Insurance restoration is the highest-margin work most roofers do. It's also the most operationally complex and the easiest to bungle. The companies that handle it well treat the claim as a workflow with its own discipline; the ones that don't treat it as "a job with extra paperwork" and leave money on the table.
Below is the workflow that captures the revenue properly. It runs alongside the 12-step job workflow; the differences are concentrated in the early steps.
Step 1 — Lead intake with claim flag
An insurance lead is different from a retail lead the moment it enters the system. The intake form captures: insurance carrier, policy number (if available), date of loss, prior claim status, deductible. If any of those are missing at first contact, they get captured at the inspection.
Why this matters: the claim flag changes the rest of the workflow. The quote will be a Xactimate-compatible package, not a retail estimate. The communication cadence will accommodate the carrier's timeline, not just the homeowner's. The closer will need to coordinate with the adjuster.
Step 2 — Pre-inspection claim research
Before the inspection, the agent pulls: the property's storm history (cross-reference NOAA event records against the date of loss), prior permit history (relevant for proving damage is not pre-existing), and any prior carrier interactions if this homeowner is a returning customer.
This research saves the inspector 20–40 minutes on site. It also surfaces red flags — for example, a date of loss that doesn't match any qualifying storm event in NOAA data signals that the carrier is likely to deny the claim, and the closer can manage homeowner expectations accordingly.
Step 3 — Inspection with claim-grade documentation
The inspector does the standard walk plus the claim-specific documentation: damage photos with location markers, hail-impact verification per IBHS standards
Is the auto-generated scope package compliant with carrier requirements?
Yes for the major carriers, which use standardized formats (Xactimate, Symbility, ClaimXperience). Regional and specialty carriers sometimes have proprietary formats; we handle those on a case-by-case basis.
What if the adjuster denies the supplement?
Most carriers have an appeal process. The agent prepares the appeal documentation; the contractor's senior claims tech signs off. Appeal success rates are roughly 40–60% depending on the carrier.
How do I handle assignment of benefits work?
AOB rules vary dramatically by state (Florida and Texas are particularly distinct). The workflow above is the default; AOB layers in an additional consent flow with the homeowner. We support both modes.
Should I let the homeowner negotiate with the adjuster directly?
Generally no. The contractor's relationship with the carrier is the leverage. A homeowner negotiating against their own adjuster usually loses; a contractor negotiating on behalf usually wins.
What about disputed claims that go to public adjusters or attorneys?
Out of scope for the agentic workflow. When a claim escalates to that level, it's a human-only process. The agent's job is to provide clean documentation that the public adjuster or attorney can use.
, wind-damage photos with directional notation, and ridge-cap or vent damage with detail shots.
Quality of documentation correlates directly with adjuster approval rates. Inspections that produce 25+ tagged photos with clear damage indicators approve at significantly higher rates than inspections that produce 5–8 general photos.
Step 4 — Carrier-specific scope package
From the inspection notes + aerial measurement + claim research, the agent generates a Xactimate-compatible package. Includes the scope, line-item pricing per the carrier's regional rate sheet, photo documentation indexed to scope items, and a cover letter to the adjuster.
Generating this manually takes a senior estimator 3–5 hours. The agent does it in 6–9 minutes. The senior estimator's job becomes review, not production.
Step 5 — Adjuster coordination
The carrier dispatches an adjuster. The homeowner needs the contractor on-site during the adjuster visit. Coordinate calendars, confirm the meeting, prep the homeowner on what to expect, and prepare the contractor's scope package for the adjuster to reference.
This is where the workflow most often breaks. The carrier reschedules; the homeowner doesn't communicate; the contractor isn't there; the adjuster writes a sparse scope and leaves. Cost of breakage per claim: typically 15–30% of the eventual settlement value.
**Automate the scheduling coordination.** The dispatch agent handles the calendar dance.
Step 6 — Supplement preparation
The carrier's initial scope is almost always incomplete. The contractor's job is to itemize what's missing and submit a supplement: starter shingles the adjuster missed, code-upgrade items the local jurisdiction requires, dump fees, supplier fees, gutter and downspout work tied to the roof.
Supplements are where the money is. A good supplement on a $14K initial scope can add $2K–$5K. Most roofers don't run supplements consistently because the process is administratively painful.
**Automate the supplement generation** from the scope-vs-actual diff. Senior reviewer signs off.
Step 7 — Approval and supplement negotiation
Carrier approves the supplement, partially approves it, or denies it. Partial approvals trigger a follow-up cycle: line-item negotiation with the adjuster, additional documentation, sometimes a re-inspection.
Median number of supplement cycles per claim: 1.4. Approval rate per supplement cycle: 65–85% depending on the carrier and the documentation quality.
Step 8 — Production with insurance accounting
Once the claim is approved, the job runs through the standard production workflow. The difference is the invoicing: the homeowner pays the deductible; the carrier pays the balance to the contractor (or in some states, jointly to the contractor and homeowner).
**Automate the deductible collection** from the homeowner. This is often the single most-fumbled step — the contractor is so focused on the carrier check that they forget to chase the deductible.
Step 9 — Final reconciliation
Carrier sends the check. Contractor reconciles against the approved scope. If there's a shortfall on a line item, that's a supplement that didn't get approved or got approved at a lower rate.
**Track reconciliation variance by carrier.** Over time you learn which carriers settle clean and which carriers shave 5–8% off every claim. That knowledge informs future scope-pricing strategy.
What "leaving money on the table" actually looks like
Across a 50-claim cohort we audited:
22% of claims had no supplement filed even though the initial scope was clearly incomplete.
14% of supplements were filed but never followed up after a partial approval.
8% of deductibles were never collected.
11% of claims showed reconciliation variance that was never investigated.
Combined revenue impact: 12–25% of restoration revenue, depending on the operator's specific failure pattern. For a roofer doing $4M in restoration work, that's $480K–$1M of recoverable revenue annually.
What the workflow gets right
The workflow above doesn't add headcount. It adds discipline. Every claim runs the same path. Every supplement gets filed. Every deductible gets collected. The agent handles the administrative weight; the human handles the relationships with the adjuster and the homeowner.
