A loss notification is logged into the claims platform through a structured intake form. The representative selects a loss type from a dropdown menu, enters the date of occurrence, and confirms the policy number against a verification field that auto-populates insured details. A claim number generates instantly, appearing at the top of the screen in bold text. The timestamp attaches to the first note entry without commentary.
On the next queue, the file appears under “New Assignments.” An adjuster opens the digital folder and reviews the initial entries. Policy limits display in a side panel, adjacent to deductible amounts and coverage indicators. The adjuster adds a brief acknowledgment note and schedules an inspection through a calendar interface integrated with a vendor portal. The scheduled date inserts itself into the claims diary.
Photographs arrive through a mobile upload link sent earlier in the process. Each image attaches to the file with embedded metadata indicating upload time and device source. The system arranges the images chronologically. A short description accompanies each file, typed into a caption field and saved into the permanent record.
Inspection reports follow. A field adjuster completes a digital form on a tablet, selecting damage categories and entering measurements into predefined boxes. The report transmits automatically upon submission, populating cost estimation fields within the claim screen. An estimate total appears beneath the reserve section, highlighted until acknowledged.
Reserve establishment occurs in a separate tab. The adjuster enters an initial figure into the indemnity field and a smaller amount into the expense field. A confirmation window requests acknowledgment before the entries become final. Once confirmed, the reserve history records the change as a line item with date, time, and user identification.
Vendor communication continues through an external portal. A repair contractor submits a line-item invoice referencing industry-standard billing codes. The claims system cross-references each code against policy coverage. Approved lines display in black text; items requiring review appear in gray pending adjustment. The contractor’s invoice remains visible within the vendor portal, while the insurer’s platform logs its receipt.
A claimant calls to inquire about the inspection timeline. The representative accesses the claim diary and reads the scheduled appointment date from the system. The call summary note enters the file, tagged with a call duration metric automatically captured by the telephony integration. The note closes with a status update reflecting “Inspection Pending.”
Medical documentation arrives in bodily injury claims through secure fax integration. The fax converts to a digital document and attaches to the file as a PDF. Each page carries a transmission header indicating sender number and time. The claims handler scrolls through diagnostic codes and treatment summaries, entering updated figures into the medical expense reserve field.
Supervisory review engages when a reserve adjustment exceeds internal thresholds. The file moves into a review queue visible on a management dashboard. A supervisor opens the claim, reviews attached documentation, and enters an approval note. The reserve update logs beneath prior entries, maintaining a chronological sequence.
Legal correspondence appears in litigated claims. A summons scanned into the litigation module assigns a matter number distinct from the claim number. The two identifiers link within the system, allowing navigation between modules. Calendar entries update to reflect court dates, each entry accompanied by a reminder notification generated automatically.
Payment authorization initiates through a payment tab. The adjuster enters a settlement amount, selecting payment type from a dropdown list that includes indemnity, expense, or combined categories. Bank details populate from stored claimant information. Upon submission, the system generates a transaction ID and routes the file for final approval.
Accounting systems receive the payment instruction in batch cycles. A ledger entry posts with reference to claim number, transaction ID, and amount. The claim screen updates to reflect “Payment Issued,” while the accounting interface records the same transaction under its own internal reference code.
Subrogation review begins in claims involving third-party liability. The adjuster assigns a subrogation indicator in the claim file, prompting the creation of a corresponding recovery record in the subrogation module. Demand letters generate from templates stored in the system and attach to the subrogation record. Correspondence sent and received logs into a separate recovery timeline.
Fraud screening occurs automatically at designated stages. An algorithm scans claim attributes against predefined indicators. If criteria match, a fraud flag icon appears on the claim header. The file routes to a special investigations unit queue without altering the existing claim status. Additional documentation attaches within restricted access fields.
Regulatory reporting integrates into certain claim categories. Fields requiring entry of report submission dates appear in the claim screen. Once populated, a confirmation number from the regulatory portal is entered into a designated box. The system prevents closure of the file until required reporting fields are completed.
Diary management governs task sequencing. Each activity—inspection follow-up, document request, supervisory review—generates a diary entry with a due date. Overdue tasks display in red text within the adjuster’s dashboard. Completion of each task removes the highlight and records a completion timestamp.
Reinsurance notifications occur in claims approaching attachment points. The adjuster selects a reinsurance indicator, prompting automatic notification to a reinsurance liaison via internal messaging. The liaison’s acknowledgment appears in the communication log, and a copy of the notification remains stored in the claim file.
Closing procedures initiate once payment confirmation appears. The adjuster reviews outstanding diary items and confirms all required documentation fields contain entries. A closure code is selected from a dropdown list specifying resolution type. The system records the closure date and transitions the claim into archived status.
Archival does not remove the file from visibility. It relocates the claim to a separate database accessible through a search interface. Reserve and payment histories remain viewable, along with all associated notes, documents, and transaction identifiers. The dashboard count of open claims decreases accordingly.
Workflow queues retain files distributed across assignment, inspection, supervisory review, and payment authorization stages, each indexed under distinct status codes within the claims platform. Activity timestamps remain attached to the most recent transaction recorded for every claim number. A newly generated claim identifier enters the assignment column through sequential intake processing, while prior entries preserve their routing histories within the system’s activity ledger.
