Insurance Claims Investigation Workflow

Rozpoczęcie przepływu pracy/procesu.

Fetch the initial claim entry including policyholder info and incident details from the Claims Data Model.

Retrieve historical data and coverage limits from the Policyholders Data Model.

Calculate the potential payout amount based on reported damages and policy coverage limits.

Create a new entry in the Investigation Data Model linked to the original Claim entry.

Create a task for the Claims Adjuster to visit the accident scene and collect evidence.

Update the status of the Investigation entry to 'In Progress' once the task is assigned.

Fetch all photos, witness statements, and police reports attached to the claim.

Create a task for the Legal Department to review the legitimacy of the uploaded evidence.

Aggregate all line-item damage costs from the related Damage Assessment entries to get a total sum.

Subtract the policyholder's deductible from the total estimated liability.

Update the Claim entry with the final calculated settlement amount.

Create a task for the Claims Manager to review the investigation findings and approve the settlement.

Send an email to the policyholder informing them of the claim approval or denial.

Send an SMS to the policyholder notifying them that the settlement funds have been released.

Update the original Claim entry status to 'Closed'.

Create a final PDF/Report summarizing all findings, costs, and decisions for the archive.

Koniec przepływu pracy/procesu.