Claims Adjudication Engine
InsuranceClaim submitted, policy rules engine evaluates coverage, benefit calculation applied, payment system processes, notification sent to claimant.
eventsystemdbapi
Why OSOP matters here
Automated claims processing must be auditable. OSOP records every rule applied, calculation performed, and payment issued — satisfying insurance regulatory requirements.
Workflow Steps (6)
1
Claim Submission Event
event2
Policy Lookup
db3
Coverage Rules Engine
system4
Benefit Calculation
system5
Payment System
api6
EOB Notification
apiConnections (5)
Claim Submission Event→Policy Lookupsequential
Policy Lookup→Coverage Rules Enginesequential
Coverage Rules Engine→Benefit Calculationconditionalclaim.eligible == true
Benefit Calculation→Payment Systemsequential
Payment System→EOB Notificationsequential
6
Steps
5
Connections
4
Node Types