Workflow Tutorial

Introduction

Connected Claims allows you to design workflows tailored to your needs, without relying on pre-built templates. These workflows can represent an entire claim management process, which may feel complex and overwhelming at first. To help you get started with confidence, we've created this tutorial to guide you through setting up a workflow step by step. You'll set up tasks and task blocks, identify milestones, and configure all the parts that make up a complete workflow.

By the end of this tutorial, you'll be able to create a workflow that integrates input from multiple teams, tracks progress, and ensures tasks are completed efficiently—no technical expertise required.

What is a workflow?

Workflows help organize and streamline tasks by breaking down complex processes into clear, actionable steps. They ensure that the right people are involved at the right time, helping teams collaborate efficiently and meet deadlines. Workflows are a critical part of managing claims, as they help track progress and ensure nothing falls through the cracks.

Basic workflow example

Think of a workflow like your morning routine—a series of tasks you complete to get your day started. Each step in the routine depends on what came before and prepares you for the next. For example:

1. Wake up: This starts the process. It signals the rest of your tasks to begin.
2. Make coffee: A key step that happens early in the routine. It helps you wake up and get energized.
3. Check your calendar: You need to know what's coming up for the day. This step gives you the information you need to prioritize the rest of your tasks.
4. Get dressed: Once you know your schedule, you can pick an outfit that fits your day.
5. Head out the door: With everything done, you're ready to leave and start your day.

A workflow in Connected Claims works in the same way. It organizes tasks and steps in a sequence, so each one is completed in the right order. Just like your morning routine, some tasks might be dependent on others, and some might run in parallel. Workflows make sure that everyone involved knows what to do and when to do it, ensuring that the process moves smoothly from start to finish.

About this tutorial's workflow

In this tutorial, you'll set up a basic claims process. By the end, you'll have a workflow that manages claims efficiently from submission to settlement, ensuring all parties are informed and the claim is properly closed.

The basic configuration of this workflow is made up entirely of tasks. You can use advanced configuration of this workflow at the end of the tutorial to add automations, milestones, and task blocks.

Before you begin

Make sure you've set up a category and a claim type. If a claim type hasn't been set up, create a new Category called Automobile and a claim type named Generic Automobile.

Configure a basic claim workflow

To configure a basic Claim workflow, complete the following steps:

• Step 1. Create tasks
• Step 2. Configure the workflow

Step 1: Create tasks

Tasks drive activity within connected claims applications by representing the work claim adjusters/examiners/supervisors perform. A workflow is a sequence of these tasks.

To create tasks directly from the Tasks page:

1. In the Tasks page, click TASKING > CREATE TASK to open the Create Task dialog.
2. In the Create Task dialog, configure the following task properties.

Property	Description
Name	The name of the task.
Task Type	The kind of activity the task represents. There are eleven task types available out-of-the-box: confirmation, decision, document upload, set reserves, make payment, liability assessment, cost estimate, survey, create claim, send email and settlement.
Claim Type	The claim type to create a new claim in using the create claim task type.
Relationship to Original Claim	The relationship between the new claim created using the create claim task type. There are seven relationships to choose from: related, duplicates, duplicated by, parent, child, cloned by and clone of.
Email Template	The new or existing email template to use for the send email task type.
Default Assigned Group	The group that is initially assigned this task, unless otherwise specified.
Task Cost	The total cost that is initially assigned to this task, unless otherwise specified.
SLA	The service level agreement to apply to the task, calculated in calendar days, hours, and minutes. To calculate SLAs in business days, enable the Calculate the due date using business days option.
Document Type	The type of document for your users to upload. Document Type is required for the document upload task type.
Question	The question for your users to answer. Questions are required for the decision task type.
Response Options	The possible responses for your users to choose from. Response options are required for the decision task type.
Description	Description of the task. This text box contains many text formatting options, so you can write the best description of the task, including instructions, for your users.

1. When you're done configuring the task, click CREATE.

To begin setting up your workflow, repeat these setup steps for each task in the Intake review, Claim decision, Claim processing, and Closure tables. You will need all of these tasks for the claim workflow.

• Intake review
• Claim decision
• Claim processing
• Closure

Intake review tasks

Task Name	Default Group	Task Type	Description
Intake Review	Claim Examiner	Confirmation	Ensure incoming applications for completeness and initial compliance to ensure a smooth processing workflow. Responsibilities include verifying required documents, data entry, and communicating with applicants for missing or erroneous information.

Claim decision tasks

Task Name	Default Group	Task Type	Description
Claim Validity	Claim Examiner	Decision	Ensure the incoming claim request aligns with specific technical or regulatory requirements for it to be a valid claim request.
Claim Rejected	Claim Supervisors	Confirmation	The claim is invalid and was rejected. The customer will be notified of this decision.

Claim processing tasks

Task Name	Default Group	Task Type	Description
Set Reserves	Claim Examiner	Set Reserves	To set reserve amounts for the claim.
Assess Liability	Claim Examiner	Liability Assessment	Process of determining who is legally responsible for a loss or damage in a claim.
Upload Claim Documents	Claim Examiner	Document Upload	To upload the claim related documents.
Estimate Cost	Claim Adjuster	Cost Estimate	To estimate the projected expenses required to repair, replace or compensate for a covered loss. It helps to determine the claim settlement.
Calculate Settlement	Claim Examiner	Settlement	To calculate the final settlement value based on the evaluations done so far.
Make Settlement Payment	Claim Supervisors	Make Payment	Disburses the approved claim amount to the policy holder/beneficiary.

Closure task

Task Name	Default Group	Task Type	Description
Notify Customer	Claim Examiner	Confirmation	Email the customer about the claims' outcome.

Note: Once you're comfortable using the Control Panel, you can also create tasks from the Workflow tab in claim types.

Step 2: Configure the workflow

Now that your tasks are in place, let's transform them into a streamlined workflow.

1. From the Details tab of a claim category, click the claim type you want to add a workflow to.

   

   

2. Click the Workflow tab.

   

3. Click CONFIGURE WORKFLOW.

   

4. Click ADD TASKS.

   

   The Add Tasks window is divided into two main sections:

   • Tasks Library: This section allows you to browse or search for predefined tasks. You can use the search bar to quickly find specific tasks or filter tasks by type using the dropdown menu.
   • Selected Tasks: This pane displays the tasks you have chosen to add to your workflow. As you select tasks from the Tasks Library, they will appear in this area, providing a clear overview of what you have included before finalizing your choices.

5. Select the checkboxes next to all of the tasks you created in Step 1: Create tasks then click ADD.

   The Configure workflow window displays again with all of the tasks that you added displaying in the left panel.

   

6. Select a task from the list to see and configure its details. Refer to the configuration information provided in this table:

   Task	Details
   Start	Click ADD DEPENDENT and select Intake Review
   Intake Review	Click ADD DEPENDENT and select Claim Validity
   Claim Validity	In the Workflow Settings, select: Set Reserves (Yes Response) Claim Rejected (No Response)
   Set Reserves	Click ADD DEPENDENT and select Assess Liability Click ADD DEPENDENT and select Upload Claim Documents
   Assess Liability	Click ADD DEPENDENT and select Estimate Cost
   Estimate Cost	Click ADD DEPENDENT and select Calculate Settlement
   Calculate Settlement	Click ADD DEPENDENT and select Make Settlement Payment
   Make Settlement Payment	Click ADD DEPENDENT and select Notify Customer
   Claim Rejected	Click ADD DEPENDENT and select Notify Customer

7. Click UPDATE.

When you complete this tutorial, the workflow should look similar to this:

Congratulations! You just set up your first workflow. If you're ready to fine-tune your workflow, check out the next section for some advanced configuration options.

Advanced configuration

In this section, we'll show you how to enhance your workflow by adding some additional tasks, creating milestones, and using task blocks. These additions can help you manage more complex scenarios, like handling claim challenges and tracking ongoing claims, while organizing key stages of your workflow. Task blocks, which group tasks into sequences, add even more efficiency since they can be used as a template when configuring new claim workflows.

Add additional activities to your workflow

In this tutorial, we've kept things simple to make it easy to follow and learn. However, you'll probably want to add more advanced tasks to handle claim challenges, upload documents, and track ongoing claim statuses. Here are some tasks and automations that we recommend adding when you're ready:

Task Name	Default Group	Activity Type	Description
Re-evaluate Claim	Claims Examiners	Document Upload Task Type	Allows customers to upload supporting documents to defend their claim.
Claim Ongoing?	-	Automation	Evaluates the status of a claim to automatically verify whether a claim is still in progress or has been revoked/rejected by any party.

After adding these activities, your workflow will be more flexible and ready to handle complex situations. The extra decision points and document handling features will help your team manage claims involving challenges and multiple reviews more smoothly.

Add a workflow automation for ongoing claims

Workflow automations are configurable activities completed by the system with rules and conditions that specify how to progress in a workflow. Use automations for activities that don't need a user to act on it, like evaluating the next task in a claim.

For this workflow, it would be helpful to add an automation to automatically validate if a claim is ongoing and has a loss value lesser than a predetermined amount, so that we can fast track the claim and route it properly.

To do this, we'll set up an automation with rules and conditions that evaluate the status data field and the Loss Amount data field. The automation will send all claims with an open or in-progress status and have Loss Amount quote less than $500 to the Liability Assessment task, and send all claims with a closed status and have Loss Amount quote greater than $500 to the Notify Customer step.

To create this workflow automation:

1. On the Workflow tab, click MODIFY WORKFLOW.
2. Click ADD AUTOMATION.
3. In Name, enter a name for the automation, such as Is Claim Valid?.
4. In the Rules section of the automation, click ADD CONDITIONS.
5. In the first condition of the automation rule, select Claim Cfg Status in Field.
6. Set the operator to Not equal to and the value to Closed.
7. Click ADD CONDITION and set the operator between the conditions to AND.
8. In the second condition of the automation rule, select Loss Amount in Field.

9. Set the operator to Less than or equal to and the value to 500.

   

10. Click Add.
11. For Go To, select Liability Assessment. This directs all open and in progress claims and the claims that have Loss Amount less than 500 to the Liability Assessment task.
12. For If no rule is met, Go To, select Notify Customer. This directs all closed claims and the claims that have Loss Amount greater than 500 to the Notify Customer task.

13. Click UPDATE to save changes to your workflow.

    

Add milestones

Milestones, which are color-coded and labeled, help you organize tasks visually. They are specific to each claim type and can be managed exclusively within the Workflow page of that particular claim type.

The following milestones each represent a crucial phase in the claim process. While we didn't set up milestones immediately, you can add them as part of the setup process when you're adding your tasks.

Milestone	Description
Intake review	This milestone marks the beginning of the claim process, where claims are initially submitted and assessed for validity. It includes gathering necessary information from the customer through an intake form and initial verification of the details against specified criteria.
Claim decision	At this milestone, the workflow focuses on making key decisions based on the information gathered. This includes determining whether the claim should be sent for further processing or resolved based on existing data, and may involve reevaluating the initial information if new details emerge.
Claim processing	This milestone handles the core processing of the claim, involving more detailed investigations.
Closure	The final milestone in the workflow where the claim is formally resolved. This includes notifying all parties involved of the outcome and closing out the claim in the system. It ensures that all necessary documentation is completed and that the resolution is recorded for future reference.

To add milestones to your workflow, complete the following steps:

1. On the Workflow tab, click UPDATE next to the Milestone heading.

   

2. Add the following milestones by clicking ADD MILESTONE for each new row.
   • Intake review
   • Claim decision
   • Claim processing
   • Closure
3. Click UPDATE.
4. Click UPDATE next to the Tasks heading.

5. Select a task from the list to see and configure its details. Refer to the milestone information provided in this table:

   Task	Milestone
   Intake Review	Intake review
   Claim Validity	Claim Decision
   Claim Rejected	Claim Decision
   Set Reserves	Claim Processing
   Assess Liability	Claim Processing
   Upload Claim Documents	Claim Processing
   Estimate Cost	Claim Processing
   Calculate Settlement	Claim Processing
   Make Settlement Payment	Claim Processing
   Notify Customer	Closure

6. Click UPDATE.

Your milestones are now set and show up in the Milestones section, linked to their respective tasks. The workflow visualization updates automatically, giving you a clear view of how everything fits together.

Task blocks

Task blocks are groups of tasks that are chained together in a sequence to create flexible pathways within a workflow. Task blocks aren't specific to a claim type.

To create a task block:

1. In the TASK BLOCKS page, click CREATE TASK BLOCK.
2. Enter a name and description and click NEXT.
3. Click Add Tasks.

4. Select the tasks you want to include in the task block and click ADD.

   

5. (Optional) Use the up and down arrows in each block to re-order the sequence of tasks in your task block.
6. To add dependents, open each task and click ADD DEPENDENT.
   • Note: This step will automatically set the chronological order in which the tasks are done by selecting the task that should directly follow the current task.
7. Click CREATE.

Note that task blocks can only be created and edited from the TASK BLOCKS page.

Next Steps

Congratulations on completing the Workflow tutorial! Now that you know how to build a robust Claim workflow from start to finish, learn more about common low-code configurations you can perform in Connected Claims.

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