Main Workflow Definition

File: /home/clawbot-insurance/Workflows/claims/main-claims-workflow.yaml

name: insurance-claims-automationdescription: 24/7 insurance claims automationversion: 1.0.0
triggers:  - type: phone_call    source: ivr_system  - type: web_submission    source: customer_portal  - type: agent_report    source: claims_system  - type: scheduled    cron: "0 */4 * * *"
workflows:  # CLAIM INTAKE WORKFLOW  claim_intake:    trigger: fnol_received    steps:      1_verify_policy:        skill: claim-intake        action: verify_policy        output: policy_verification            2_collect_information:        skill: claim-intake        action: collect_fnol_data        output: fnol_data            3_create_claim:        skill: claims-system-connector        action: create_claim_record        output: claim_record            4_assign_adjuster:        skill: workflow-router        action: assign_to_adjuster        based_on: claim_type_and_workload        output: assignment
  # DOCUMENT ANALYSIS WORKFLOW  document_analysis:    trigger: document_uploaded    steps:      1_classify_document:        skill: document-analyzer        action: classify_document        output: document_type            2_extract_data:        skill: document-analyzer        action: extract_key_data        output: extracted_data            3_validate_data:        skill: document-analyzer        action: validate_against_claim        output: validation_result
  # FRAUD SCREENING WORKFLOW  fraud_screening:    trigger: intake_complete    steps:      1_screen_claim:        skill: fraud-detector        action: analyze_claim        output: fraud_analysis            2_route_based_on_risk:        conditions:          - if: fraud_analysis.risk_level == "HIGH"            action: escalate_to_siu          - if: fraud_analysis.risk_level == "MEDIUM"            action: flag_for_review          - if: fraud_analysis.risk_level == "LOW"            action: standard_processing
  # RESERVE & PAYMENT WORKFLOW  reserve_payment:    trigger: coverage_verified    steps:      1_calculate_reserve:        skill: reserve-calculator        action: calculate_reserve        output: reserve_calculation            2_adjuster_review:        skill: workflow-pauser        action: await_adjuster_approval        timeout: 48_hours            3_authorize_payment:        conditions:          - if: reserve_approved == true            skill: payment-connector            action: issue_payment            output: payment_confirmation
  # CUSTOMER COMMUNICATION WORKFLOW  customer_communication:    trigger: customer_inquiry    steps:      1_identify_claim:        skill: customer-communicator        action: find_claim        output: claim_data            2_generate_response:        skill: customer-communicator        action: generate_status_update        output: response            3_send_response:        skill: email-sender        action: send_response
error_handling:  on_failure:    - log_error    - notify_claims_manager    - retry_with_backoff  escalation_rules:    - condition: fraud_score > 70      action: immediate_siu_notification    - condition: claim_unassigned > 4_hours      action: escalate_to_supervisor