The case file of a claim or a committed service — documents, participants, adjusters and external providers, deadlines and resolutions — coordinated through to a confirmed answer delivered to whoever raised it, with a record of who, or which system, confirmed it.
01 · The problem
A claim stalls for a specific reason: a document nobody formally asked for is missing, the adjuster report never arrived, a query about the repair shop quote remains unresolved, or the provider visit was rescheduled without telling the person waiting for an answer. Outside insurance the same thing happens to a committed service: an assistance job, a warranty or a field visit left halfway between whoever asked for it and whoever has to carry it out.
Coordination runs on whatever is at hand: a Microsoft Excel spreadsheet holding the open cases and their deadlines, email to chase the adjuster report, phone calls to confirm the provider visit, and a shared repository — Microsoft SharePoint, for example — where documents are filed with no link back to the case they belong to. None of them records what was asked for, who owed an answer, or what evidence closed the case.
Even with those systems in place, a case stalls when nobody can see what was asked for, who owes an answer, and what is still missing before it can close.
02 · The solution
Every case opens with its type set and moves as a single file: classification, documents and participants, requests to the third parties that type calls for, deadlines and open issues, a resolution recorded by the authorizing owner, and a confirmed answer to whoever raised it. Scope is agreed type by type — vehicle damage, a committed assistance job, a service warranty — because each one has its own network of third parties, its own deadlines and its own way of closing.
A case never starts from a blank form. The policy or contract behind it, the affected asset or service, the network of providers approved for that type and the owner who can authorize the resolution are already defined and approved in the Operational Graph. BPMflow runs the work itself — cases, assignments, deadlines, authorizations and evidence — so the selected provider and the applicable deadline come from the organization's own context rather than from a standalone diagram.
When the work is a planned intervention on the organization's own asset — contractor qualification, prerequisites and acceptance — the adjacent path is Contractors, Assets and Interventions. The Insurance industry page brings this path together with portfolio review, and the documentary evidence rests on Document Governance & Evidence.
03 · Capabilities
Open cases sit in a single queue, showing the case type, the participant whose response is pending, the deadline and any open issue. Max answers questions about a case within the authorized context: it explains what is missing and shows the evidence on record.
Opens the case from a notification by whoever raised it, a filing by an authorized third party, or the system that received the claim, and classifies it there and then: each type brings its own requirements, participants and closing condition.
Holds the claim or request, the supporting documents, the reports, the quotes and the correspondence in one place, with the current version clearly marked.
Sends requests straight from the case file: the report from the adjuster, the quote from the repair shop, the visit from the provider. Each third party sees and responds only to the request assigned to them, and their reply lands back in the case.
Shows the deadline that applies to each participant, which open issue is holding up progress, and which visit was rescheduled and why.
Records the resolution, who authorized it, the supporting evidence and the rule that applied. Specialist results come in as decisions recorded by the owners who made them.
Records the answer given to whoever raised the case and who — or which system — confirmed it, alongside a reviewable trail of what was asked for, what was assessed and how it was resolved.
04 · Roles
Owns the case and keeps it moving.
What they see
Open cases by type and age, the participant each one is waiting on, and the deadline.
What they do
Classifies the case, chases what is missing, assigns participants and records the agreed outcome.
Provides the assessment the resolution rests on.
What they see
Their assigned cases, with the background, the documents and the scheduled visit.
What they do
Assesses the case, uploads the report, and records the conclusion with its date and author.
Delivers the committed service.
What they see
The work assigned to them, its scope, the deadline and any open issue — limited to their own case.
What they do
Confirms or reschedules the visit, does the work, attaches the evidence and flags what is still pending.
Makes decisions within their authority.
What they see
Cases awaiting their decision, with the assessment and the supporting documents.
What they do
Approves the resolution, rejects it on stated grounds, or sends it back with a specific issue to fix.
Policyholder, customer or requesting business area.
What they see
Where their case stands, what is still missing and what happens next, through scoped access.
What they do
Supplies the documents requested, accepts or disputes the service, and receives the confirmed answer.
05 · Implementation
Implementation begins with the operation as it stands today and a single bounded case type. You can start with only the context needed for that case type; no prior architecture project is required. Further types are added later on the same base.
1 · Agree on scope and closure
Which claim or service type is in scope — vehicle damage, a committed assistance job, a warranty on installed equipment — who takes part, which deadlines apply, and what counts as a confirmed answer.
2 · Bring in existing context and connect sources
The contract or policy behind the case, the affected asset or service, the provider master data and the authorized document repository become the sources the case draws on, and case status is written back to the system that has to hold it.
3 · Test the workflow and hand it over
The workflow is tested against cases from the current period; rules, deadlines and owners are tuned for each case type; and day-to-day operation passes to the client's own team.
06 · Typical scenarios
Different lines of business, a network of external providers and field teams spread across locations: the same mechanism, with its own rules for each case type. The examples are illustrative.
A case moves when it is clear what is missing, who owes an answer, and what counts as an answer that closes it. The place to start is a single case type, with its own network of third parties and its own closing condition.
Claims and Service Coordination is an EAFlow cross-industry solution on the Operational Graph, supported by BPMflow automation capabilities. It coordinates the case file and its resolution: it is not an insurance core system, it does not calculate coverage, and it performs neither underwriting nor fraud detection: those results come into the case as recorded decisions. It also applies outside insurance — field service, warranties and assistance — each with its own trigger and its own closing condition. The examples are illustrative; scope is agreed per case type.
