Assignment of claims to appropriate loss adjusters based on expertise or workload

Purpose

 1.1. Automate the assignment of insurance claims to loss adjusters based on individual expertise, available capacity, specialization, and current workload.
 1.2. Optimizes allocation and improves response times by reducing manual sorting and enhances accuracy and fairness in claim handling processes.
 1.3. Centralizes intake and case creation protocols, automating data extraction from intake forms, routing, and real-time workload tracking for loss adjustment professionals.

Trigger Conditions

 2.1. New claim intake through portal, email, API, or document upload.
 2.2. Update in adjuster workload (manual entry or real-time integration with workforce management tools).
 2.3. Change in adjuster status or expertise tag.
 2.4. Scheduled batch processing of claims needing assignment.

Platform Variants

 3.1. Salesforce
  • Feature: Process Builder, Flows, or Apex Triggers — automate triage using claim type and adjuster skill matching.
 3.2. Microsoft Power Automate
  • Feature: Automated Workflow — configure to trigger on new item in SharePoint/List, use conditions for expertise/workload queries.
 3.3. Zapier
  • Function: Multi-step Zap — on new claim form (Typeform, Google Forms, JotForm) route to appropriate adjuster via filter and lookup steps.
 3.4. Workday
  • Function: Custom Business Process — automate task assignment and notifications based on people data.
 3.5. ServiceNow
  • Feature: Flow Designer — create automated flows reacting to intake via Service Catalog or Incident module.
 3.6. AWS Lambda
  • Function: Event-driven handler — automate assignment logic triggered by S3 update or API Gateway event.
 3.7. Google Apps Script
  • Feature: Scripted automation — monitor Google Sheet of claims, apply assignment rules, and send emails/notifications.
 3.8. IBM Watson Orchestrate
  • Setting: Workflow — automate assignment using AI for skills parsing and intent matching.
 3.9. Monday.com
  • Feature: Automations — use status and people columns, automate allocation and notifications.
 3.10. Asana
  • Feature: Rules — create automated workflow that assigns claim tasks based on custom fields.
 3.11. Jira Service Management
  • Feature: Automation Rules — configure if/then rules for claim issue types using workload and labels.
 3.12. Freshservice
  • Feature: Workflow Automator — trigger on new tickets/cases, route to adjusters based on fields.
 3.13. Oracle Integration Cloud
  • Function: Orchestrations — automate assignments with employee/skills API and process flows.
 3.14. K2 Nintex
  • Feature: Workflow Automation — automate routing using forms and employee directories.
 3.15. Smartsheet
  • Feature: Automated Workflows — assign claims based on status, workload columns, and notifications.
 3.16. Slack
  • API: Workflow Builder or custom bot — trigger assignment message or direct assignment via Slack API.
 3.17. HubSpot
  • Feature: Workflows — automate ticket assignment based on custom properties.
 3.18. Pega
  • Feature: Case Management — automate assignment logic within claims case creation process.
 3.19. UiPath
  • Feature: RPA workflow — extract details from intake, automate API calls to workforce systems for assignment.
 3.20. QuickBase
  • Feature: Pipeline Automations — automate data flows and record updates for adjuster assignment.
 3.21. BambooHR
  • Feature: Webhooks/API — sync adjuster availability and automate routing through connected automators.
 3.22. AirTable
  • Feature: Automations — script assignment logic using automation blocks and notification actions.
 3.23. Trello
  • Feature: Butler Automation — set rules for automatic card assignment based on claim type and worker load.
 3.24. Make (Integromat)
  • Feature: Scenario builder — chain steps to fetch skills, check workloads, and assign claim accordingly.

Benefits

 4.1. Automates manual triage, reducing claim allocation time and errors.
 4.2. Increases operational efficiency through automated data processing and workflow automating.
 4.3. Balances workload and leverages expertise automatically, improving adjuster performance.
 4.4. Enables automator-driven compliance with business logic, audit trails, and reporting.
 4.5. Enhances customer and employee satisfaction by automating notifications and status updates.
 4.6. Automatable integration with HR, CRM, and ticketing systems ensures updated and consistent assignments.
 4.7. Facilitates automated scalability as claim volumes grow, maintaining response speed.
 4.8. Centralizes automating of data flows, making onboarding of new adjusters fully or partially automated.