Exploring Insurance claims

  • Release version: Zurich
  • Updated July 31, 2025
  • 2 minutes to read
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    Summary of Exploring Insurance claims

    The Insurance claims application in ServiceNow enables organizations to create and configure a comprehensive claims workflow tailored for property and casualty (P&C) insurance lines. It supports the entire process from first notice of loss (FNOL) to claim resolution, allowing various roles such as FNOL representatives, adjusters, processors, and managers to efficiently create, manage, and settle claims. The application includes an example claim flow for travel insurance and provides a flexible framework adaptable to different single-policy use cases.

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    Key Features

    • Versatile Framework: Adaptable to multiple P&C claims without needing separate case types or workflows, streamlining configuration and management.
    • Role-Specific Functionality: Customizable workspaces and landing pages tailored for administrators, FNOL representatives, claims processors, adjusters, and managers, supporting their unique tasks and responsibilities.
    • Rapid Configuration: Enables claims administrators to quickly set up end-to-end claims workflows, including service definitions, product models, policies, and incident data tables.
    • Claims Workflow Support: Facilitates the full lifecycle of a claim—from intake and documentation upload by FNOL representatives to evaluation, reserve setting, approval, and settlement by adjusters and managers.
    • Approval Process: Automatically routes approval tasks to claims managers when reserve or payment amounts exceed adjuster limits, ensuring proper authorization.
    • Multi-Adjuster Support: Allows collaboration among multiple adjusters on claim tasks to enhance claim evaluation and processing efficiency.

    Claims Roles and Responsibilities

    • Claims Administrators: Configure the application, set up policies, service definitions, and claim incident configurations.
    • FNOL Representatives: Serve as front-line staff who create claims and upload customer documents.
    • Claims Adjusters: Evaluate claims, set reserves, approve payments, and make approval or denial decisions.
    • Claims Processors: Manage cases, create and track adjuster tasks, and add tasks as needed.
    • Claims Managers: Authorize reserves and payments requiring additional approval and monitor staff performance through dashboards.

    Practical Benefits for ServiceNow Customers

    By using the Insurance claims application, ServiceNow customers can:

    • Implement a streamlined, configurable claims process that supports multiple insurance lines and personnel roles.
    • Improve collaboration and task management across front-office and back-office claims teams.
    • Ensure compliance with approval policies through automated workflows and role-based approvals.
    • Gain visibility into claims handling performance with customizable dashboards and metrics.

    Next Steps

    To maximize the value of the Insurance claims application, customers can explore detailed guidance on setup, daily use, and configuration through ServiceNow's documentation on Setting up Insurance claims, Using Insurance claims, and the Insurance claims reference materials.

    Learn how to create and configure a claims workflow for your organization by using the Insurance claims application. Your first notice of loss (FNOL) representatives, adjusters, processors, and managers can use this claims workflow to create and manage claims.

    Insurance claims overview

    With the Insurance claims application, you can easily set up an entire claims process for a single policy use case under property and casualty (P&C) lines of business. The Insurance claims application provides a claims framework that you can use for multiple lines of business.

    A travel insurance claim flow is included with this application as an example.

    Insurance claims users

    Table 1. Users
    User Description
    Administrator Claims administrators are responsible for configuring the Insurance claims application. They set up the service definitions, product models, policies for personal and commercial products, and tables to record information on claims incidents. They can also set up the claim incident configuration for a new line-of-business claims flow or to update an existing configuration.
    FNOL representative FNOL representatives are front-office staff who create a claim case on behalf of a customer and upload the relevant documents.
    Claims adjuster Claims adjusters are middle or back-office staff that work on adjuster tasks to evaluate claims, approve reserve and payment amounts, and settle payments.
    Claims processor Claims processors are middle or back-office staff that own cases. They create claim tasks for adjusters, track adjuster tasks to ensure they're worked to completion, and add additional tasks as required.
    Claims manager Claims managers are middle or back-office staff that authorize the reserve and amounts that require additional approval. They also monitor staff performance with dashboards and metrics.

    Insurance claims workflow

    Here's a typical workflow for an insurance claim in the Insurance claims framework.

    Infographic that shows a typical workflow for an insurance claim. For the text description, refer to the steps that follow.

    1. A customer reports a claim.
    2. The FNOL representative, in the claim intake playbook, selects the claim type, the policy, the claim participants, and the incident details. If applicable, they add any itemized losses and supporting documentation provided by the customer.
    3. The claim is submitted and assigned to a claims specialist or adjuster.
    4. The claims specialist or adjuster reviews the policy details and requests additional information from the customer if necessary.
    5. The claims specialist or adjuster sets the reserve funds and payments, modifies the coverage exposures and reserve funds over time, and monitors the claim handling activity.
    6. If the reserve or payment amounts are above the adjuster's approval limit, an approval task is generated for the claims manager, who approves or rejects the amount.
    7. The claims specialist or adjuster makes the claim approval or denial decisions based on the provided evidence, and the workflow ends.

    Benefits of the Insurance claims application framework

    Benefit Feature Users
    Versatile framework that adapts to any single policy P&C claims without the need to create case types or flows Using Insurance claims Claims administrators, FNOL representatives, claims processors, claims adjusters, or claims managers
    Rapid configuration that enables the setup of a comprehensive end-to-end claims workflow quickly and easily Setting up Insurance claims Claims administrators
    Support for single and multiple adjusters Work on Insurance claims adjuster tasks Claims adjusters or claims managers
    Customizable persona-based workspaces to fit specific roles and responsibilities Insurance claims landing pages and workspaces Claims administrators, FNOL representatives, claims processors, claims adjusters, or claims managers

    What to explore next

    To learn more about configuring and using Insurance claims, see: