Claims intake and processing

Step-by-Step Breakdown

Detailed explanation of each automated stage in the workflow.

1. 1

   Trigger

   Receive claim submission

   Customer submits claim details including incident description, photos, and policy information through digital channels. System automatically captures and validates initial claim data.

   Applied EpicAMS360
2. 2

   Action

   Validate policy coverage

   System verifies active policy status, coverage limits, deductibles, and claim eligibility against policy terms. Cross-references with policy management system for accuracy.

   Applied EpicHawkSoft
3. 3

   Action

   Create claim file

   Generates unique claim number, establishes claim folder with all documentation, and assigns initial reserve amount based on claim type and coverage. Sends confirmation to customer.

   AMS360AgencyZoom
4. 4

   Decision

   Assess claim complexity

   AI evaluates claim severity, damage amount estimates, and fraud indicators to determine if claim requires special investigation or can proceed with standard processing workflow.

   Applied EpicHawkSoft
5. 5

   Action

   Assign adjuster and schedule

   Routes claim to appropriate adjuster based on complexity assessment, location, and workload. Automatically schedules inspection appointment and notifies all parties.

   AMS360AgencyZoom
6. 6

   Action

   Process settlement calculation

   System calculates settlement amount based on adjuster findings, policy terms, and deductibles. Generates settlement documentation and payment authorization.

   Applied EpicHawkSoft
7. 7

   Output

   Issue payment and close

   Processes settlement payment to customer, updates claim status to closed, and triggers satisfaction survey. Archives all claim documentation in system.

   AMS360AgencyZoom

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