How to support claim adjustment and benefit payout processes? Tech trends, part 1: workflow engines

Insurance companies have few opportunities for direct interaction with their customers, except when selling health insurance, which requires more contact. Judging by the standard insurance company portfolio, the claim adjustment and benefit payout processes are among the most emotional moments of contact between the customer and the insurer, second only to the act of purchasing insurance services.
This is why it is really important to ensure that the whole process is top-notch from start to finish and leaves a positive imprint on the customer’s memory. The question is: how can new tech trends help you pull it off?

How to support claim adjustment process and benefit payout process? Tech trends, part 1

Claim adjustment: customers and insurers

It goes without saying that the incident behind the claim is usually an unpleasant experience as such. Accordingly, the way you handle the subsequent claim adjustment process and the emotions it involves will be engraved on your customers’ memory for a long time. Their experience will impact customer loyalty and determine whether or not they stick with you for the long haul.

This is confirmed by the EY survey, in which as many as 87% customers admit that their experience with the claim adjustment process has had an important impact on their decision to continue with the same insurer*.

On the other hand, claim adjustment processes are very cost intensive. According to a Deloitte survey, processes related to claim adjustment and benefit payouts account for a whopping 70% of the total expenditure of property insurers**. It is only natural, then, to want to optimize your costs by turning to new technologies.

What are workflow engines?

Workflow engines are an important tech trend designed to support insurers in their claim adjustment processes and benefit payouts. They can considerably speed up claim adjustment processes and optimise their costs. The solution is not entirely new, but recent technological advances have significantly increased their potential.

Process engines

A small reminder: workflow engines are tools you can use to manage, automate and optimise your business processes. Their main task is to streamline workflows, minimise the time and effort needed to get things done, but also to ensure compliance with rules and procedures, including auditability.

Workflow engines in claim adjustment processes

Workflow solutions can support claim adjustment in many ways:

Claims classification

Workflow engines help classify claims and define different claim adjustment paths depending on the product purchased by the client (or type of claim). They also allow you to create claim registration or support forms, which means you can adapt your forms and processes to different claim types and thus simplify them, providing customers with clear information.

Claim valuation

Workflow solutions can calculate the value of a claim by analysing input data, attached photos and documents. This is especially useful when you have to deal with many repetitive, low-value claims.

Once you have made an estimate, some processes can be automated. For example: if the value of the claim is low, you can take the mobile claim adjuster or repair service out of the process. You can simply fast-track the claim directly to the payout queue, thus automating the entire process from registration to payment.


Workflow engines also make it easy to introduce any necessary changes. The constant drive toward process improvement and optimisation and intense legislative reforms mean that the ability to change and modify processes (or forms) is crucially important for insurance companies. It makes business tasks faster and more flexible and, as a consequence, reduces their cost.

End-to-end process management

Workflow engines also have management functions, allowing you to manage the whole claim adjustment process from registration to payout. On the one hand, they automatically assign tasks to individual users (as long as they are necessary to the process), and on the other, monitor their work progress. This allows you to get an idea of how long it takes to process a payout and identify any possible bottlenecks or sub-optimal workflows.

What’s more, a new class of Power BI tools make it possible to create separate dashboards for various user groups so as to clearly visualise their progress towards their KPIs.

Legacy core systems vs workflow engines

What to do if you want a workflow engine but your core system does not support all these functions? Legacy systems are often not flexible or parametrizable enough. One solution is to deploy an advanced Claims Management solution, but that would be a long and costly project, often involving migration, which always carries a certain project risk.

In our experience, one of the most cost-optimal solutions is to use your existing core system and replace the front-end and process layer with the workflow engine.

Integrating the workflow engine with the core system

When deploying a workflow engine in an enterprise with a legacy core system, you can replace selected processes (e.g., for a given claim category) piecemeal by creating new forms and processes directly in the workflow solution.

Do not forget to integrate the engine with your current core system to continue to use existing integrations, such as with the general ledger or a data warehouse. In this way, even after deploying the new workflow solution, you will still be able to use some purely back-office operations supported by your core system, which are critical to your business.

With this iterative approach, you can gradually move processes until you are satisfied, i.e., until the entire existing solution has been replaced or limited to the role of a database.

While it may take longer, this strategy will require much fewer resources to modernise your solution and deliver many new functionalities that your legacy core systems would not be able to provide or could only do so at a prohibitive cost.

Claim adjustment process. A workflow engine and what else?

To sum up, using workflow engines for claim adjustment processes and benefit payouts generates considerable benefits for insurers and customers alike. Using workflow engines allows you to classify claims accurately, quickly calculate their value, and flexibly introduce changes in your processes, which is extremely important in the dynamic environment of the insurance sector.

It is important to keep in mind, however, that a workflow engine is not enough. Only once you have deployed additional solutions can it really show their full potential.

* EY, Claims in a digital era. Data, analytics and AI transform the customer experience 

** Deloitte, Preserving the human touch in insurance claims transformations. How exponential claims professionals can balance automation and personalized customer service