, home
Customer access Request an enterprise demo
Request an enterprise demo Customer access

Insurance

Insurance Claims & Settlement

Follow loss notification through evidence collection, authorised coverage review, settlement approval, payment reconciliation and closure.

Request a tailored demonstrationExplore the interface

12 workspace menus · 5 role profiles · Connected records

Designed for insurance claims operations directors

Insurance Claims & Settlement workspace interface preview; illustrative records and figures.
Insurance Claims & Settlement — operational workspaceInterface preview · Illustrative dataView full interface →

Explore the system interface.

Operational workspace and record review. Select a screen to inspect it in full.

Insurance Claims & Settlement workspace interface preview; illustrative records and figures.
Insurance Claims & Settlement — operational workspaceInterface preview · Illustrative dataView full interface →
Insurance Claims & Settlement record interface preview; illustrative records and figures.
Insurance Claims & Settlement — record and workflow reviewInterface preview · Illustrative dataView full interface →

Operational dashboards and work queues.

Operational views

Review work, evidence, exceptions and authorised decisions within a defined operating scope.

Portfolio / service teamPeriodAssigned teamReview state

Dashboard measures

  • Active reconciliation items
    Count of all records in the selected workspace.
  • Review queue
    Records at the third stage of the business workflow.
  • Needs attention
    Records with an assigned review requirement.
  • Final-stage records
    Records in the fourth business workflow stage.

Business workflow and operating scope

Follow loss notification through evidence collection, authorised coverage review, settlement approval, payment reconciliation and closure. A claim changes hands between intake, assessment, decision and payment teams. Missing evidence or an unresolved coverage question can become difficult to see once the next team starts work. The system keeps those dependencies and the responsible decision-maker connected to the claim.

Operational visibility

  • Claim settlement cycle time
  • Open cases by priority and ageing
  • Service level / cycle time dashboard
  • Escalation and exception report
  • Resolution outcomes and rework

Operations

Operational overview

Review the work position and priority actions.

Loss notification intake

Coordinate loss notification intake with assigned responsibilities, linked records and review history.

Claim evidence

Coordinate claim evidence with assigned responsibilities, linked records and review history.

Coverage review

Coordinate coverage review with assigned responsibilities, linked records and review history.

Assessment coordination

Coordinate assessment coordination with assigned responsibilities, linked records and review history.

Settlement approval

Coordinate settlement approval with assigned responsibilities, linked records and review history.

Payment reconciliation

Coordinate payment reconciliation with assigned responsibilities, linked records and review history.

Customer closure records

Coordinate customer closure records with assigned responsibilities, linked records and review history.

Insights

Reports and saved views

Review the reporting scope and export agreed operational views.

Governance

Approvals and exceptions

Review delegated decisions, exceptions and recorded conditions.

Audit history

Trace accepted changes, decisions and accountable actions.

Access and configuration

Manage the agreed role permissions and configurable operating rules.

The end-to-end business journey.

From intake to authorised completion, with evidence at each decision.

01

Register the loss

Register loss notification and supporting evidence.

02

Review coverage

Assign authorised coverage and liability review.

03

Approve settlement

Approve repair or settlement proposal.

04

Reconcile and close

Reconcile payment and communicate closure.

Governance and control

  • Every case must have an owner, priority and status.
  • Sensitive records must be visible only to authorised roles.
  • Escalation rules must be configurable by severity and elapsed time.
  • Decisions that affect entitlement, safety or payment require accountable human approval.
  • Closed cases may reopen only through a controlled path that preserves history.
  • Jurisdiction-, regulator- or authority-specific rules must be configurable and validated by an authorised domain owner before production use.

Accountable roles

Claims intake officer
Assessor
Coverage reviewer
Settlement approver
Payment officer

Permissions are configured and tested for the agreed responsibilities.

Data, interfaces and operating requirements.

Core records

Case / requestPerson / customerService / issue typeTaskAssignmentDecisionEvidence / communicationResolution

Systems and interfaces

  • Policy administration records
  • Assessment service interfaces
  • Approved payment systems

Interface scope, data mapping and testing are agreed for each engagement.

Implementation requirements
Requires policy, assessment and payment integrations, product-specific claims rules and accountable human approval of denials and material settlements.

Mobile and tablet access

Submit permitted claim evidence and complete authorised assessment tasks on suitable field devices.

Access approved workflows through the Dalfin mobile app. Device tasks and permissions are confirmed for the deployment.

Apple App Store ↗Google Play ↗

AI extensions

Summarise claim evidence for assessor review. Coverage denials and material settlement decisions remain human approved.

AI extensions are scoped around the required data, business outcome and review controls.

Engineered with Genesis.

Structured application engineering

Connect requirements, roles, records, workflows and interfaces through the agreed Genesis engineering process.

Controlled changes

Review dependency impact and validation requirements. Context Memory supports governed changes and accepted application revisions.

Deployment and support

Agree customer cloud or on-premises requirements, device access, implementation acceptance and ongoing engineering support.

An example operating scenario

See the process, its exception and the evidence.

A claim is returned for missing loss evidence. An authorised reviewer resolves a coverage question, the settlement proposal is approved within delegated authority and payment is reconciled. The claimant receives the approved closure communication.

What to review

  • A saved end-to-end transaction
  • An exception and its authorised resolution
  • Different operator, approver and reviewer permissions
  • Final records, history and the relevant report
Discuss this solution

Questions before implementation.

How is this system adapted to our organisation?

Roles, approval authority, business rules, records and reporting are configured around your operating model. Scope definition connects the required business outcome to workflows, interfaces and acceptance criteria.

How are approvals and responsibilities defined?

Operators, reviewers and authorised decision makers have defined responsibilities. Approval limits, exception handling and access permissions are agreed with your business owners and tested against the selected workflows.

Can it connect with our existing systems?

Interface requirements cover your existing business systems, data ownership, mapping and authentication. Connection design and testing form part of the agreed implementation scope.

What will we review in a solution walkthrough?

Start with a relevant business transaction, then review its approvals, an exception, role permissions and final records. Discuss the integrations, reporting and operating requirements that matter to your organisation.