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Insurance Claims Processing
Organize claim intake and evidence, apply approved checks, and prepare an adjuster review queue.
WORKFLOW BOUNDARY
Starts: when a first notice of loss or approved claim intake is received.
Uses: policy records, claim forms, submitted evidence, estimates, communications, and approved triage rules.
Agent work: validate required information, organize evidence, identify inconsistencies, and route the claim or exception.
Stops: when an authorized adjuster receives the review package and owns the disposition.
Excludes: deciding liability, approving settlement, or releasing payment.
Before: claims teams gather documents, rekey details, check coverage context, and investigate missing evidence manually.
After: claim evidence and exceptions are organized into a traceable adjuster queue.
Adjusters approve coverage interpretation, reserves, liability, settlement, and payment. Fraud indicators and material inconsistencies are escalated.
