Claims ManagementPurpose
1. Automate the identification and escalation of overdue or high-priority renter’s insurance claims to responsible agents, managers, or external teams.
2. Automate timely intervention to prevent SLA breaches, improve client satisfaction, and ensure regulatory compliance.
3. Automate notifications, create tickets, send reminders, and assign escalations based on customized business logic, deadlines, or client urgency levels.
Trigger Conditions
1. Automate escalation when claim status is “Pending” or “In Review” for more than X days (customizable).
2. Automate upon claim’s priority field set as “High” or flagged by customer or AI sentiment analysis.
3. Automatedly trigger workflow if required documents or approvals are not received within deadline.
4. Automate escalation if SLAs on response or resolution time are about to breach.
Platform Variants
1. Twilio SMS
- Feature/Setting: Automate SMS to manager when a claim is flagged. Configure with Twilio API `messages.create({to, from, body})` using dynamic escalation data.
2. Slack
- Feature/Setting: Automate channel or DM alert. Use `chat.postMessage` with claim and escalation context.
3. Microsoft Teams
- Feature/Setting: Automate escalation notification via Teams Webhook or Graph API to a specific user or team.
4. Zendesk
- Feature/Setting: Automate escalated ticket creation via `Tickets API POST /api/v2/tickets` with escalated priority.
5. Salesforce
- Feature/Setting: Automate case escalation using Workflow Rules or `REST API PATCH /services/data/vXX.X/sobjects/Case/` for status/priority update.
6. Freshdesk
- Feature/Setting: Automate ticket update and escalation using `Update Ticket` API with escalated status/priority.
7. ServiceNow
- Feature/Setting: Automate incident escalation using `Table API PATCH /api/now/table/incident` with escalation reason.
8. Google Workspace (Gmail)
- Feature/Setting: Automate escalation alert email via Gmail API `users.messages.send`.
9. Outlook 365
- Feature/Setting: Automate escalation mail to next-level manager using Microsoft Graph `sendMail` API.
10. PagerDuty
- Feature/Setting: Automate incident trigger via `POST /incidents` for assignation to on-call team.
11. Asana
- Feature/Setting: Automate escalated task with `Tasks API /tasks` for follow-up.
12. Monday.com
- Feature/Setting: Automate escalated item creation via Board API with priority and status mapped.
13. Jira
- Feature/Setting: Automate issue transition to “Escalated” status via Jira REST API `POST /issue/{issueIdOrKey}/transitions`.
14. HubSpot
- Feature/Setting: Automate escalation task or ticket via `crm/v3/objects/tickets` API with escalation flag.
15. ClickUp
- Feature/Setting: Automate new escalation task creation with `POST /api/v2/task`.
16. Intercom
- Feature/Setting: Automate chat or ticket escalation using Conversation API `POST /conversations/{id}/reply`.
17. Airtable
- Feature/Setting: Automate update record with escalation status using REST API `PATCH /v0/{base}/{table}/{recordId}`.
18. Notion
- Feature/Setting: Automate escalation note creation in project database via `PATCH /v1/pages/{page_id}`.
19. Trello
- Feature/Setting: Automate card movement to “Escalated” list using Trello API `PUT /1/cards/{id}/idList`.
20. SAP
- Feature/Setting: Automate claim escalation workflow via Business Workflow Engine, call relevant escalation function module.
21. Zoho CRM
- Feature/Setting: Automate case escalation with API `PUT /crm/v2/Cases/{record_id}` updating escalation field.
Benefits
1. Automates consistent and instant escalation of high-priority or overdue claims, minimizing manual oversight.
2. Automates multi-channel, multi-level notifications for improved response times.
3. Automates compliance with regulatory deadlines and internal SLAs.
4. Automates documentation of every escalation event for audit and performance analytics.
5. Automates coordination among departments, reducing bottlenecks and human errors.