Lumen Claims Portal

Claims used to arrive by courier and disappear into a queue nobody could see. The portal gave policyholders a status page and gave adjusters a workflow with clear hand-offs.

The brief

Let policyholders and agents submit claims online, show them where the claim is, and give adjusters a queue with SLAs instead of a pile of folders.

Key points

• Use-case and activity diagrams for every claim type.
• Document checklist rules per product.
• SLA tracking with escalation.
• Regulatory reports generated on schedule.

What we built

A web portal on the insurer’s Java stack with document capture, a UML-modelled adjudication workflow, PL/SQL integrations to the policy administration system and Jasper reports for the regulator.

Example in code

<?php

namespace App\Models;

use App\Support\Enums\PostStatus;
use Illuminate\Database\Eloquent\Builder;

class Post extends Model
{
    public function scopePublished(Builder $query): Builder
    {
        return $query
            ->where('status', PostStatus::Published)
            ->where('published_at', '<=', now());
    }
}

Outcome

Median claim turnaround fell from nineteen days to six, and the call-centre volume for “where is my claim” dropped by two thirds.

A good requirement reads like a test case and a bad one reads like a wish.

Takeaways

Visibility was the product: once people could see the queue, the queue got shorter.