CLAIMS RESERVE MANAGEMENT WORKFLOW

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

[ ] Fetch New Claim Details: Retrieve the initial claim entry and associated incident data from the Claims Data Model.
[ ] Retrieve Historical Reserve Data: Get previous reserve entries for the same claim ID to identify changes in reserve amounts.
[ ] Calculate Reserve Variance: Calculate the difference between the new proposed reserve and the current existing reserve.
[ ] Sum Total Outstanding Reserves: Aggregate all open reserve entries across the portfolio to calculate total financial exposure.
[ ] Assign Claims Adjuster Review: Create a task for the assigned Claims Adjuster to validate the new reserve amount.
[ ] Update Claim Status to 'Under Review': Update the main Claim entry status to reflect that a reserve change is being processed.
[ ] Manager Approval Task: If the variance exceeds a specific threshold, create an approval task for the Claims Manager.
[ ] Create Reserve Transaction Record: Create a new entry in the Reserve Transactions data model to log the new amount.
[ ] Update Master Claim Record: Update the total 'Incurred Amount' on the main Claim entry to include the new reserve.
[ ] Notify Adjuster of Approval: Send an email to the Adjuster confirming the reserve change has been approved and processed.
[ ] Notify Stakeholders of High-Value Change: Send an email to the Finance Department for any reserve updates exceeding the high-value threshold.
[ ] Generate Monthly Reserve Report: Create a summary report of all reserve movements processed during this period.
[ ] Cleanup Temporary Calculation Logs: Delete temporary data entries used for intermediate calculation steps during the workflow.
[ ] Urgent Alert to Manager: Send an SMS to the Claims Manager if a reserve increase is flagged as 'Critical' or 'Urgent'.

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