Claims Resolution Orchestrator
Coordinates evaluation, reserves, services, recovery, and settlement into an authority-ready resolution packet.
Holds the claim plan and keeps every specialist workstream reconciled against coverage, limits and the authority matrix. On a severe commercial fire that is forensic cause, building valuation and business-interruption accounting arriving at different times and having to agree before anything is offered. Reserves, settlement ranges and the large-loss strategy go up as a recommendation, and the claims officer at the applicable authority level commits them.
Authority
Recommend
Team role
Coordinates the work
Handoffs
Named collaborators
The role
What it owns and where its authority ends
Desk
Claims & Recovery
Desk workflow
Capture the loss and route it on urgency and line, reconstruct the policy at the date of loss and analyze coverage and liability, test the integrity signals and refer what carries, then assemble reserves, payments and a settlement recommendation for the authority level that can commit them.
Collaboration
Coordinates specialist contributions
Decision boundary
Prepares a recommendation for an accountable decision owner.
Systems and capabilities involved
Claims management API
Damage and bill review services
Vendor and counsel task network
Payment service
Specialist claim agents
Handoffs
What this role gives and receives
Capabilities offered
Claim resolution plan
Coordinates specialist claim work into a supported reserve, payment, recovery, and settlement recommendation.
- Receives:
- Claim file, coverage position, authority limits, customer needs, and open evidence
- Returns:
- Claim plan, delegated results, reserve and settlement recommendation, payments, and authority requests
Delegates
claim evaluation specialist
Evaluate line-specific damage, medical, legal, restoration, or business-interruption evidence. Trigger: The claim plan identifies specialist evaluation work. Returns: Evidence-cited evaluation, uncertainty, and recommended next action.
Delegates
Resolve material integrity signals before consequential payment or settlement. Trigger: A defined fraud or integrity threshold is met. Returns: Cleared signal or authorized SIU referral recommendation.
Handoff to
Handoff to
Handoff to
Receives from
External handoff
Claims officer at the applicable authority level
External handoff
Large-loss committee
Context
What the role needs to do the work
- Current work
- Claim plan, coverage, liability, damages, reserves, authority, payments, recoveries, and open tasks.
- Prior interactions
- Every investigation, evaluation, negotiation, payment, customer contact, and authority decision in the claim.
- Policies and reference
- Claims handling standards, authority matrix, reserving rules, vendor playbooks, and recovery methodology.
- Working method
- Line-specific claim plans and negotiation patterns learned only through governed review.
Illustrative workflow
How the work moves
Starting point
A severe commercial fire creates property damage, business interruption, employee displacement, and subrogation potential.
- 01
Build a claim plan and delegate forensic, valuation, business-interruption, recovery, and customer-support work.
- 02
Reconcile specialist results with coverage, limits, prior payments, reserve methodology, and authority.
- 03
Recommend staged undisputed payments, revised reserves, and a large-loss settlement strategy.
Result
Authority-ready resolution packet with supported payments and explicit open uncertainties.
Checks and boundaries
What must be tested or reviewed
- 01Authority tests cover routine payment, large loss, vulnerable claimant, denial, litigation, structured settlement, salvage, and subrogation scenarios.
- 02Reserve and settlement recommendations are graded for evidence support, uncertainty, coverage consistency, and prohibited shortcut avoidance.
- 03Payment tests require exact payee, coverage, authority, duplicate, sanctions, and ledger controls before release.
Human authority
- The claims officer at the applicable authority level commits the settlement, the release and any payment above the delegated threshold, and the large-loss committee commits above its own.
- A licensed adjuster in the loss state signs the coverage decision or denial the resolution rests on, before any figure is put to the claimant.
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