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.

유형 BPMN표준 OMG BPMN 2.0.2 / ISO/IEC 19510:2013엔진 schematex-bpmn업데이트됨 2026. 9. 24.

요청 내용

“Draw a BPMN insurance claim process with customer service, adjuster, and payments lanes; check claim details, assess the claim, send a denial notice when declined, and issue payment when approved.”

그렇다면Add a document request task.Add a fraud review lane.

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01Intake

Customer service checks the information received.

02Assessment

The adjuster decides whether the claim is approved.

03Outcome

Payments issues an approved settlement.

Use this pattern when distinct teams own claim intake, assessment, and payment; align it with the actual policy and claim process.

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자주 묻는 질문

Why use swimlanes for claims?

They show the handoff from claim intake to assessment and payment, making ownership visible.

Where should approval be decided?

Place the decision after the adjuster's assessment, before the payment or denial outcome.

Can I add fraud review?

Yes. Add a fraud lane and route selected claims to it before a final decision.