- Introduction to UiPath Maestro™
- Getting started
- Maestro landing page
- Process modeling
- Process implementation
- Process operations
- Process monitoring
- Process optimization
- Licensing
- Reference information
Maestro user guide
Claims processing is the end-to-end workflow that insurance companies follow to evaluate, validate, and settle claims filed by policyholders. The process typically includes:
- Claim submission
A customer submits a claim via an online portal, email, or phone, providing required documentation (e.g., medical records, photos, invoices).
- Claim intake and data
capture
The submitted information is captured, categorized, and entered into the claims management system.
- Verification and
validation
The claim is reviewed against policy terms, coverage limits, and required documents. Third-party data (e.g., police reports, medical records) may be verified.
- Assessment and
adjudication
The insurer evaluates the claim’s legitimacy and determines the payout amount based on rules and policy conditions.
- Approval or denial
The claim is either approved, denied, or routed for further investigation if flagged as suspicious or incomplete.
- Settlement and payment
Once approved, the claim amount is disbursed to the claimant or service provider.
- Automate decision logic for eligibility, coverage checks, and fraud detection at scale.
- Ensure consistent, rule-based adjudication while allowing human-in-the-loop exceptions when needed.
- Integrate AI tools for document understanding, medical record analysis, and anomaly detection.
- Improve transparency with full audit trails and compliance monitoring across the claims lifecycle.
- Accelerate claim resolution and payment, improving customer satisfaction and reducing operational costs
