How Are Claims Automatically Adjudicated in Automotive Cloud

Review the Tools

Use process automation tools to consolidate all information related to a warranty claim, validate the claim against eligibility rules, adjudicate each expense, and update claim status.

• Context Service: Context Service enables easy retrieval and consumption of information in tools such as Business Rules Engine. It comprises context definitions, which is a structured set of data required to execute a process. Warranty Lifecycle Management has a predefined context definition called Claim Detail that can be used in adjudication processes. See Context Service.
• Business Rules Engine: Business Rules Engine is a suite of components, services, and objects that are used to automate complex decision-making processes. Expression sets are the key components in the Business Rules Engine and consist of a sequential set of steps to run a process. In an expression set, you can add step elements to decide the operations to be performed, and can add variables and constants as placeholders for values. Warranty Lifecycle Management has a predefined element called Claim Validation that you can add to a expression set. See Business Rules Engine .
• Flow Builder: Flow Builder is a declarative tool for building complex workflows. Elements in a flow can run various actions, such as aggregate data, create or update records, and assign values to resources. See Flow Builder .

How do the different tools work together?

Review the High-Level Steps in a Warranty Claim Adjudication Process

Review the key steps in a warranty claim adjudication process built by using the predefined Claim Details context definition, an expression set, and a record-triggered flow.

1. Experience Cloud users, warranty adjudicators, or an automated process create warranty claim records.
2. When a Claim record meets the predefined conditions, a flow is triggered. For example, a flow can be triggered when the status of a Claim record is Submitted and the claim type is Warranty Claim.
3. To retrieve all information related to a Claim record, the flow invokes the Build Context invocable action. The invocable action consolidates and caches the claims data associated with a context definition. The cached claims data is used in succeeding steps.
4. The flow invokes an expression set and passes the required input values to the expression set.
5. The expression set validates the warranty claim by using business rules. It passes its output values—such as the adjusted amount in a claim coverage payment detail record or the status of a claim record—back to the flow.
6. The flow performs operations based on the values from the expression set. For example, if a claim is rejected, the flow updates the status of the claim record and emails the claim participants.

Create an Expression Set

Warranty Lifecycle Management has an extensible data model to store warranty claims information. Before you build an expression set to specify adjudication rules, decide how data is passed from the claims objects to expression sets. You can choose one of these options, or do a mix of both.

• Use Context Definitions: Add context tags from the predefined Claim Details context definition to expression sets. A context tag acts like a local variable in an expression set. Clone and modify the predefined context definition if you’ve extended the claims data model or have other custom requirements.
• Use Object and Field Aliases: Add fields from objects as variables in expression sets. To use field aliases, first create object and field aliases of the Warranty Claim usage type. See Create Source Field Aliases.
  

  Tip You can create an alias for the ID of the Claim Coverage object to easily fetch information for the related Claim and Claim Item records.

Use a Flow

Create a record-triggered flow that is invoked when the status of the claim is Submitted. To populate a context definition with the information about a specific warranty claim, add the Build Context invocable action to a flow. The flow, in turn, invokes a Business Rules Engine expression set. The expression set validates claims information against business rules and determines the adjusted amount for each Claim Coverage Payment Detail record and the status of the claim. The flow then updates this information to the claim and its related records.