Claim Assessment Process flowchart template
Editable claim assessment workflow with swimlanes for Policyholder, Claims Handler, Claims Adjuster, two decision gates, correction and review loops, and a documented handoff to the next insurance operation.
What the claim assessment process flowchart process is
This claims template follows a specific operating record from open registered claim to send decision file for approval. The Policyholder, Claims Handler, Claims Adjuster, Approver lanes show who gathers information, who evaluates it, and who owns the final handoff. Adapt the roles and documents to your product and distribution model.
The first gate asks whether evidence sufficient. An incomplete case goes through request and verify additional evidence and returns to validation. The later gate asks whether assessment ready for decision; a failed review goes through refer dispute, complexity or specialist question before the decision is reconsidered. Record the reason at each branch so the next team can reconstruct the outcome.
This is an operational starting point. Coverage terms, authority limits, notices and required records vary by insurer, product and jurisdiction; the diagram does not establish regulatory compliance or decide an individual customer's entitlement.
What this flowchart covers
In this template
- File review and Evidence: review coverage and reported loss and identify documents and assessment needs
- A correction loop from evidence sufficient? to request and verify additional evidence
- Valuation: assess cause, extent and relevant terms and estimate supported loss or benefit
- An exception route through refer dispute, complexity or specialist question
- Closure through record assessment and recommendation and send decision file for approval
When to use this template
- You need to assign ownership across Policyholder, Claims Handler, Claims Adjuster for claims work
- Cases regularly pause for missing information or unclear authority and need a visible return path
- You are updating a procedure and want staff to compare actual handoffs with the documented path
How it works
Map the actors
Replace the example lanes with the actual teams that perform review coverage and reported loss, estimate supported loss or benefit and record assessment and recommendation. Keep a separate lane for any independent decision owner.
Define the intake check
Specify the information and evidence needed before the Evidence sufficient? gate can pass. Put the owner of request and verify additional evidence on the return loop.
Set the decision authority
Document who may decide assessment ready for decision? and what sends a case through refer dispute, complexity or specialist question. Use your own product terms and authority matrix.
Confirm the handoff
Check the output of record assessment and recommendation against what the receiving team needs to complete send decision file for approval.
Frequently asked questions
What does this claim assessment template show?
It shows open registered claim, intake and validation, an information correction loop, assessment, an exception review loop, and send decision file for approval. The lanes identify the teams responsible for each handoff.
Can I use this flowchart for every insurance product?
Use it as an editable starting point. Replace the example evidence, decision criteria, authorities and communications with those for the product, insurer and jurisdiction involved.
Does this template establish legal or regulatory compliance?
No. It illustrates an operational workflow and contains no universal deadline, threshold or mandatory regulatory procedure. Have the relevant specialists check local obligations before adopting it.
Where this process fits
In most operations this process follows Claim Documentation Process flowchart template and hands off to Claim Settlement Process flowchart template.
It is one step in Claims.
Step 1: First Notice of Loss (FNOL) Process flowchart template
Step 2: Claim Documentation Process flowchart template
Editable claim documentation workflow with swimlanes for Policyholder, Claims Handler, Claims System, two decision gates, correction and review loops, and a documented handoff to the next insurance operation.
Step 3: Claim Assessment Process flowchart template You are here
Editable claim assessment workflow with swimlanes for Policyholder, Claims Handler, Claims Adjuster, two decision gates, correction and review loops, and a documented handoff to the next insurance operation.
Step 4: Claim Settlement Process flowchart template
Editable claim settlement workflow with swimlanes for Claims Handler, Approver, Finance, two decision gates, correction and review loops, and a documented handoff to the next insurance operation.