AXL — Agentic Experience Labs Genesys
Great American
& Genesys
Agentic Experience Lab
Prepared for
Great American Insurance Group
1 session
From an idea to a working AI agent.
Built with you
Side-by-side with Genesys AI specialists.
Yours to keep
See it, validate it, leave with a plan.
AXL — Agentic Experience Labs
What we know about you

Summit today

What you do
Summit, a Great American Insurance Group company, provides workers' compensation insurance and claims/billing services through four affiliate carriers — "Know the people who know workers' comp®."
Who you serve
7,000+ independent agents and 31,000+ policyholders across 18 states plus D.C. — and, on the billing line, the medical providers and injured employees behind every claim.
Service today
A relationship-led, human-touch model: a field team in every state, and a dedicated Medical Bill Reviewer group in Lakeland, FL fielding billing calls alongside fee-schedule audits and dispute handling.
Brand voice
Warm, plainspoken, specialist-not-corporate — "More access. More know-how. More commitment." Always a real person reachable.
Where the volume sits
Inbound billing/claims calls on Summit's medical bills — payment status, receipt confirmation, documentation, denials and appeals — the exact drivers named in your brief.

Signals we picked up

  • Summit publicly staffs a dedicated "Medical Bill Reviewer" role that fields billing calls and audits bills against state fee schedules — the same volume the brief wants to automate is already competing with core review work.
  • "You'll always be able to speak to a real human being" is a stated brand promise — any automation has to keep a fast, visible path to a person, not bury it.
  • Summit underwrites through four affiliate carriers across 18 states plus D.C. — claim identifiers and fee-schedule rules likely vary by state.
  • Bill Reviewers already own "billing disputes" and SIU referrals — denial and appeal questions sit with a specialist team today, not a generalist queue.

What we couldn't see from outside

  • The real volume mix across the five call drivers — the brief names them, not their share of total calls.
  • Which system(s) the Tax ID + Bill ID lookup would actually query today.
  • Whether the AI-powered leg after IVR authentication is voice, and what the existing IVR already exposes at hand-off.
AXL — Agentic Experience Labs
Where we'd start

Which one do we build in the lab?

One intent each, so it can be finished in a session. Pick one to prototype today — the others are parked, not discarded.
1
Recommended
Use case 1

Payment status inquiry

A caller already validated by the IVR (Tax ID + Bill ID) asks "has my payment gone out?" and gets a specific, dated answer — no hold, no transfer.

Tools2 actions + KB
SystemsBilling platform (mock)
Lab fitSingle read lookup
Brand-grounded Highest call volume
2
Use case 2

Documentation & submission status

A provider isn't sure a bill or its supporting records arrived — the AVA names exactly what's on file, what's outstanding, and offers to trigger a reminder.

Tools2 actions + KB
SystemsDocument tracking (mock)
Lab fitRead + confirmed write
Brand-grounded
3
Use case 3

Denial & appeal guidance

A caller whose bill was denied hears the specific reason and appeal deadline in plain language, then hands off to Appeals with the denial code already on screen.

Tools2 actions + KB
SystemsClaims & appeals (mock)
Lab fitExplain, then hand off
Brand-grounded Delivery proposed
AXL — Agentic Experience Labs
Use case 1 · deep dive

Payment status inquiry

Happy path
  1. The IVR has already collected and validated the caller's Tax ID and Bill ID and hands off to the AI experience with that context.
  2. The assistant confirms the bill it's looking at (provider, date of service, amount) so the caller knows it has the right one.
  3. It calls get_bill_payment_status and reads back the status — e.g. "processed on 9/18, payment issued 9/20 for $412.50."
  4. If the caller asks a follow-up ("what's an EOB?"), it answers from Billing Knowledge; otherwise it offers "anything else?" and closes cleanly.
Why it matters
Payment status is the single most common billing call named in your brief — and today each one ties up a Medical Bill Reviewer who also owns fee-schedule audits and dispute work.
Wow moment
A caller gets a specific, dated payment answer — no hold, no transfer — in under 30 seconds, built entirely on the identifiers the IVR already validated.
Tools & knowledge — what the assistant calls
Action Knowledge System
get_bill_payment_status
Action · Read
Looks up payment status, date and amount for a validated Bill ID.
New Data Action · mock billing platform
get_claim_context
Action · Read
Pulls the linked claim number, provider and date of service so the assistant confirms the right bill.
New Data Action · mock claims platform
billing_terms_knowledge
Knowledge
Answers "what does that mean" follow-ups — EOB, fee-schedule adjustment, remittance codes.
Knowledge Fabric · new source
Escalation
System · Hand-off
Hands to a Medical Bill Reviewer if the caller wants to dispute the amount or the answer isn't enough.
Routes to Billing queue · Bill ID, claim number, status passed
AXL — Agentic Experience Labs
Use case 2 · deep dive

Documentation & submission status

Happy path
  1. The IVR hands off an already-authenticated caller (Tax ID + Bill ID / claim identifiers validated).
  2. The assistant calls get_documentation_status to check what's on file for the bill or claim.
  3. It reads back what's received and what's outstanding — e.g. "we have the bill and the itemized statement; we're still waiting on the treatment notes."
  4. If something's missing, it offers to send a reminder (with a clear "yes" first) or hands off if the caller wants to submit it another way.
Why it matters
Documentation status is a named top call driver — and today it's a repeat call: a provider checks once, then again after resubmitting, competing with the same reviewer team's audit workload.
Wow moment
The assistant doesn't just say "something's missing" — it names exactly what's outstanding, and can trigger the reminder itself after a confirmation.
Tools & knowledge — what the assistant calls
Action Knowledge System
get_documentation_status
Action · Read
Checks which required documents are on file for a bill/claim and which are outstanding.
New Data Action · mock document-tracking system
send_document_reminder
Action · Write
Sends a reminder of outstanding documents to the provider's file, after the caller confirms.
New Data Action · mock notification service
billing_terms_knowledge
Knowledge
Explains what a given document type is and why it's required — same source as use case 1.
Knowledge Fabric · shared source
Escalation
System · Hand-off
Hands to a Medical Bill Reviewer if the caller needs to fax/upload directly or disputes what's requested.
Routes to Billing queue · outstanding-document list passed
AXL — Agentic Experience Labs
Use case 3 · deep dive

Denial & appeal guidance

Happy path
  1. The IVR hands off the authenticated caller with the Bill ID / claim ID already validated.
  2. The assistant calls get_denial_reason and explains the denial code in plain language, plus the appeal steps and deadline from Appeals Knowledge.
  3. If a dispute is already open, it calls get_appeal_status and reads back where it stands.
  4. If the caller wants to file or argue the appeal, it hands off to an Appeals specialist with the denial code and claim already on screen.
Why it matters
Denial and appeal calls are the most emotionally charged and highest-risk of the five drivers named in your brief — getting the reason and status right, without a hold, protects both the caller and the appeals SLA.
Wow moment
The caller hears the specific denial reason and appeal deadline in plain language, then reaches a specialist who already has the denial code and claim loaded — no re-explaining.
Tools & knowledge — what the assistant calls
Action Knowledge System
get_denial_reason
Action · Read
Returns the denial code and a plain-language reason for a Bill ID / claim.
New Data Action · mock claims/billing platform
get_appeal_status
Action · Read
Checks whether a dispute is already open for this bill/claim and its current stage.
New Data Action · mock appeals tracking
appeals_process_knowledge
Knowledge
Explains the appeal steps, required documentation and deadlines from Summit's dispute process.
Knowledge Fabric · new source
Escalation
System · Hand-off
Hands to an Appeals specialist to file or argue the appeal, with the denial code and any open dispute already loaded.
Routes to Appeals queue · full context passed
AXL — Agentic Experience Labs
Appendix

Reference & provenance

Supporting material for the use cases above — where each claim traces to, and the questions we'd settle with you before building.
AXL — Agentic Experience Labs
Appendix · Provenance

Where this came from

Everything tagged Brand-grounded traces to a public page below. Proposed items are our inference from the vertical, flagged so you can push back on them.
Grounded Summit Billing IVR / AI Automation Opportunity briefProvided directly by the Summit stakeholder team, Sep 2026
Grounded Summit division overview — "Know the people who know workers' comp®"greatamericaninsurancegroup.com/about-us/business-operations/division/summit
Grounded Great American Insurance Group homepage & company overviewgreatamericaninsurancegroup.com
Grounded Summit Medical Bill Reviewer role — billing review, disputes, HIPAA/state-law compliancegreatinsurancejobs.com & emploive.com job postings
Proposed Exact backend systems and field names behind the Tax ID + Bill ID lookupInferred from the brief's caller journey — mocked for the lab, to confirm against the real platform
Proposed Tool names, mock logic and the three-use-case split (payment status / documentation / denial & appeal)Our structuring of the brief's five call drivers into single-intent prototypes — not yet confirmed with Summit
What we'd confirm with you before we build
Volume mixWhich of the five drivers — payment status, receipt confirmation, documentation, denial, appeal — is highest-volume today, to sequence the phased rollout?
System of recordWhat system(s) hold bill/claim status and documentation today, so the mocked Data Actions mirror the real fields?
Escalation destinationWhen automation can't resolve it, does it route to the same Medical Bill Reviewer team, or a distinct billing/appeals queue?