ChecklistGuro Insurance Claims Investigation Workflow
Streamline your claims management with our comprehensive Insurance Claims Investigation Workflow. Designed to optimize accuracy and speed, this step-by-step process guides adjusters through evidence collection, fraud detection, and loss verification to ensure seamless, high-integrity claim resolutions.
Start
Start of the Workflow/Process.
1. Retrieve Claim Details
Fetch the initial claim entry including policyholder info and incident details from the Claims Data Model.
2. Get Policyholder Profile
Retrieve historical data and coverage limits from the Policyholders Data Model.
3. Calculate Estimated Liability
Calculate the potential payout amount based on reported damages and policy coverage limits.
4. Create Investigation File
Create a new entry in the Investigation Data Model linked to the original Claim entry.
5. Assign Field Investigator
Create a task for the Claims Adjuster to visit the accident scene and collect evidence.
6. Update Investigation Status
Update the status of the Investigation entry to 'In Progress' once the task is assigned.
7. Retrieve Evidence Attachments
Fetch all photos, witness statements, and police reports attached to the claim.
8. Verify Documentation
Create a task for the Legal Department to review the legitimacy of the uploaded evidence.
9. Sum Total Reported Damages
Aggregate all line-item damage costs from the related Damage Assessment entries to get a total sum.
10. Calculate Deductible Subtraction
Subtract the policyholder's deductible from the total estimated liability.
11. Update Final Claim Valuation
Update the Claim entry with the final calculated settlement amount.
12. Final Approval Task
Create a task for the Claims Manager to review the investigation findings and approve the settlement.
13. Notify Policyholder of Decision
Send an email to the policyholder informing them of the claim approval or denial.
14. Send Payment Alert
Send an SMS to the policyholder notifying them that the settlement funds have been released.
15. Close Claim Entry
Update the original Claim entry status to 'Closed'.
16. Generate Investigation Summary Report
Create a final PDF/Report summarizing all findings, costs, and decisions for the archive.
End
End of the Workflow/Process.
Start of the Workflow/Process.
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.
End of the Workflow/Process.
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