Claims ManagementPurpose
1.2. Automating internal case management, allocating responsible investigators, aggregating relevant documents or communications, and tracking investigation status.
1.3. Improve speed and accuracy in claims handling, reduce manual oversight, and ensure compliant resolution and documentation.
1.4. Automatedly alert management and relevant teams, trigger audit process, and store escalation trail for regulatory review.
Trigger Conditions
2.2. Pattern recognition automates issue detection (e.g., duplicate claims, inconsistent data).
2.3. Specific incident types (e.g., suspected fraud, missing documents) automatically initiate the internal case workflow.
2.4. Automated rules for compliance red flags or manual staff override triggers an internal investigation.
Platform Variants
3.1. Salesforce Service Cloud
• Feature/Setting: Flow Builder automates initiation of investigation ticket on custom claim criteria.
3.2. Microsoft Power Automate
• Feature/Setting: Automated flow triggers investigation email and Teams notification when claim status meets thresholds.
3.3. Zapier
• Feature/Setting: Zap setup automates creation of a new task in project management apps upon flagged claim.
3.4. Slack
• Feature/Setting: Workflow automator posts channel alert and assigns investigator role via API.
3.5. Trello
• Feature/Setting: Automated card creation via REST API when flagged claim is logged.
3.6. Jira
• Feature/Setting: Automation rule creates new investigation issue, links to claim, and sets priority labels.
3.7. HubSpot
• Feature/Setting: Workflow automates internal notification and task creation in CRM when claim record changes.
3.8. Monday.com
• Feature/Setting: Automation recipe assigns cases and auto-updates investigation board.
3.9. Asana
• Feature/Setting: Rule to auto-create new project and assign tasks to investigators on flagged claims.
3.10. Freshdesk
• Feature/Setting: Dispatch’r automates tagging and routing of investigation tickets.
3.11. ServiceNow
• Feature/Setting: Flow Designer automates opening of investigation request with prescribed workflow steps.
3.12. Zendesk
• Feature/Setting: Trigger automates sub-ticket creation for investigations linked to claim ID.
3.13. DocuSign
• Feature/Setting: Automated template workflow for gathering statements or confirmations.
3.14. Google Workspace (Gmail/Sheets/Drive)
• Feature/Setting: Apps Script automates sending internal investigation alerts and sharing files with investigators.
3.15. AWS Lambda
• Feature/Setting: Event trigger automates execution of backend scripts for records aggregation.
3.16. Twilio
• Feature/Setting: Programmable SMS API automates investigator notifications for urgent cases.
3.17. SendGrid
• Feature/Setting: Email API automates formal notification to internal audit.
3.18. Notion
• Feature/Setting: Automation integrates new database entries for tracking investigations across teams.
3.19. Airtable
• Feature/Setting: Automation triggers new row for each flagged claim and assigns to available investigator.
3.20. Intercom
• Feature/Setting: Workflow automated to send internal notes and begin case tracking when irregularity detected.
3.21. Microsoft Teams
• Feature/Setting: Automated posting in investigation channel using webhook based on claim event.
3.22. Okta
• Feature/Setting: Automated user provisioning for forensic investigation access controls on cases.
Benefits
4.2. Automated flows enable quick response, centralized oversight, and escalate cases faster.
4.3. Automating notifications and records ensures complete audit trails for legal and regulatory requirements.
4.4. Automatedly allocates workload, avoiding staff bottlenecks and ensuring every flagged claim receives prompt attention.
4.5. Overall process automator increases investigator productivity and enhances policyholder confidence.