Claim Workflows

Claim Workflows

Workflows let you automate how claims are routed, reviewed, and resolved, reducing manual work and speeding up resolution times.

Default Workflow

Out of the box, every claim follows this path:

1. Submission → claim enters the queue
2. Auto-scoring → AI assigns a risk score (0–100)
3. Routing → low-risk claims auto-approved; high-risk claims assigned to human reviewer
4. Resolution → repair dispatched, replacement shipped, or refund issued
5. Closure → customer notified, claim archived

Custom Workflow Rules

Create rules in Settings → Workflows to customize behavior:

- name: Auto-approve low-value claims
  trigger: claim.submitted
  conditions:
    - claim.amount <= 50
    - claim.risk_score <= 30
    - customer.claim_count < 3
  actions:
    - approve_claim
    - send_email: "claim_approved"
    - create_repair_order

- name: Escalate high-value claims
  trigger: claim.submitted
  conditions:
    - claim.amount > 500
  actions:
    - assign_to: "senior_adjuster"
    - send_notification: "high_value_claim"

Resolution Types

• Repair: dispatch to an authorized service center; track repair status in real time
• Replacement: ship a replacement unit from your inventory or a partner warehouse
• Refund: issue full or partial refund to the customer’s original payment method
• Store credit: provide credit toward a future purchase

Workflow Analytics

Track workflow performance in Analytics → Workflows: average resolution time, auto-approval rate, escalation frequency, and customer satisfaction scores.