Salesforce Flow Assignment: Insurance Claim Processing
Business Requirement
An insurance company wants to automate its claim review process using Salesforce Flow.
When a new Claim is submitted, the system should first execute a Fraud Detection Subflow. The subflow returns the following values:
- Fraud Score
- Risk Level
- Recommendation
After receiving the results, determine whether an investigation is required.
An investigation must be created if any of the following conditions are true:
- Fraud Score is greater than 50
- Claim Type = Fire
- Claim Type = Medical Fraud
If an investigation is required:
- Create an Investigation record related to the claim.
- Automatically assign an available Investigator.
- Create a follow-up task for the investigator.
Next, verify that all required claim documents have been uploaded. The required documents are:
- Claim Document
- Photo
- Police Report
- Medical Report
- Invoice
Use a Loop to evaluate each related document.
If any required document is missing:
- Create a task named Upload Missing Documents.
- Assign the task to the claim owner.
If the Claim Amount is greater than $100,000, update the claim priority to Critical.
Update the claim's Approval Status according to the approval stage:
- Pending Manager Approval
- Pending Director Approval
- Pending VP Approval
Create a Scheduled Path that runs 48 hours after the claim enters the approval process.
If the claim is still pending approval after 48 hours:
- Create an Escalation Task.
- Notify the Manager.
Configure email notifications for the following events:
- Customer receives a "Claim Received" email.
- Manager receives an "Approval Required" email.
- Investigator receives an "Investigation Assigned" email.
- Finance receives a "Payment Approved" email.
Implement proper Fault Connectors throughout the flow.
If creating a task fails:
- Create an Error Log record containing:
- Flow Name
- Record ID
- Running User
- Error Message
- Date and Time
- Notify the System Administrator.
Hi @Rohit .
This is a great real-time Salesforce Flow scenario. It covers key concepts such as
Subflows, Decisions, Loops, Scheduled Paths, Fault Connectors, Tasks, and Email Notifications. A very good assignment for practicing end-to-end Flow automation.
Possible Flow approach:
Record-Triggered Flow (Claim – After Save) → Call Fraud Detection Subflow → Decision for Fraud Score/Claim Type → Create Investigation and assign Investigator → Create follow-up Task → Get Related Documents + Loop to identify missing documents → Create “Upload Missing Documents” Task → Update Priority to Critical if Claim Amount > $100K → Update Approval Status based on Approval Stage → Scheduled Path (48 hours) for escalation → Configure required Email Alerts → Add Fault Connectors for Task creation and log errors in an Error Log
record, with an admin notification.
This approach keeps the automation modular, scalable, and easier to maintain.
Hope this Helps!!
