updates. The platform automates these workflows, reducing average handling time (AHT) by 30-45%.
2. Target User Group: The product serves insurance carriers, MGAs, and TPAs in the US and Europe managing workers' compensation, property & casualty (P&C), and health claims. It is particularly valuable for organizations processing over 10,000 claims annually.
3. Typical Use Cases: Automating first notice of loss (FNOL) intake, resolving 80% of inbound status inquiries via AI, coordinating with third-party stakeholders (e.g., medical providers), and generating compliance-ready documentation for audits.

Unique Advantages

1. End-to-End Workflow Integration: Unlike point solutions that automate isolated tasks, Avallon’s AI agents operate across the entire claims lifecycle, from intake to resolution. This includes bidirectional synchronization with CMS platforms like Guidewire and Duck Creek.
2. Agentic AI Architecture: Avallon’s AI proactively initiates actions (e.g., auto-dialing providers) rather than merely responding to triggers. It uses reinforcement learning to optimize communication timing and channel selection (e.g., email vs. phone) based on historical success rates.
3. Enterprise-Grade Customization: The platform supports custom rulesets for claim routing, compliance thresholds, and escalation protocols without requiring API development. Prebuilt connectors for IVR systems, data warehouses (Snowflake, BigQuery), and CRMs ensure deployment in under 4 weeks.

Frequently Asked Questions (FAQ)

1. How does Avallon integrate with existing claims management systems? Avallon connects to CMS platforms like Guidewire and Duck Creek via prebuilt APIs, enabling real-time data synchronization and write-back automation. Custom integrations can be configured for proprietary systems using RESTful APIs or SFTP pipelines.
2. Can Avallon handle complex workers’ compensation claims involving multiple stakeholders? Yes, the platform automates multi-party coordination by auto-dialing employers, medical providers, and claimants, then reconciling conflicting data using policy-specific logic. Complex cases are escalated to human adjusters with annotated context.
3. What security measures protect sensitive claims data? Avallon employs AES-256 encryption for data at rest and TLS 1.3 for in-transit data, with SOC 2 Type II compliance. Access controls include role-based permissions and audit trails for all AI-driven actions.
4. Does Avallon support non-English claims processing? The platform currently handles English and Spanish interactions via voice and text, with plans to add French and German in Q4 2024. Custom language models can be trained for niche dialects or industry jargon.
5. How is AI accuracy measured and improved? Avallon’s NLP models are validated against human adjuster decisions, with a 98.2% accuracy rate for routine tasks. Continuous feedback loops update models weekly using anonymized claim data, while edge cases are routed to quality assurance (QA) dashboards for review.