Case Studies
Automated Insurance Claim Intake with Power Platform
An insurance company needed a scalable, modern way to claim intake and manage claim intake and assignment. At the time, claims were entered manually and routed through a heavily hands-on process. As volume grew, the organization struggled with uneven workloads, slow routing, and inconsistent claim handling.
To address these challenges, IncWorx built a Microsoft Power Platform solution using Power Apps, Power Automate, and Dataverse. This approach centralized claim intake, streamlined processing, and introduced automated assignments that replaced much of the manual effort.
Technologies Supported
- Power Automate
- Dataverse
- Power Apps
The Challenge
Manual Claim Intake and Routing
The client’s existing claim‑intake process created several operational bottlenecks that slowed productivity and reduced consistency. Key issues included:
- Manual entry and assignment added time, created delays, and increased the likelihood of errors
- Examiner and Analyst workloads shifted unevenly, making it difficult to distribute work fairly
- Claim routing relied on claim type and claimant state, increasing workflow complexity
- Assignments often ignored team availability, causing avoidable delays and inefficiencies
- Staff created and stored claim summaries manually, limiting standardization and slowing downstream processes
Collectively, these challenges prevented the organization from scaling efficiently and maintaining consistent claim handling as volumes grew.
The Solution
Power Platform-Driven Claim Automation
IncWorx designed a Microsoft Power Platform solution that centralizes claim intake, automates assignments, and improves workload visibility across the organization.
Dataverse Architecture
The solution begins with a structured Dataverse data model that anchors all core functionality. Custom tables store claims, referrals, team members, workloads, and assignment rules. By consolidating this data in one place, the model enables automation, reporting, and secure, role‑based access to claim information.
Claim Intake and Management App
Next, a cloud‑based Power App provides the primary interface for managing claims. Users can quickly add, update, and assign claims, while also linking multiple referrals to a single record for clearer visibility into related activity.
Administrators gain full control over operational settings, including:
- Adding, updating, or removing Examiners and Analysts
- Adjusting daily assignment caps by claim type
- Maintaining assignment rules without code changes
Automated Assignment with Power Automate
From there, Power Automate flows route claims automatically. Assignments are determined using claim type requirements, claimant state of residence, team availability from a Microsoft 365 Group calendar, and real‑time workload data stored in Dataverse. According to the client, these automations now handle roughly 70–80% of claim assignments without manual intervention.
Document Generation and Records Management
After intake is complete, another flow generates a claim summary PDF and uploads it directly to a SharePoint 2016 library. This step supports downstream processes and ensures consistent documentation for audit purposes.
Data Integration
To extend reporting and automation, a dataflow extracts metadata from an existing SharePoint 2016 library and writes it to Dataverse. As a result, metadata becomes readily available across the entire solution.
Future‑Ready Integrations
Finally, the architecture was intentionally designed to support additional automation scenarios. Planned enhancements include sending payment preference data to a bank API and logging transaction activity in Dataverse for auditing. Although these components were removed from the initial release, the architecture preserves them for future expansion.
This solution delivers a centralized claim intake process using Power Apps, Power Automate, and Dataverse. Claims are entered through a cloud app, assigned automatically based on rules and availability, and documented with generated summaries stored in SharePoint. The result is reduced manual effort, improved consistency, and better workload visibility.
The Outcome
Faster Assignments and Balanced Workloads
The Power Platform solution significantly reduced manual effort and accelerated claim processing across the organization. As a result, the team saw measurable improvements, including:
- Automated assignment for the majority of incoming claims
- More balanced workloads across Examiners and Analysts
- Faster claim routing without increasing headcount
- Centralized control over assignment rules and capacity limits
- Greater consistency in claim documentation and referral handling
Together, these outcomes give the insurance organization a scalable foundation for continued automation and future process enhancements.
The Conclusion
A Scalable Foundation for Insurance Automation
By leveraging Power Apps, Power Automate, and Dataverse, IncWorx helped the insurance organization modernize claim intake and assignment without disrupting existing systems. The solution cut manual effort, increased workload visibility, and automated the majority of claim routing using clearly defined business rules.
With a centralized data model and flexible automation framework, the organization now operates on a scalable foundation that supports future enhancements while delivering efficiency gains today. Ultimately, the result is a more consistent, adaptable claim process—one that improves current operations and is built to grow with the business.