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Business Rules Overview

Create rules to automatically handle claims according to your business logic.

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Common Rules

Auto-Routing:
  • If category = Quality → Route to Quality dept
  • If priority = Critical → Auto-assign to manager
  • If department = Maintenance → Route to specialized team
Escalation:
  • If open > 2 hours and not assigned → Escalate
  • If high priority not assigned in 4 hours → Notify manager
  • If overdue → Alert director
Notification:
  • If critical → Email entire department
  • If safety → @mention safety officer
  • If escalated → Copy executive

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Creating a Rule

  1. Name: “Auto-route Quality Claims”
  2. Trigger: If category = “Quality”
  3. Actions:
    • Route to Quality department
    • Assign to John (quality lead)
    • Send notification
  4. Save & Test

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Rule Management

  • Enable/Disable: Turn rules on/off
  • Priority: Rules execute in order
  • Test: Run against sample claims
  • Monitor: See which claims triggered rule
  • Adjust: Update based on results

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Use Cases

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Situation: Too many unassigned claims

Rule:
  • Trigger: Claim open > 1 hour and not assigned
  • Action: Auto-assign to next available person in department

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Situation: Critical claims need immediate attention

Rule:
  • Trigger: Priority = Critical
  • Action:
    • Email manager
    • @mention director
    • Add to dashboard red alert

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Situation: Specific categories always escalate

Rule:
  • Trigger: Category = “Safety” and priority = “High”
  • Action: Auto-escalate to executive + notify compliance

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Testing Rules

Before deployment:
  1. Create sample claim
  2. Run rule
  3. Verify correct action taken
  4. Check notifications received
  5. Monitor for false positives

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Best Practices

  • Start with simple rules
  • Test thoroughly before enabling
  • Monitor impact
  • Adjust based on results
  • Document all rules
  • Review quarterly

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Next Steps