System You summarize insurance sales and service call transcripts for a quality-assurance team in India.
Transcripts may be in English, Hindi (Devanagari) or Hinglish. Always write the summary in English.
Return only a JSON object with these keys:
- outcome: what was decided, a few words
- need: what the customer wanted
- products: array of strings, each with the plan, cover and premium exactly as said on the call
- disclosures: array of {key, made, at} for each disclosure that applies to this call; key is one of ped, waiting, exclusions, free_look, market_risk, ncb, grievance, benefit_illustration, grace; made is true or false; at is a short exact quote from the transcript (omit when not made)
- medical: array of medical facts the customer gave
- objections: array of objections the customer raised
- flags: array of {key, note, at} for every mis-selling or data-leakage moment; key is one of guaranteed_returns (Guaranteed returns on a market-linked plan), ped_suppressed (Told to hide a medical condition), cover_misstated (Cover or rights misstated), pressure (False urgency), rebating (Off-book cashback or discount), otp_requested (OTP, PIN or card details asked); at is a short exact quote; empty array when the call is clean. A guarantee that is part of a non-linked guaranteed plan is not a flag.
- next: the follow-up the agent promised
- sentiment: positive, neutral or negative
- brief: two or three sentences
Rules: quote only figures said on the call. Never repeat a phone, PAN, Aadhaar, card, CVV, OTP or policy number.
Customer
TRANSCRIPT:
Agent (Pankaj): नमस्ते, पॉलिसीबाज़ार क्लेम सपोर्ट से पंकज। कॉल रिकॉर्ड हो रही है। बताइए रमेश जी।
Customer (रमेश): मेरे पति अस्पताल में भर्ती हैं, कैशलेस मना कर दिया गया। अस्पताल कह रहा है ₹65,000 जमा करो।
Agent (Pankaj): मैं देख रहा हूँ। बीमा कंपनी ने कैशलेस इसलिए रोका है क्योंकि डॉक्टर का नोट अधूरा है, क्लेम मना नहीं हुआ है।
Customer (रमेश): तो अब क्या करें? हमारे पास इतने पैसे नहीं हैं।
Agent (Pankaj): मैं अस्पताल के इंश्योरेंस डेस्क से बात करके नोट दोबारा भिजवाता हूँ। हमारी टीम अस्पताल में भी जा सकती है।
Customer (रमेश): कितना समय लगेगा?
Agent (Pankaj): आमतौर पर 3 से 4 घंटे। आपका टिकट नंबर PB-CL-22871 है। मैं 2 घंटे में आपको कॉल करूँगा।
Customer (रमेश): ठीक है, जल्दी कीजिए।
Judged turngoogle/gemini-4-argon
Outcome: Agent to coordinate with hospital insurance desk to resubmit doctor's note for cashless approval
Need: Assistance with a held cashless claim for a hospitalized spouse where the hospital demanded a ₹65,000 deposit
Disclosures: none required
Medical: Spouse is admitted in the hospital
Objections: Does not have ₹65,000 to deposit at the hospital
Risk flags: none
Next step: Speak to the hospital's insurance desk to get the doctor's note resubmitted and call the customer back in 2 hours (resolution expected in 3 to 4 hours)
Sentiment: neutral
Summary: The customer called regarding a cashless claim for their hospitalized spouse that was put on hold, with the hospital asking for a ₹65,000 deposit. The agent clarified that the claim was not rejected, only held due to an incomplete doctor's note. The agent promised to coordinate with the hospital's insurance desk to resubmit the note and call the customer back in 2 hours, estimating a 3 to 4 hour resolution time.