claims-intake-and-triage.md

Uploaded 8/8/2026, 11:53:05 PM

# Claims Intake and Triage

When a policyholder reports a new claim, the Claims Team logs it in the Claims Management System first, then verifies the policy is active in the Policy Administration System. Once verified, the Claims Team assigns a severity tier based on estimated loss amount.

Next, the Claims Team routes the claim: property claims go to a Property Adjuster, auto claims go to an Auto Adjuster, and anything flagged for possible fraud goes straight to the Fraud Investigation Unit instead of a regular adjuster.

Policy requires every claim to be assigned to an adjuster within 24 hours of intake. In practice, the Claims Team usually assigns straightforward auto claims same-day, and only lets property claims wait the full 24 hours when there's a backlog.

If the estimated loss exceeds $50,000, the claim is escalated to a Senior Adjuster instead of a standard Adjuster, per the Large Loss Policy.