Workflow routing based on claim complexity or value

Purpose

1.1. Automate workflow routing for loss adjusters by evaluating incoming claims’ complexity or value, directing cases to appropriate specialist teams, levels of authority, or review stages.
1.2. Automatedly improve turnaround, minimize human error, prioritize high-value claims, and standardize communication and documentation as part of process automation.
1.3. Ensure compliance, auditability, and SLA adherence for each automated workflow step.

Trigger Conditions

2.1. Automated claim intake (e.g., via portal, email, API) initiates case evaluation.
2.2. Claim complexity or estimated value reaches pre-set thresholds triggering routing automations.
2.3. Manual override or flag by an adjuster for exceptional cases starts automated routing logic.

Platform Variants (with functions to configure)

3.1. Salesforce
• Feature: Process Builder/Flow — configure “Record-Triggered Flow” for claim evaluation and routing.
3.2. Microsoft Power Automate
• Connector: Common Data Service (CDS) — automate condition-based flows using “When a record is created/updated.”
3.3. Zapier
• Zap: Filter/Paths — build path automations based on “Claim amount” or “Complexity” custom fields.
3.4. ServiceNow
• Workflow Designer: Decision nodes — route incidents based on claim metadata.
3.5. UiPath
• Studio: “If-Else” activities — automate claim classification and task assignment.
3.6. Pega
• Case Management: “Decision Table” route cases using claim parameters.
3.7. Kofax TotalAgility
• Rule Engine — automate claim categorization and subsequent task creation.
3.8. IBM BPM
• Condition Gateway — automate routing workflows for claims by value/complexity.
3.9. monday.com
• Automation Recipe: “When status/field changes” — automate notification/routing based on claim data.
3.10. Asana
• Rules: Trigger actions when custom field (claim value) is populated — automate task assignment.
3.11. Trello
• Butler Automation: Rules to move cards to lists (team boards) based on claim custom fields.
3.12. Jira
• Automation: “If: Field value” then assign to team/member (Loss Adjuster routing automation).
3.13. Google Apps Script
• Script: Evaluate form/sheet input and email/assign claim to appropriate mailbox/Google Group.
3.14. AWS Lambda
• Function: Parse event data from API Gateway, automate routing via SNS/SQS or invoke downstream systems.
3.15. Slack
• Workflow Builder: Conditional steps — automate routing of claim intake to channels/users based on claim data.
3.16. Twilio
• Studio Flow: Route SMS/Voice reports to phone numbers/teams based on automated claim parsing.
3.17. SendGrid
• Inbound Parse Webhook — automate email-to-workflow routing by claim data found in the message.
3.18. DocuSign
• Connect Webhooks: Trigger API that automates routing upon envelope/data completion.
3.19. Freshservice
• Workflow Automator: Condition-action automation based on claim fields.
3.20. HubSpot
• Workflow: Automated property-based claim assignment, marketing, and notification workflows.
3.21. Make (Integromat)
• Scenario: Router module — automated branching based on claim data via HTTP/API.
3.22. Smartsheet
• Automation: Automated “Request an Update/Alert” triggers with branching logic for claim value tiers.

Benefits

4.1. Automate consistent, rules-based loss adjuster allocation, ensuring SLAs and regulatory compliance.
4.2. Automatedly speed up case review and processing, freeing staff from repetitive triage.
4.3. Automator reduces manual errors and ensures every claim follows automatable best-practices.
4.4. Automated workflow improves transparency and audit trails for communication and actions.
4.5. Enables scalable, centralized, and automating operations for insurers and third-party adjusters alike.