Insurance Claim Swimlane BPMN
An insurance claim swimlane diagram shows how work moves from customer-service intake to an adjuster's decision and, when appropriate, to payments. The lanes make responsibility visible at the point where a claim changes hands. The decision gateway separates the paid and declined outcomes so both paths are understood. Use clear labels that match the team's actual claim vocabulary, and add document requests, fraud review, legal review, or customer communication only when they are part of the process. This map is useful for operational review and training, but it does not determine coverage, settlement amounts, or legal obligations. Update it whenever the responsibilities or claim procedure changes.
Open it in the AI editor with a prompt pre-filled — keep what works, change what doesn't.
Scenario
An insurer processes a submitted claim.
Key decisions
- Intake: Customer service checks the information received.
- Assessment: The adjuster decides whether the claim is approved.
- Outcome: Payments issues an approved settlement.
When to reuse this
Use this pattern when distinct teams own claim intake, assessment, and payment; align it with the actual policy and claim process.
Frequently asked questions
Why use swimlanes for claims?
Where should approval be decided?
Can I add fraud review?
Tweak it with chat, export PNG/SVG, or fork it for your own use case.