Process

Claims, disputes and exceptions

Cases that need a decision with reasons: a claim, a dispute, a failed payment. The judgement is the category and the action; the evidence is the policy, the rules and the record.

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Workflows

15 workflows, 10 industries.

Cross-checked: 9 · Proven by code: 3 · Checked by the outcome: 2 · Vetoed by code: 1

Finance and accounting

Customer deductions and short-pay disputes

Valid deduction (promotion, damage) or not

Proven by code

Banking and payments

Payment exceptions and investigations

Why a payment failed or is queried; the action

Proven by code

Card disputes and chargebacks

Network reason code; evidence enough to fight

Cross-checked

Customer complaints handling (UK FCA)

Complaint category, redress due

Cross-checked

Wealth, asset management and fund administration

Trade settlement fails

Why it failed; the fix

Cross-checked

Insurance

First notice of loss triage

Claim type, severity, fast track or adjuster

Cross-checked

Claim coverage check against policy wording

Covered, excluded, limits

Cross-checked

Subrogation and recovery identification

Whether a third party is liable

Checked by the outcome

Healthcare

Claim denial management and appeals

Denial reason, appealable, evidence

Checked by the outcome

Manufacturing and supply chain

Quality non-conformance triage

Defect category, severity, supplier

Cross-checked

Warranty claim validation

In warranty, covered failure, parts

Proven by code

Retail, hospitality and consumer

Returns and refund review

Policy met; abuse indicators

Vetoed by code

Logistics and transport

Carrier damage and loss claims

Liability, amount, evidence

Cross-checked

Telecoms

Billing dispute resolution

Valid dispute; credit due

Cross-checked

Public sector

Benefit claim verification

Evidence supports eligibility

Cross-checked

Your version of it. On your data.

Start from the closest workflow and describe your differences.

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