Claims processing automation
with human decisions.
Bring claim documents and next steps into one record, while your team keeps every decision.
Discuss your claims workflowCollect the claim.
Record the claim ID, source, date, and required documents. Put each item in one case record. Route missing details to a person before review begins.
Prepare a review queue.
In an illustrative flow, agreed rules flag duplicate IDs, missing files, and mismatched fields. Show the reason for each flag. Keep the original submission and every later change.
Assign each case to the right reviewer. Show its owner, due date, and current hold. Reminders can surface delays without changing a decision.
Keep decisions with people.
A reviewer checks the evidence and decides what happens next. Record their decision and reason. Move a case forward only after that approval. Keep a manual path for unusual cases.
Test the exceptions.
Try fictional cases with a complete file, a missing document, and a repeated ID. Check each route before using real claims. This is a planning example, not a client result. Eden scopes custom work and fees through an individual proposal.