Overview of Complaint Management
The Complaint Management section provides full visibility into all complaints associated with your agency and agents Within this section, you will see:
Complaint Status Categories
Each complaint is assigned to a status bucket representing its current stage:
In Progress – Complaint has been created and is actively being worked.
Response Generated – A response has been drafted and is pending further action.
Sent to Carrier – The case has been officially forwarded to the carrier for review.
Completed / Unfounded – Investigation concluded; complaint determined to be invalid or unsubstantiated.
Completed / Founded – Investigation concluded; complaint found to have merit.
Average Resolution Time – a useful metric for performance monitoring and compliance benchmarks.
These status counts help your team quickly assess workload and resolution flow.
Search Capabilities
You can search and filter by:
Case ID
Lead information
Complaint status
This makes it easy to locate specific complaints or track patterns across cases.
Creating a New Complaint
To initiate a new complaint, click the “Create a New Complaint” button. You will be guided through a 4-step setup process:
Step 1 — Complaint Info
In this step, you will enter or confirm the details of the complaint. There are two ways to populate lead information:
Option A — Use an Existing Lead
Search for an existing lead, and the system will automatically pull in key details already on file.
Option B — Create a Custom Lead
If the complaint is not tied to an existing lead, select Custom lead and manually enter the required details.
Required & Optional Fields
You will have fields to complete, including:
Lead ID (auto-populated if using an existing lead)
Member Phone Number *
Member Name
Carrier
Case ID
Date Received
Notes (optional — add any internal context or relevant information)
This step ensures all complaint data is accurately captured before continuing.
Step 2 — Attachments
Supporting documentation can be added to strengthen your complaint submission.
You may attach:
Call logs (automatically retrievable for existing leads)
Uploaded files such as recordings, screenshots, correspondence, or carrier documentation
Multiple attachments may be uploaded as needed.
Step 3 — Assignment
This step assigns responsibility and provides guidance for the agent handling the case.
Assignee Fields
Agent (Assignee) Search by name, email, or NPN to locate the correct agent.
Agency Automatically populated once the agent is selected.
Due Date Set the required resolution or follow-up date.
Agent Attestation Questions (Optional)
You can add custom questions to ensure the agent understands requirements or to standardize the response process. These questions are optional but can greatly improve consistency and clarity.
Step 4 — Review & Submit
The final step allows you to:
Review all entered data
Confirm attachments
Verify assignment details
Ensure accuracy before submission
Once confirmed, click Submit to finalize the complaint. The complaint will now move into the In Progress status and follow your team’s standard resolution workflow.
Best Practices
To ensure complaints are handled consistently, efficiently, and in compliance with carrier expectations, follow these recommended best practices:
Use Accurate and Complete Lead Data
Whenever possible, select an existing lead so the system can auto-fill verified information.
If using a custom lead, double-check phone numbers, names, and carrier details for accuracy.
Provide Clear and Relevant Notes
Add context such as call dates, member concerns, or prior interactions.
Avoid vague notes—specific details improve resolution speed and reduce back-and-forth.
Attach All Supporting Documentation
Include call logs, recordings, screenshots, or carrier correspondence whenever available.
More documentation upfront leads to faster resolutions and fewer carrier requests for clarification.
Assign Complaints Thoughtfully
Select the appropriate agent based on involvement or expertise.
Always review the Due Date to ensure timely follow-up, especially for carrier-sensitive cases.
Use Attestation Questions for Quality and Consistency
Add optional questions when you want to standardize agent responses or ensure certain steps are followed.
Recommended for training new agents or handling high-risk complaint types.
Review Before Submitting
Ensure all four steps are complete and accurate.
Confirm that attachments are correct and that no required fields are missing.
Monitor Statuses and Resolution Times
Regularly check your dashboard to identify delays or bottlenecks.
High resolution times may indicate training opportunities or process changes needed.
Keep Carrier Expectations in Mind
Carriers often base compliance scoring on the accuracy and timeliness of complaint responses.
Submitting complete, well-documented cases protects your agency and builds credibility.