Automated Claims Settlement Process

Начало на работния поток/процеса.

Fetch the initial claim entry submitted by the customer including policy details and incident description.

Retrieve user data and historical claim records for the identified policyholder.

Get all line items from the 'Damage Assessment' data model associated with this claim ID.

Sum the cost of all parts and labor entries from the Damage Assessment data model.

Subtract the policyholder's mandatory deductible from the Total Estimated Loss.

Calculate the final payout amount (Total Loss - Deductible).

Update the claim entry status to reflect that an adjuster is currently reviewing the file.

Create a task for a Claims Adjuster to verify the validity of the damage estimates.

Retrieve data from the Fraud Detection model to check for suspicious patterns.

Calculate a risk score based on claim frequency and fraud flag presence.

Create a high-priority task for the Fraud Investigation Unit if the risk score exceeds a threshold.

Update the claim entry with the final approved amount and settlement decision (Approved/Denied).

Create a new entry in the 'Payments' data model to trigger the bank transfer.

Send an automated email to the customer confirming their claim has been settled and providing the payout details.

Send a brief SMS notification to the user's registered phone number regarding the funds transfer.

Update the user's policy data model to reflect the completed claim and any impact on premiums.

Generate a summary report of all settled claims, total payouts, and average processing time for management.

Край на работния поток/процеса.