# Claims processing use case

> Claims processing is the end-to-end workflow that insurance companies follow to evaluate, validate, and settle claims filed by policyholders. The process typically includes:

Claims processing is the end-to-end workflow that insurance companies follow to evaluate, validate, and settle claims filed by policyholders. The process typically includes:

* **Claim submission**

   A customer submits a claim via an online portal, email, or phone, providing required documentation (e.g., medical records, photos, invoices).
* **Claim intake and data capture**

   The submitted information is captured, categorized, and entered into the claims management system.
* **Verification and validation**

   The claim is reviewed against policy terms, coverage limits, and required documents. Third-party data (e.g., police reports, medical records) may be verified.
* **Assessment and adjudication**

   The insurer evaluates the claim’s legitimacy and determines the payout amount based on rules and policy conditions.
* **Approval or denial**

   The claim is either approved, denied, or routed for further investigation if flagged as suspicious or incomplete.
* **Settlement and payment**

   Once approved, the claim amount is disbursed to the claimant or service provider.

The following diagram shows a claims processing workflow in Maestro. It follows a claim from submission through validation, assessment, and resolution, involving both system actions and user review.

  ![claims processing](https://dev-assets.cms.uipath.com/assets/images/maestro/maestro-claims-processing-601233-bc6ea513.webp)

## How Maestro adds value

UiPath Maestro™ strengthens claims processing by enabling insurers to:

* Automate decision logic for eligibility, coverage checks, and fraud detection at scale.
* Ensure consistent, rule-based adjudication while allowing human-in-the-loop exceptions when needed.
* Integrate AI tools for document understanding, medical record analysis, and anomaly detection.
* Improve transparency with full audit trails and compliance monitoring across the claims lifecycle.
* Accelerate claim resolution and payment, improving customer satisfaction and reducing operational costs