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Claims Systems
Claims Workflow Architecture
Map the claims process as states, decisions, evidence, handoffs, exceptions, and audit trails before automation.
Decision Lens
Make the structure visible.
The purpose of a lab page is to show how the analytical problem can be decomposed before implementation or formal review.
IntakeWhich channels, documents, validations, and identity checks begin a claim?
TriageWhich rules route claims by complexity, severity, coverage, fraud indicators, or urgency?
Human reviewWhere must judgment remain visible and attributable?
AuditabilityWhat evidence is needed to reconstruct why a decision or payment occurred?
