Every line of business has different rules — your workflow engine should handle that without IT tickets
Regure's drag-and-drop workflow builder lets claims operations teams configure exactly how claims move through your organization. Auto, property, health, casualty, workers comp — each gets its own workflow with the right SLAs, approval thresholds, and escalation triggers.
Claims workflows shouldn't be hardcoded — they should be configurable by the people who understand the business
Insurance claims don't follow a single linear process. An auto liability claim with injuries follows a different path than a property water damage claim. A workers comp claim in California has different regulatory requirements than the same claim in Texas. A commercial property loss above $500K requires different approvals than a residential claim under $50K.
Yet most claims systems force all claims through the same rigid workflow — or require IT development to create custom workflows for each scenario. Every workflow change requires a development ticket, a 2-week sprint, QA testing, and a deployment window. By the time the workflow is updated, the business has already worked around it with email and spreadsheets.
Regure's workflow engine puts control in the hands of claims operations teams. Drag-and-drop workflow building, conditional routing logic, configurable SLAs, and pre-built insurance templates mean workflow changes happen in hours, not months.
This is the configurable workflow engine that insurance operations teams need: powerful enough for complex multi-stage claim lifecycles, simple enough that a claims manager can modify it without writing code.
Drag-and-drop workflow design that claims managers can operate without engineering support
The workflow builder is a visual canvas where claims operations teams design, test, and deploy workflows. Drag stages onto the canvas, connect them with routing logic, configure SLAs and approval rules, and activate — all without writing a line of code.
Insurance workflow requirements change constantly. A new state regulation changes claim acknowledgment deadlines. A carrier client updates their SLA requirements. A new product line launches with unique approval chains. Management decides to add a quality review step for claims above a certain threshold.
With traditional systems, each change requires IT involvement: requirement gathering, development, testing, deployment. The average workflow change takes 4-6 weeks. With Regure, claims managers make changes directly in the visual builder and deploy in the same session.
The workflow builder provides:
- Visual canvas with drag-and-drop stage creation — intake, triage, investigation, review, approval, settlement, closure
- Connector logic between stages: automatic progression, conditional branching, parallel paths, merge points
- Stage configuration: required actions, documents, approvals, and time limits per stage
- Role assignment per stage: which roles can perform actions, which roles receive notifications
- SLA configuration per stage: deadline, warning threshold, escalation target, and notification recipients
- Testing mode: run simulated claims through the workflow before activating in production
- Version control: every workflow change is versioned — roll back to any previous version instantly
For TPAs managing multiple carrier clients, each carrier gets a separate workflow configuration — with unique stages, rules, and SLAs — all managed from the same visual builder.
Route claims through different paths based on type, amount, jurisdiction, or any attribute
Not every claim follows the same path. Conditional routing evaluates claim attributes at each stage and directs the claim down the appropriate branch — automatically, without human triage decisions.
Amount-Based Routing
Settlement authority limits are the most common routing condition. Claims under $10K follow a fast-track workflow with adjuster-level approval. Claims between $10K-$50K require supervisor approval. Claims above $50K require claims director review with supporting documentation. Claims above $250K trigger executive notification and external audit review.
Amount-based routing applies at the settlement stage — but also at investigation, where high-value claims may require specialist assessment, independent medical examination, or engineering evaluation.
Type-Based Routing
Auto collision claims follow a different investigation process than property water damage claims. Health claims require medical necessity review that other lines don't. Workers compensation claims have state-specific reporting requirements. Type-based routing directs each claim to the workflow designed for its specific handling requirements.
Sub-type routing adds further precision: within auto claims, comprehensive (theft, weather) follows a different path than collision. Within property, fire damage requires different documentation than water or wind.
Jurisdiction-Based Routing
Insurance regulation varies by jurisdiction. California requires different claim acknowledgment timelines than Florida. UK FCA Consumer Duty requires different documentation than US state insurance departments. UK claims follow different escalation paths than US claims.
Jurisdiction-based routing ensures claims in each jurisdiction follow the correct regulatory workflow — with the right SLAs, notification requirements, and documentation standards for that jurisdiction's regulations.
Risk Score Routing
Claims with elevated fraud risk indicators route to enhanced investigation workflows with additional documentation requirements, mandatory field inspection, and SIU notification. Claims from priority policyholders route to senior adjusters with accelerated SLAs. Claims involving litigation route to legal-coordinated workflows with attorney notification.
Risk scores are calculated from multiple inputs: fraud model scores, policy history, claimant history, and real-time indicators — providing nuanced routing that simple rules can't achieve.
SLA monitoring with automated alerts and escalation at every workflow stage
Every workflow stage has a deadline — regulatory, contractual, or operational. Regure tracks time at every stage with warning alerts, escalation triggers, and management dashboards showing SLA performance across the claims operation.
Stage-Level SLA Tracking
Each workflow stage has a configurable SLA: FNOL acknowledgment within 24 hours, claim assignment within 2 hours, initial investigation within 5 days, settlement decision within 30 days. The system tracks elapsed time per stage and alerts when claims approach SLA deadlines.
SLA warnings fire at configurable thresholds — typically at 50%, 75%, and 90% of the allowed time — giving handlers and supervisors time to act before deadlines are breached.
Automated Escalation
When a claim breaches its stage SLA, the system escalates automatically: notifications to the assigned handler's supervisor, reassignment if the handler is unavailable, and management alerts for repeated SLA breaches. Escalation paths are configurable per stage and per severity.
For compliance teams, SLA breach data feeds into compliance dashboards showing regulatory timeline adherence across the organization — identifying systemic issues before regulators do.
Performance Dashboards
Operations managers see real-time SLA performance: claims approaching deadlines, claims in breach, average stage duration trends, and per-adjuster performance metrics. Dashboards drill down by line of business, team, adjuster, carrier client, and time period.
Weekly and monthly SLA reports generate automatically — providing the performance data carriers expect from TPA oversight reviews and that regulators expect during market conduct examinations.
Pre-built insurance workflow templates — deploy in hours, customize as needed
You don't need to build workflows from scratch. Regure includes pre-built templates for common insurance claim types that you can deploy immediately and customize to match your specific operational requirements.
Auto Claims Workflow
Complete lifecycle from FNOL through settlement: intake and classification, liability determination, damage assessment with repair estimate review, total loss evaluation, subrogation analysis, settlement approval, and payment. Includes branches for injury claims, uninsured motorist claims, and comprehensive (non-collision) claims.
Property Claims Workflow
From loss notification through restoration: intake, coverage verification, field inspection scheduling, damage assessment, contractor bid management, scope agreement, settlement approval, and payment with holdback for completed repairs. Includes branches for water, fire, wind, theft, and catastrophe events.
Health Claims Workflow
Pre-authorization through claim adjudication: eligibility verification, medical necessity review, provider network verification, benefit calculation, member cost-sharing calculation, payment processing, and explanation of benefits generation. HIPAA-compliant document handling and access controls built into every stage.
Workers Compensation Workflow
Injury notification through return-to-work: employer report intake, employee statement collection, medical treatment authorization, compensability determination, benefit calculation per state formula, vocational rehabilitation referral, and settlement negotiation. State-specific requirements configured per jurisdiction.
What claims operations teams ask about the workflow engine
Can non-technical staff really build workflows?
Yes. The visual builder uses drag-and-drop with guided configuration — no code, no SQL, no scripting. Claims managers, operations directors, and compliance officers regularly build and modify workflows. Complex conditional logic is configured through dropdown menus and rule builders, not programming languages.
How do we handle workflow changes for active claims?
Workflow version control ensures active claims continue on the workflow version they started with. New claims use the updated workflow. Optionally, active claims can be migrated to the new workflow at their current stage — with full audit trail of the transition. No claims are ever lost or stuck during workflow updates.
Can we run different workflows for different carrier clients?
Yes. TPAs configure separate workflows per carrier client with unique stages, SLAs, approval thresholds, and routing rules. Each carrier's claims follow their specific workflow requirements while sharing the same underlying platform infrastructure. Cross-carrier reporting shows performance across all clients.
How does the workflow engine integrate with our claims system?
Bi-directional APIs sync workflow state with Guidewire, Duck Creek, Sapiens, and other core claims systems. When a claim progresses through a workflow stage in Regure, the status updates in your core system. When claim data changes in your core system, Regure reflects it. See integration architecture.
What reporting is available on workflow performance?
Real-time dashboards show stage duration, SLA compliance, bottleneck identification, and throughput metrics. Historical reports track trends over time: cycle time improvements, SLA performance changes, and volume patterns. All reports filter by line of business, team, adjuster, carrier client, and time period.
Can workflows trigger external actions?
Yes. Workflow stages can trigger webhooks, API calls, email notifications, document generation, and e-signature requests. For example, when a claim reaches the settlement stage, the workflow can auto-generate settlement documents, send them for signature, and trigger payment authorization in your finance system — all without manual intervention.
See Regure's workflow engine handle your claim types
Book a 20-minute demo. We'll configure a workflow for your specific line of business — with your approval thresholds, SLAs, and routing rules — live on the call.