- Introduction
- Getting started
- Building with Maestro BPMN
- Understanding Maestro BPMN modeling
- Opening the modeling canvas
- Modeling your process
- Aligning and connecting BPMN elements
- Autopilot for Maestro (Preview)
- Process Repository
- Implementing a simple BPMN process
- Implementing a complex BPMN process
- Debugging
- Simulating
- Evaluations (Preview)
- Common implementation scenarios
- Building with Maestro Case
- Introduction to Maestro Case
- Maestro BPMN vs. Maestro Case: when to use case management
- The Maestro Case lifecycle: from event trigger to app experience
- Build your first case with Maestro Case
- Build a Maestro Case with a coding agent (preview)
- Defining case keys (system vs. external)
- Establishing task I/O and write-back contracts
- Exit rules and early stage termination
- Modeling primary and secondary stages
- Triggering a case from Data Fabric
- Implementing stage-level personas and permissions
- Setting SLAs and automated escalation rules
- Configuring a rework loop (re-entry)
- Configuring and testing the Case Manager Agent (preview)
- Case Manager input and output contract
- Maestro Case component dictionary
- Building with Maestro Flow
- Maestro Automate
- Integrations
- Operating
- Monitoring
- Optimizing
- Reference information
End-to-end claims processing workflow in insurance, covering submission, validation, evaluation, and settlement steps as a Maestro use case.
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:
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Claim submission
A customer submits a claim via an online portal, email, or phone, providing required documentation (e.g., medical records, photos, invoices).
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Claim intake and data capture
The submitted information is captured, categorized, and entered into the claims management system.
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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.
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Assessment and adjudication
The insurer evaluates the claim’s legitimacy and determines the payout amount based on rules and policy conditions.
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Approval or denial
The claim is either approved, denied, or routed for further investigation if flagged as suspicious or incomplete.
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Settlement and payment
Once approved, the claim amount is disbursed to the claimant or service provider.
The following diagram shows a claims processing workflow in Maestro. It follows a claim from submission through validation, assessment, and resolution, involving both system actions and user review.
How Maestro adds value
UiPath Maestro™ strengthens claims processing by enabling insurers to:
- 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