Organize a policy's claims, renewals, and onboarding as processes

An insurance policy collects years of activity: underwriting at onboarding, a claim for hail damage, another for a burst pipe, an annual review every renewal. Put all of it in one record and the documents, tasks, and notes soon become impossible to navigate, the electronic version of a binder stuffed with loose paper.

In this walkthrough you give each piece of work its own process, the equivalent of a labeled manila folder inside the policy’s binder. Each process has its own open and close dates, status, tasks, documents, messages, and workflow:

Process	Opened	Closed	Status
Policy Onboarding	Feb 1	Feb 15	Approved
Insurance Claim: Fire Damage	May 1	Jun 15	Paid
Insurance Claim: Mold	Aug 1	Aug 3	Rejected
Annual Review	Feb 15 (next year)	Feb 16	Renewed

You’ll build three process templates (Policy Onboarding, Insurance Claim, and Annual Review), set their close rules, and use a rules matrix so each new claim starts the workflow that fits its state and coverage amount.

Who it’s for

Power users who maintain templates for an insurance operation: claims, underwriting, or policy servicing.

Prerequisites

• Permission to create and edit process templates, workflow templates, and rules matrices.
• The workflow templates you want processes to start (this walkthrough uses Customer Outreach, Metro NY Outreach, and High Value Outreach). See Workflow to build them.
• A place to keep policies. QBO’s insurance policy record works well (see step 1); any record type can be the parent of a process.

Building blocks used

• Cases: process templates, close rules, and assignment
• Workflow: the work each process starts
• Business Rules: the matrix that picks a workflow
• Templates: custom statuses, types, and reasons
• Contacts: insurers and insureds

Steps

1. Decide what a policy is

QBO’s insurance policy record is itself a kind of process, so it gets everything a process has (status, assignment, workflow, documents, tasks) plus policy fields:

Field	Holds
Insurance Policy	The policy number or label (required)
Status, Type	From the policy’s template, or the standard lists
Effective Date, Expiration Date	The policy term
Insurer	The carrier, chosen from the organizations in a collection named InsurancePolicy Insurer Organizations
Insured	The insured contact
Premium, Coverage, Deductible, Replacement Cost	Money amounts
Escrow	Yes or No
Flood Zone	Text

Any other value you save with a policy, such as a field added on the edit form with New Parameter or a column in an import, is kept with the policy rather than discarded. A policy can also point to a parent policy, for endorsements or renewals that replace an earlier policy.

To use it, create the collection InsurancePolicy Insurer Organizations and add your carriers, so the Insurer list is populated.

Note

The insurance policy record is a sibling of a process: a process template’s Sibling setting names the record type that inherits process behavior. If you’d rather track policies on a different record type, the processes in the next steps can attach to that record instead.

2. Create the process templates

Go to Templates > Processes and create a template for each kind of work:

Setting	Policy Onboarding	Insurance Claim	Annual Review
Process Template	Policy Onboarding	Insurance Claim	Annual Review
Applies To	InsurancePolicy	InsurancePolicy	InsurancePolicy
Workflow	Template: your onboarding workflow	Matrix (step 4)	Template: your renewal workflow

Applies To makes these processes children of a policy, so each one opens from the policy and appears in its list of processes. Every process template allows many processes per parent record, which is what you want for claims and renewals.

3. Give each template its own vocabulary

A claim ends Paid or Rejected; an annual review ends Renewed or Non-renewed. Set Statuses to Custom on each template and define the list on the template’s Custom Statuses tab. Do the same for Types (Fire, Water, Hail, Liability), Open Reasons, and Close Reasons as needed. Mark the statuses that end the work as final; the close rules in step 5 depend on it.

4. Let a matrix choose the claim workflow

Claims in some regions and claims above a coverage threshold need different outreach. Rather than creating a template for each, set the Insurance Claim template’s Workflow to Matrix and open the Workflow Matrix tab:

1. Add an input State, value type List, weight 10.
2. Add an input Coverage Amount, value type Money range, weight 5.
3. Set each input’s XPath to where that value lives in the claim’s data.
4. Add an output named DecisionTemplate. Its value is the name of the workflow template to start.
5. Add one row per rule:

State	Coverage Amount	DecisionTemplate
NY, NJ		Metro NY Outreach
	1,000,000 – 5,000,000	High Value Outreach
		Customer Outreach

A blank cell matches anything, and the eligible row with the highest total weight wins:

• NJ, $2.5 million: all three rows are eligible. State (10) outweighs Coverage Amount (5), so Metro NY Outreach starts.
• CA, $2.5 million: the coverage row wins, so High Value Outreach starts.
• CA, $400,000: only the blank row matches, so Customer Outreach starts.

Type test values into the input boxes above the rows to see which row wins before any claim depends on it. If the matrix returns nothing and the template also names a fixed workflow, the fixed workflow starts.

Tip

The weights decide precedence. If high-value claims should get High Value Outreach even in New York, give Coverage Amount the higher weight instead.

5. Set the close rules

Under Behavior on each template:

Setting	Recommended for claims
Close process when entering a final status	Yes, so Paid or Rejected closes the claim
Require a final status when process is closed	Yes, so no claim closes without an outcome
Cancel workflows when closed	All, so outreach stops on closed claims
Close children when closed	Yes, to clear open worklist items
Close children when entering a final status	Yes

6. Decide who can work the processes (optional)

Organizations, People, and Clients each take a collection that limits who a process can be assigned to. Assigning a process to an outside organization, such as an independent adjuster firm, gives that organization access to that process and nothing else.

7. Customize the screens (optional)

The template’s Summary, Select, Edit, Search, and Dashboard Xslt settings each offer Create Override, which replaces the standard screen for processes of this template. Use it when claims need a different layout from reviews, for example to show the loss date and adjuster at the top.

8. Open a claim

Create a process on a policy with the Insurance Claim template, whether by hand, through an import, or from another workflow’s Open a Process step. QBO opens the claim, evaluates the matrix, starts the chosen workflow as of the claim’s open date, and records it as the claim’s current workflow.

The result

Each policy now has a tidy set of folders. Every claim, review, and onboarding has its own tasks, documents, messages, and workflow, with an outcome-specific status and an open and close date. New claims start the right outreach without anyone choosing it, and closing a claim stops its work.

Tip

Created processes before adding a workflow to the template? Select them in search results and use EnsureChildren to start any missing workflow. Processes that already have one are left alone.

Next steps

• Generate a claim document from a Word template using data from the claim and the policy.
• Automate force-placed insurance notices and discrepancy review with imports, timed workflows, and a worklist.
• See how insurance teams use these building blocks on QBO for insurance.