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Escalation Overview

Escalation rules automatically promote claims up the chain when needed.

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When to Escalate

  • Claim approaching SLA deadline
  • No one assigned after X hours
  • Critical priority not addressed
  • Safety concern requires executive review
  • Cross-department issue needs coordination

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Creating Escalation Rules

  1. Admin Console → Escalation Rules
  2. Click “Add Rule”
  3. Set trigger conditions:
    • Priority = Critical
    • Category = Safety
    • Open > 2 hours without assignment
  4. Set escalation action:
    • Escalate to manager
    • Escalate to director
    • Notify department head
  5. Save and test

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Common Escalation Scenarios

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Scenario 1: Unassigned Critical Claims

Rule:
  • Trigger: Priority = Critical AND no assignment after 1 hour
  • Action: Escalate to Department Manager
Effect: Ensures critical claims get attention quickly

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Scenario 2: SLA At-Risk Claims

Rule:
  • Trigger: SLA status = At-Risk (2 hours before deadline)
  • Action: Notify assignee + add to manager dashboard
Effect: Proactive intervention before deadline missed

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Scenario 3: Safety Claims

Rule:
  • Trigger: Category = Safety AND Priority = High
  • Action:
    • Auto-escalate to Safety Manager
    • Email Safety Officer
    • Copy Executive Director
Effect: Safety gets priority treatment

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Scenario 4: Cross-Department Issues

Rule:
  • Trigger: Comments mention multiple departments
  • Action: Escalate to Operations Director
Effect: Executive aligns departments

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Escalation Chain

Define multi-level escalation: 
Level 1: Assigned person works on it
    ↓ (if not assigned in 2 hours)
Level 2: Department manager notified
    ↓ (if still not resolved in 4 hours)
Level 3: Operations director takes over
    ↓ (if still open next day)
Level 4: Executive review for process change

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Managing Escalations

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Preventing Escalations

Better to prevent than escalate:
  • More resources upfront
  • Clear procedures
  • Better training
  • Process improvements

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Responding to Escalations

When escalated:
  1. Drop what you’re doing
  2. Prioritize over routine work
  3. Get help if needed
  4. Update status frequently
  5. Report resolution quickly

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Monitoring Escalations

Dashboard shows:
  • How many escalations per week
  • Which rules trigger most
  • Escalation success rate
  • Patterns in escalations
High escalation rate suggests:
  • Insufficient resources
  • Process issues
  • Unclear procedures
  • Need for training

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Next Steps