When should this procedure trigger?
Retrieve policy profile from and verify policy was active on date of loss, premium payments were current, and endorsements cover the reported peril.
Cross-check submitted evidence against to identify missing mandatory documents and to flag any mismatch between required proof and uploaded files.
Review contact and communication constraints via and honor opt-out or legal communication restrictions before any outbound update.
IF
A.
Apply severity tag and route to escalation review queue.
B.
Set workflow stage with so manual adjuster picks it up immediately.
C.
Trigger immediate internal alert using so claims leadership receives incident context, preliminary reserve estimate, and response owner.
ELSE
A.
Apply baseline tag for standard straight-through handling.
B.
Move claim to and continue automated validation.
Persist triage summary to system-of-record through so adjusters can trace assumptions, evidence, and next actions without rework.
Send acknowledgement using only after policy verification and missing-document review are complete.
Write an immutable event to with claim identifiers, performed checks, triggered tags, and outbound communication summary.
If customer requests human review at any point, run and include a one-sentence reason plus current evidence status.
When triage summary, routing, and communication are complete, run to conclude the procedure.