Insurance Developer Guide

Get Started with Insurance Developer Resources
Insurance Brokerage
Insurance Claims Management
Insurance Claims Business APIs
Insurance Claims Standard Invocable Actions
Insurance Claims Apex Reference
Insurance Claims Metadata API Types
Insurance Claims Developer Journey
Claims Processing Journey
Insurance Group Benefits
Insurance Policy Administration
Insurance Product Administration
Insurance Quoting
Insurance Apex Reference
Error Codes and Responses
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Insurance Claims Developer Journey

Learn how to effectively use the Insurance Claims Connect APIs, along with the associated invocable actions, to automate end-to-end claims processing workflows, from initial coverage verification to final payment settlement or cancellation by using Salesforce Flows and Omniscripts.

This guide walks you through the complete claims lifecycle, explaining:

  • The business scenario behind a claim.
  • The sequence of API calls across the Claims and Financial domains.
  • The data states and system transitions at each step.
  • The standard claim resolution flow for successful payments.
  • The exception paths for voiding or canceling payments.
Key TERMS DESCRIPTIONS
Coverage Validation Confirms policy status, coverage type, and claim eligibility.
Claim Coverage Payment Detail (CCPD) The payment record that’s created for each coverage-level payment request.
Claim Status Represents lifecycle stages, such as Submitted, Pending Review, Approved, and Paid.
Deductible The portion of loss the policyholder pays before insurer coverage applies.
Limit The maximum payout that’s allowed for a policy coverage type.