{
  "id": "workflow:insurance-claims-adjudication",
  "_kind": "Workflow",
  "_file": "workflows/workflows/workflows-expanded-3.yaml",
  "_cluster": "workflows",
  "attributes": {
    "displayName": "Insurance Claims Adjudication",
    "workflowKind": "operational",
    "triggerType": "event-driven",
    "typicalCadence": "per-claim",
    "complexity": "moderate",
    "description": "Processing insurance claims from submission to resolution — claim\nintake, coverage verification, damage assessment, fraud screening,\npayment calculation, and settlement. Includes appeals handling and\nregulatory compliance with claims processing timelines.\n"
  },
  "outgoingEdges": [
    {
      "from": "workflow:insurance-claims-adjudication",
      "to": "role:actuary",
      "kind": "involves_role",
      "attributes": {}
    },
    {
      "from": "workflow:insurance-claims-adjudication",
      "to": "role:fraud-analyst",
      "kind": "involves_role",
      "attributes": {}
    },
    {
      "from": "workflow:insurance-claims-adjudication",
      "to": "role:compliance-officer",
      "kind": "involves_role",
      "attributes": {}
    },
    {
      "from": "workflow:insurance-claims-adjudication",
      "to": "domain:insurance",
      "kind": "applies_to_domain",
      "attributes": {}
    },
    {
      "from": "workflow:insurance-claims-adjudication",
      "to": "responsibility:fraud-rule-tuning",
      "kind": "triggers_responsibility",
      "attributes": {}
    },
    {
      "from": "workflow:insurance-claims-adjudication",
      "to": "responsibility:regulatory-reporting",
      "kind": "triggers_responsibility",
      "attributes": {}
    }
  ],
  "incomingEdges": []
}