CLAIMS PROCESSING LIFECYCLE MANAGEMENT

Created by ChecklistGuro (https://checklistguro.com)

[ ] Retrieve Claim Details: Fetch the primary claim entry including claimant info, incident date, and reported loss type.
[ ] Fetch Policy Coverage: Retrieve the specific policy data model associated with the claimant to check for active coverage.
[ ] Validate Coverage Limits: Compare the reported loss amount against the maximum coverage limit defined in the policy data model.
[ ] Update Claim Status to 'Under Review': Update the claim entry status to reflect that the initial intake is complete and investigation has begun.
[ ] Assign Claims Adjuster: Create a task for the Claims Department to assign a specific adjuster to the case.
[ ] Retrieve Incident Documentation: Fetch all uploaded evidence, photos, and statements linked to the claim entry.
[ ] Investigation Task: Create a task for the assigned adjuster to conduct field investigation or remote verification.
[ ] Create Investigation Log: Create a new entry in the 'Investigation Notes' data model to document findings.
[ ] Update Claim Severity: Update the claim entry with the calculated severity level based on the investigation findings.
[ ] Calculate Total Loss Estimate: Aggregate all line-item repair/medical costs from the 'Estimate' data model to find the total sum.
[ ] Calculate Deductible Deduction: Subtract the policy deductible amount from the total loss estimate.
[ ] Update Final Settlement Amount: Update the claim entry with the final calculated net payout amount.
[ ] Fraud Detection Review: Create a task for the Fraud Unit if the claim severity exceeds a certain threshold.
[ ] Notify Claimant of Decision: Send an email to the claimant's email address informing them of the claim approval or denial.
[ ] Update Claim Status to 'Closed': Update the claim entry status to 'Closed' once the settlement is finalized.
[ ] Payment Confirmation SMS: Send an SMS to the claimant's phone number notifying them that the funds have been disbursed.
[ ] Generate Monthly Claims Report: Create a summary report of all closed claims, total payouts, and average processing time for management.
[ ] Archive Duplicate Claims: Delete or flag duplicate claim entries in the system to maintain data integrity.

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