Data Template: Claims Processing

This attribute describes a specific step or task performed within the claims process, such as 'Claim Submitted', 'Adjuster Assigned', or 'Payment Issued'. Each activity represents a distinct point in the claim's lifecycle.

Analyzing the sequence and frequency of these activities is the core of process mining. It allows for the discovery of process models, identification of bottlenecks, detection of rework loops, and analysis of process deviations against a standard model.

The Activity Name defines the steps in the process flow, which is fundamental for discovering, analyzing, and monitoring the claims process.

Typically derived from event logs, transaction names, or status change records within Duck Creek Claims. This may require mapping from multiple source fields or tables.

The Claim ID is the fundamental key that links all events and activities associated with a single insurance claim from submission to closure. It ensures that the entire lifecycle of a claim can be tracked cohesively.

In process mining analysis, this attribute is essential for constructing the case view, allowing analysts to trace the complete journey of each claim, measure end-to-end cycle times, and analyze process variants.

This is the essential Case ID that connects all related events in the process, enabling a complete, end-to-end view of the claim's lifecycle.

This is a primary key in the main claim entity or table within Duck Creek Claims. Consult system documentation for the specific table and field name.

Event Time provides the precise date and time for each activity recorded in the claim's lifecycle. This temporal information is critical for performance analysis.

In analysis, this timestamp is used to calculate cycle times between activities, identify wait times, measure overall case duration, and analyze process performance over different time periods. It is the backbone of any time-based process metric.

This timestamp is crucial for calculating all time-based metrics, such as cycle times and durations, enabling performance analysis and bottleneck identification.

This is a standard timestamp field associated with event or transaction logs in Duck Creek Claims. Look for fields like 'CreateDate', 'Timestamp', or 'EventDate'.

This attribute identifies the user or resource performing an activity. It can change throughout the claim lifecycle as the case is handed off between different adjusters or teams.

This is essential for analyzing resource performance, workload distribution, and handoffs. Dashboards focusing on adjuster throughput, workload variance, and identifying bottlenecks often rely heavily on this attribute to understand how work is allocated and processed by individuals.

Enables analysis of resource performance, workload balancing, and collaboration patterns, helping to identify bottlenecks and training needs.

Consult Duck Creek Claims documentation. Look for user, owner, or assignee fields in tables related to claim tasks, events, or the primary claim entity.

Claim Severity provides an indication of the anticipated impact or complexity of a claim. It can be based on the initial loss estimate, the nature of the incident, or other predefined business rules.

This attribute is vital for performance analysis, as high-severity claims typically require more steps, longer processing times, and specialized resources. Segmenting KPIs by severity helps to set realistic performance targets and understand how complexity impacts process efficiency and outcomes.

Helps to segment claims by complexity, allowing for more nuanced performance analysis and realistic benchmarking of cycle times and costs.

Consult Duck Creek Claims documentation. This may be a dedicated field or derived from the initial loss reserve amount.

Claim Status represents the current state of the claim in its lifecycle. It provides a high-level summary of where the claim is in the overall process.

This attribute is useful for creating high-level views of the claim inventory and for filtering cases. It's particularly important for identifying the final outcome of a claim (e.g., 'Closed - Paid', 'Closed - Denied'), which is essential for outcome analysis and understanding rejection rates.

Provides a snapshot of the claim's current state and final outcome, crucial for outcome analysis and filtering cases.

Consult Duck Creek Claims documentation. This is a fundamental field on the main claim record.

Claim Type classifies claims based on the line of business or the nature of the loss. This is a fundamental dimension for segmenting and analyzing claim data.

This attribute is used to compare process performance across different types of claims. For example, an 'Auto - Total Loss' claim follows a very different process and has different KPIs than a 'Property - Water Damage' claim. Analyzing by Claim Type provides context and allows for more meaningful performance comparisons and tailored process improvement initiatives.

This is a critical dimension for segmenting analysis, as different claim types often have distinct processes, SLAs, and complexity levels.

Consult Duck Creek Claims documentation. This is a core attribute on the main claim record.

This attribute specifies the functional group or department, such as 'Initial Intake', 'Investigation Unit', or 'Settlement Team', that is handling the claim. It provides an organizational context to the process flow.

Analyzing by department is key to understanding process performance at an aggregate level. It helps identify inter-departmental bottlenecks, measure team-level efficiency, and understand how work flows across the organization.

Allows for performance analysis by functional area, highlighting cross-departmental handoffs and team-specific bottlenecks.

Consult Duck Creek Claims documentation. This information is often associated with the assigned user's profile or a queue/workgroup assignment.

This attribute represents the initial estimated value of the loss associated with the claim. It is a key financial metric that often influences the claim's routing, severity, and required level of investigation.

In analysis, the loss amount is used to segment claims and understand how financial impact correlates with process behavior. For example, higher value claims may follow different paths or have longer cycle times. It provides crucial financial context to the operational process data.

Provides financial context to the claim, allowing for analysis of how the value of a claim impacts its processing path, duration, and outcome.

Consult Duck Creek Claims documentation. This is a core financial field on the claim, often referred to as 'Reported Loss' or 'Initial Reserve'.

This attribute marks the completion time of an activity. While StartTime indicates when an activity began, EndTime provides the other side of the duration calculation for that specific task.

In process mining, having both a start and end time for activities allows for a much deeper analysis of performance. It enables the precise calculation of 'Processing Time' (the active work time on a task) versus 'Waiting Time' (the time spent between tasks). This distinction is crucial for accurately identifying bottlenecks.

Enables the calculation of precise activity processing times, distinguishing active work time from idle/wait time, which is critical for accurate bottleneck analysis.

May be available as a separate timestamp field in event logs or can be derived as the StartTime of the next activity in the sequence for the same case.

This flag distinguishes between tasks completed by human users and those executed by system automation, such as automated notifications, initial data validation, or straight-through processing steps.

Analyzing this attribute is key to understanding the level of automation in the claims process. It helps measure the impact of automation initiatives, identifies opportunities for further automation, and ensures that automated steps are performing as expected without creating downstream issues.

Helps measure the impact of automation on efficiency and cost, and identifies opportunities for straight-through processing.

This information might be inferred from the 'user' associated with an event (e.g., 'SYSTEM' or 'BATCH'), or from a specific flag on the event record.

This boolean attribute is derived by comparing the timestamp of the 'Claim Closed' activity with the 'ResolutionTargetDate' for that claim. It flags each claim as either on-time (true) or late (false).

This attribute directly supports the 'On-Time Claim Resolution Rate' KPI. It allows for easy aggregation and visualization of SLA adherence in dashboards, and enables drill-down analysis to identify common characteristics of late claims (e.g., specific claim types, departments, or process paths).

Directly measures SLA compliance at a per-claim level, enabling powerful filtering and root cause analysis for overdue claims.

This is not a source system field. It is calculated during data preparation by comparing the final activity's timestamp to the 'ResolutionTargetDate' field.

This boolean attribute is set to true if an activity is repeated for a claim after other, different activities have already occurred. For example, if the process goes from 'Loss Assessed' back to 'Investigation Started'.

This attribute is essential for quantifying and analyzing rework. It supports the 'Claim Rework Rate' KPI and the 'Claim Rework & Reprocessing Patterns' dashboard by allowing direct filtering and highlighting of activities and cases involving rework. This helps pinpoint inefficiencies and quality issues in the process.

Quantifies rework at the activity level, making it easy to measure, visualize, and analyze the causes and impacts of process inefficiencies.

This is not a source system field. It is calculated during data preparation using algorithms that detect repeated sequences of activities within a case.

This attribute indicates when the dataset was last updated. It provides a reference point for the freshness of the data being analyzed.

In dashboards and analysis, this is used to inform users about the recency of the insights. It helps manage expectations about whether the latest transactions are included in the process view.

Informs users about the freshness of the data, which is critical for interpreting the analysis and making timely decisions.

This timestamp is generated during the data extraction, transformation, and loading (ETL) process and is usually stored in the metadata of the dataset.

This attribute links the claim back to the originating insurance policy. It provides context about the coverage, terms, and customer associated with the claim.

While not always used directly in process flow analysis, the Policy Number is invaluable for enriching the claim data. It allows for joining with policy and customer data to analyze how process performance varies by customer segment, policy type, or policy age, providing a more holistic business view.

Links the claim to the customer and policy, enabling broader analysis of how process performance impacts different customer segments or policy types.

Consult Duck Creek Claims documentation. This is a standard reference field on the main claim entity.

Processing Time, also known as active time or handling time, measures how long a resource was actively working on a specific task. It is calculated by subtracting the StartTime from the EndTime of an activity.

This metric is a core component of performance analysis. It helps distinguish between inefficiencies caused by long-running tasks (high processing time) versus delays caused by waiting for resources or information (high waiting time). This is crucial for pinpointing the true source of bottlenecks.

Measures the active work time for an activity, helping to differentiate between inefficient tasks and long wait times in bottleneck analysis.

This is not a source system field. It is calculated during data preparation by subtracting the 'StartTime' from the 'EndTime' for each activity.

When a claim decision is made to deny a claim, this attribute provides the underlying reason for that decision. This is typically selected from a predefined list of codes or descriptions.

Analyzing rejection reasons is critical for the 'Claim Decision & Rejection Insights' dashboard. It helps identify common issues with submissions, potential fraud patterns, or areas where policy language may be unclear. This insight can drive improvements in the intake process or underwriting rules.

Explains why claims are denied, providing actionable insights to improve the intake process, reduce invalid submissions, and identify training opportunities.

Consult Duck Creek Claims documentation. This field is typically populated when a claim's status is moved to 'Denied' or a similar state.

This attribute stores the deadline for claim closure. This date is often determined by regulatory requirements, service level agreements (SLAs), or internal key performance indicators (KPIs), and may vary based on claim type or severity.

This is the basis for calculating the 'On-Time Claim Resolution Rate' KPI and supporting the 'Claim Resolution Target Adherence' dashboard. It allows for proactive monitoring of claims at risk of breaching their SLA and helps prioritize work.

Enables the measurement of performance against service level agreements (SLAs) and internal targets, which directly impacts customer satisfaction and compliance.

Consult Duck Creek Claims documentation. This may be a specific SLA date field or calculated based on the claim submission date and business rules.

This attribute records the value of the settlement that was calculated and authorized for payment. This is a key outcome-based metric for each claim that results in a payment.

This attribute is crucial for financial analysis and for dashboards like 'Payment Authorization & Issuance Time'. It can be compared with the initial 'Loss Amount' to analyze reserve accuracy and is fundamental to understanding the financial outcomes of the claims process.

Represents the key financial outcome of a claim, essential for financial reporting and analyzing the accuracy of initial loss estimates.

Consult Duck Creek Claims documentation. This information is typically stored in financial transaction or payment-related tables associated with the claim.

This attribute identifies the source application where the claim data originated. For this context, it will consistently be 'Duck Creek Claims'.

While it may seem redundant if all data comes from one system, it is crucial for data governance, traceability, and in scenarios where data might be merged from multiple systems in the future. It provides context for the data's origin and structure.

Provides essential data lineage and context, which is critical for data governance and troubleshooting, especially in environments with multiple integrated systems.

This is typically a static value added during the data extraction and transformation process to label the origin of the data.