Workflow Automation

Workflow automation helps you process claims faster by automatically handling routine tasks.

What Can You Automate?

• •Auto-assign claims to team members based on rules
• •Send notifications at key stages
• •Update statuses based on conditions
• •Create tasks and reminders
• •Generate reports automatically

Creating Automation Rules

Step 1: Define the Trigger

What event starts the automation?

• •New claim submitted
• •Claim status changed
• •Claim assigned
• •Photo uploaded
• •Time-based (e.g., claim pending for 48 hours)

Step 2: Set Conditions

When should the automation run?

• •Claim value above/below threshold
• •Product category matches
• •Customer type (new/returning)
• •Issue type
• •AI confidence score

Step 3: Define Actions

What should happen?

• •Assign to specific team member or queue
• •Change claim status
• •Send email notification
• •Add internal note
• •Create follow-up task
• •Apply tag/label

Example Automations

Auto-Approve Low Value Claims

Trigger: New claim submitted

Conditions:

• •Claim value under $25
• •AI confidence above 90%
• •Customer has no previous fraud flags

Actions:

• •Auto-approve claim
• •Send approval email
• •Create refund task

Route High-Value Claims

Trigger: New claim submitted

Conditions:

• •Claim value over $500

Actions:

• •Assign to Senior Agent queue
• •Add "High Value" tag
• •Send Slack notification to manager

Follow-Up Reminder

Trigger: Claim pending for 72 hours

Conditions:

• •Status is "Awaiting Customer Response"

Actions:

• •Send reminder email to customer
• •Add internal note
• •Create follow-up task for agent

Best Practices

1. 1.Start simple - Begin with one or two automations
2. 2.Test thoroughly - Use test claims to verify behavior
3. 3.Monitor results - Check automation logs regularly
4. 4.Iterate - Refine rules based on outcomes