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.

Claims Processing Journey

A claim is a formal request submitted by a policyholder to receive benefits or compensation for a covered loss under an active insurance policy. A claim journey begins when the policyholder reports an incident, such as damage, injury, or another qualifying event that they believe is covered by their policy.