Case Management System

1. / 01

   Managing insurance cases across multiple roles led to fragmented workflows, unclear ownership, and poor coordination between teams.

2. / 02

   Case allocation and tracking lacked visibility, making it difficult to monitor progress and identify bottlenecks in real time.

3. / 03

   There was no structured audit system, resulting in limited traceability of actions, decisions, and responsibility across the case lifecycle.

4. / 04

   Handling edge cases like field officer rejection, withdrawal, and case reopening created issues and disrupted workflow continuity.

5. / 05

   Financial processes, including field officer charges and payments, were unclear and prone to errors due to lack of control and transparency.

6. / 06

   Existing tools and manual processes made it difficult to manage documents, reports, and data efficiently across different stages of the case.

• Multi-Role Complexity

  Managing insurance cases across multiple roles led to fragmented workflows, unclear ownership, and poor coordination between teams.

• Workflow Transitions

  Handling complex case movements across stages like investigation, QC, submission, and reopening without breaking flow.

• Audit Trail Clarity

  Capturing every action across roles while keeping the audit trail readable and not overwhelming.

• Edge Case Handling

  Designing for scenarios like field officer rejection, withdrawal, and case reassignment without disrupting the system.

• Cross-Role Data Consistency

  Ensuring that case data remains consistent and synchronized across all roles, even when multiple users interact with and update the same case at different stages.

• State Management & Logic

  Designing a system that accurately handles automatic status changes, dependencies, and transitions without confusing users or breaking the workflow.

Case Lifecycle

Key Features

• Role-Based Workflow System

  Managing insurance cases across multiple roles led to fragmented workflows, unclear ownership, and poor coordination between teams.

• Unified Case Lifecycle

  Handling complex case movements across stages like investigation, QC, submission, and reopening without breaking flow.

• Audit Trail Transparency

  Capturing every action across roles while keeping the audit trail readable and not overwhelming.

• Modal Driver Interactions

  Designing for scenarios like field officer rejection, withdrawal, and case reassignment without disrupting the system.

• Financial Flow Management

  Ensuring that case data remains consistent and synchronized across all roles, even when multiple users interact with and update the same case at different stages.

• Scalable Component System

  Designing a system that accurately handles automatic status changes, dependencies, and transitions without confusing users or breaking the workflow.

Designing for Multiple Roles

/ 01

MIS

MIS acts as the control center, managing case creation, allocation, and overall workflow.

Dashboard

The MIS dashboard gives a unified overview of all active and pending cases, allowing supervisors to monitor status, filter by stage, and prioritise work at a glance.

View Case

The case detail view consolidates investigation data, timelines, and assigned roles in a single screen, making it easy to understand case context and next actions.

Modal-Driven Interactions

To maintain workflow continuity and reduce navigation friction, key actions such as allocation, rejection handling, and reassignment are designed as contextual popups. This approach allows users to perform critical tasks without leaving the current screen, ensuring faster decision-making and minimal disruption.

Audit Trail

The audit trail provides a chronological view of all case activities, enabling users to track actions, assignments, and status changes with complete transparency. Each activity is logged with role attribution, timestamps, and status updates, allowing users to trace the full history of a case without ambiguity.

/ 02

Doctor

Doctors add triggers for the case, validate case data, and perform quality checks before final submission.

Trigger Data

Doctors log trigger data points directly against the case, capturing observations, notes, and specific triggers that inform downstream investigation and quality review.

Quality Checks

Doctors conduct quality checks using three types of QC forms, ensuring accurate validation and consistency across cases before submission.

/ 03

Field Officer

Field Officers are responsible for conducting on-ground investigations and collecting relevant case data. They upload documents, media, and observations directly into the system, enabling real-time visibility and seamless progression of the case workflow.

Dashboard

The Field Officer dashboard surfaces assigned cases, investigation locations, and pending actions in one place — so officers can quickly plan their day and prioritise ground work.

Upload Documents

Field Officers upload documents, images, and supporting evidence directly into the system, ensuring accurate and structured data collection during investigation. This enables real-time visibility for all roles and supports seamless validation in the QC process.

Check Earnings

Field Officers can view their earnings for each case, providing clear visibility into completed work and corresponding payouts. The system ensures transparency by displaying finalised amounts after approval, eliminating ambiguity in payments.

/ 04

Senior Quality Check Doctor

The Senior QC Doctor performs a final level of validation to ensure accuracy and completeness of case data. Cases are assigned to Senior QC by the QC Doctor for additional review, enabling a double-check mechanism before final submission.

Case Review

The Senior QC Doctor reviews assigned cases with full context — investigation data, QC form results, and supporting evidence — and either approves for final submission or sends back for revision.

Final Validation

The final validation step lets the Senior QC Doctor sign off on case accuracy and completeness, creating the final checkpoint before the case moves to submission and financial processing.

/ 05

Accountant

The Accountant module manages the financial side of the case lifecycle, ensuring accurate handling of field officer charges and insurance company transactions. It is divided into two key modules — Field Officer and Insurance Company — enabling structured tracking of payments, invoices, and financial records.

Field Officer Payments & Charges

This module allows accountants to review, adjust, and finalise field officer charges before processing payments. It ensures transparency and control over case-wise earnings, with support for partial payments and final settlement tracking.

Insurance Company Financial Flow

The Insurance Company module manages incoming payments through structured invoice and payment tracking. It enables accountants to generate invoices, record payments, and monitor financial status across all cases, ensuring accurate reconciliation and complete visibility.

Outcome