ClaimFlow - Insurance Claims Management System

A full-featured insurance claims management platform built with SvelteKit, featuring role-based access control, automated claim processing, fraud detection, and comprehensive reporting.

Overview

ClaimFlow is a modern web application designed for insurance companies to manage the complete lifecycle of insurance claims. It supports multiple user roles with tailored dashboards and workflows for each.

Features

Authentication & Authorization

• Custom session-based authentication with HTTP-only cookies
• Role-based access control (RBAC) with 5 distinct roles
• Secure password hashing with session management

User Roles

Claim Workflow Engine

• Configurable state machine with 12 statuses:

  Draft → Filed → Under Review → Investigation → Estimation → 
  Pending Approval → Approved/Denied → Payment Pending → Paid → Closed
  

• Role-based transition permissions
• Required field validation per transition
• Automatic underwriter flagging for high-value claims

Automated Claim Triage

• Auto-assignment based on adjuster workload and specialization
• Fraud detection with configurable rules:
  • Multiple claims in 30-day period
  • Claim amount near coverage limit (90%+)
  • Recently opened policy (within 30 days)
  • Delayed filing (30+ days after incident)
  • Potential duplicate detection

Settlement Calculator

• Damage item entry with categories
• Automatic depreciation calculation by policy type
• Deductible application and coverage limit enforcement
• Manual override capability with justification tracking

Document Management

• Support for images, PDFs, and videos up to 50MB
• Document verification workflow
• Timeline view with upload history
• Version tracking

Policy Renewal Workflow

• Automatic renewal notices 30 days before expiry
• Premium adjustment based on claim history
• Underwriter review for high-risk policies
• Customer accept/reject tracking

Communication System

• Threaded messaging per claim
• File attachments in messages
• Read/unread status tracking
• Real-time notifications

Batch Operations

• Bulk status updates
• Mass claim assignment
• CSV export with filters

Analytics Dashboard

• Claims by status, type, and priority
• Approval/denial rates
• Processing time metrics
• Adjuster performance reports
• Fraud statistics

Tech Stack

Project Structure

claimflow/
├── src/
│   ├── app.css                 # Global styles and Tailwind config
│   ├── app.html                # HTML template
│   ├── hooks.server.ts         # Auth middleware
│   │
│   ├── lib/
│   │   ├── components/         # Reusable Svelte components
│   │   │   ├── AppShell.svelte
│   │   │   ├── DocumentTimeline.svelte
│   │   │   └── WorkflowTimeline.svelte
│   │   │
│   │   └── server/             # Server-side modules
│   │       ├── db/
│   │       │   ├── index.ts    # Database connection
│   │       │   └── schema.ts   # Drizzle ORM schema
│   │       ├── auth.ts         # Authentication logic
│   │       ├── batch.ts        # Batch operations
│   │       ├── notifications.ts
│   │       ├── rbac.ts         # Role-based access control
│   │       ├── renewals.ts     # Policy renewal workflow
│   │       ├── reports.ts      # Analytics/reporting
│   │       ├── seed.ts         # Database seeding
│   │       ├── settlement.ts   # Settlement calculator
│   │       ├── triage.ts       # Auto-assignment & fraud detection
│   │       ├── uploads.ts      # Document uploads
│   │       └── workflow.ts     # Claim state machine
│   │
│   └── routes/                 # SvelteKit routes
│       ├── auth/               # Login, register, logout
│       ├── dashboard/          # Policyholder dashboard
│       ├── policies/           # Policy management
│       ├── claims/             # Claims management
│       ├── messages/           # Messaging
│       ├── settings/           # User settings
│       ├── adjuster/           # Adjuster dashboard
│       ├── agent/              # Agent dashboard
│       ├── underwriter/        # Underwriter dashboard
│       ├── admin/              # Admin dashboard
│       └── api/                # API endpoints
│
├── drizzle.config.ts           # Database configuration
├── svelte.config.js            # SvelteKit configuration
├── tailwind.config.ts          # Tailwind configuration
├── vite.config.ts              # Vite configuration
└── package.json

Database Schema

Core Tables

• users - User accounts with role assignments
• policies - Insurance policies
• claims - Insurance claims
• documents - Uploaded files
• communications - Messages between users

Supporting Tables

• sessions - User sessions
• notifications - In-app notifications
• claimNotes - Investigation and status notes
• claimWorkflowHistory - Status transition audit trail
• settlementCalculations - Payout calculations
• policyRenewals - Renewal tracking
• fraudAlerts - Fraud detection flags
• messageAttachments - Message file attachments
• auditLogs - System audit trail

API Endpoints

Demo Accounts

All accounts use password: password123

License

MIT License

Contributing

Contributions are welcome! Please read the contributing guidelines before submitting a pull request.