Designing an Automated Claims Resolution Workflow

Designed an end-to-end claims intake and resolution workflow that guides users through structured submissions while automating handoffs and decision paths for internal teams.

Problem:

High variation in claim types
Manual document checks
Inconsistent handoffs between teams
Delays caused by missing information

Approach:

Solution:

Mapped claim types and resolution paths
Embedded business logic into the workflow
Designed role based steps and notifications

Guided customer intake
Automated routing based on claim type
Step by step internal resolution flow

Conceptual Workflow Overview:

Impact:

Beige and Pink Modern Business Process Flowchart Diagram.png

Claims are first classified based on claim type, material category, and the customer’s preferred resolution.

A rules based decision layer then determines which validation, coordination, or fulfillment steps are required and notifies the relevant stakeholder.

Resolution paths are modular, allowing claims to trigger only the necessary actions (such as verification, replacement, return coordination, or account adjustment) before reaching closure.

Reduced manual efforts, improved consistency across claim handling, and enabled faster resolution by embedding decision logic directly into the workflow.