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Claims Processing

Insurance claims intake, adjustment, and settlement

Complexity: Complex | Duration: 30m+ | Category: Industry/Financial Services

Tags: claims insurance adjustment settlement

Workflow Diagram​

Steps​

Step 1: Receive claim​

Agent: claims

adjuster - Capture loss details

Step 2: Verify coverage​

Agent: claims

examiner - Check policy coverage

Step 3: Assign adjuster​

Agent: claims

adjuster - Route to appropriate handler

Step 4: Investigate claim​

Agent: claims

adjuster - Gather documentation

Step 5: Detect fraud​

Agent: fraud

analyst - Screen for indicators

Step 6: Evaluate damage​

Agent: claims

adjuster - Assess loss amount

Step 7: Determine settlement​

Agent: claims

examiner - Calculate payment

Step 8: Issue payment​

Agent: claims

adjuster - Disburse settlement

Usage​

To execute this workflow:

/workflow industry/financial-services/claims-processing.workflow

See other workflows in this category for related automation patterns.