guidewire-core-workflow-b

Guidewire ClaimCenter Workflow

Overview

Drive the ClaimCenter claims lifecycle through Cloud API and survive the failure modes that derail naive automation. This is the workflow used by FNOL portals, IVR claims intake, partner-of-record APIs, and reserve-setting jobs. Assumes guidewire-install-auth provides the bearer token and guidewire-sdk-patterns provides the retrying client with checksum round-trip.

Five production failures this skill prevents:

1. Duplicate FNOL from multi-source intake — the same loss event is reported by the caller, the claimant, and the broker; without dedup logic three claims land on the same loss with three reserves.
2. Payment before reserve — code creates a payment without first setting a reserve in the matching cost category; API returns 422 reserve-required.
3. Authorization-tier violation — an integration with payment role cc.payment.write attempts a payment above its authorization limit; API returns 422 authorization-required and the payment lands in pending-approval.
4. Premature settlement — claim closed before all open reserves are zeroed or all open activities resolved; reopens compound work and generate audit findings.
5. Reopen vs. new claim confusion — late-arriving evidence on a closed claim creates a new claim with a different number, breaking the loss-event continuity downstream finance and analytics depend on.

Prerequisites

• A working auth + SDK layer per guidewire-install-auth and guidewire-sdk-patterns
• Cloud API roles cc.claim.write, cc.reserve.write, cc.payment.write assigned per least privilege; payment authorization tier matches the integration's expected payment range
• Knowledge of the carrier's loss-cause code list (AUTO, PROPERTY, WORKERSCOMP, etc.) and cost-category configuration (body, parts, medical, legal)
• A loss-dedup key strategy (typically: policyNumber + lossDate + lossCause + reporterId)

Instructions

1. FNOL with deduplication

Before creating a claim, check whether one already exists for the same loss event. The dedup key combines policy, loss date, loss cause, and the reporting party.

async function findExistingClaim(policyNumber: string, lossDate: string, lossCauseCode: string): Promise<Claim | null> {
  const url = `${BASE}/cc/rest/v1/claims?filter=policyNumber+eq+'${policyNumber}'+and+lossDate+eq+'${lossDate}'+and+lossCause.code+eq+'${lossCauseCode}'`;
  const res = await fetch(url, { headers: { Authorization: `Bearer ${await getToken()}` } });
  const body = await res.json();
  return body.data[0] ?? null;
}

const existing = await findExistingClaim(policyNumber, lossDate, lossCauseCode);
if (existing) {
  await addReporterToExistingClaim(existing.attributes.id, reporter); // additional reporter, same loss
  return { status: "deduplicated", claimNumber: existing.attributes.claimNumber };
}
const claim = await createClaim({ policyNumber, lossDate, lossCauseCode, reporter, description });

The dedup window is loss-cause-specific. For AUTO, same-day same-cause is almost certainly the same event. For PROPERTY, weather events can produce multiple legitimate same-cause same-day claims across distinct locations — extend the dedup key with the loss-location ZIP for that line.

2. Reserve setting before any payment

Reserves communicate the carrier's expected outflow per cost category. The Cloud API enforces "reserve before payment" — payments without a matching reserve return 422 reserve-required.

await retryable(async () => {
  const res = await fetch(`${BASE}/cc/rest/v1/claims/${claimId}/reserves`, {
    method: "POST",
    headers: { Authorization: `Bearer ${await getToken()}`, "Content-Type": "application/json", "Idempotency-Key": idempotencyKey },
    body: JSON.stringify({
      data: { attributes: {
        reserveAmount: { amount: 5000, currency: "usd" },
        costType: { code: "claimcost" },
        costCategory: { code: "body" },
        reserveLine: { exposure: { id: exposureId } },
      } },
    }),
  });
  if (!res.ok) throw await mapError(res, "POST", `/cc/rest/v1/claims/${claimId}/reserves`);
});

Reserve adjustments (raise/lower) use PATCH on the reserve resource; checksum round-trip applies. Lowering a reserve below cumulative payments returns 422 — fix payments first or use a reserve transfer.

3. Payments with authorization-tier handling

The integration's authorization tier is configured per Service Application in GCC. A payment that exceeds the tier does not error — it lands in Status: PendingApproval and waits for a supervisor:

const payment = await fetch(`${BASE}/cc/rest/v1/claims/${claimId}/payments`, {
  method: "POST",
  headers: { Authorization: `Bearer ${await getToken()}`, "Content-Type": "application/json", "Idempotency-Key": idempotencyKey },
  body: JSON.stringify({ data: { attributes: paymentBody } }),
}).then(r => r.json());

if (payment.data.attributes.status.code === "PendingApproval") {
  await emitPaymentEscalationEvent({ claimId, paymentId: payment.data.attributes.id, amount: paymentBody.amount });
  return { status: "pending-approval", paymentId: payment.data.attributes.id };
}

Do not poll the payment for completion. Subscribe to the App Event for payment-status-change and react asynchronously — this is covered in guidewire-webhooks-integrations.

4. Settlement with completeness gates

A claim should only close when every exposure has either been paid in full, denied, or has reserves zeroed; and every required activity (subro decision, salvage decision, supervisor sign-off) is completed.

async function isReadyToSettle(claimId: string): Promise<{ ready: boolean; blockers: string[] }> {
  const claim = await getClaim(claimId, "exposures,activities,reserves");
  const blockers: string[] = [];
  for (const reserve of claim.included.reserves) {
    if (reserve.attributes.status.code === "Open" && reserve.attributes.amount.amount > 0) {
      blockers.push(`reserve ${reserve.id} is ${reserve.attributes.amount.amount} open`);
    }
  }
  for (const activity of claim.included.activities) {
    if (activity.attributes.required && activity.attributes.status.code !== "Completed") {
      blockers.push(`activity ${activity.id} (${activity.attributes.subject}) not completed`);
    }
  }
  return { ready: blockers.length === 0, blockers };
}

Only call the close endpoint when isReadyToSettle returns ready: true. Premature closure works but creates audit findings and forces reopens.

5. Reopen vs. new claim

Late-arriving evidence on a closed claim is almost always the same loss event. Reopen the existing claim rather than creating a new one — claim numbers must remain stable for the underlying loss event so finance, analytics, and regulatory reporting continue to roll up correctly.

async function handleLateEvidence(claimNumber: string, evidence: Evidence): Promise<Result> {
  const claim = await getClaimByNumber(claimNumber);
  if (claim.attributes.status.code === "Closed") {
    await fetch(`${BASE}/cc/rest/v1/claims/${claim.attributes.id}/reopen`, {
      method: "POST",
      headers: { Authorization: `Bearer ${await getToken()}`, "Idempotency-Key": idempotencyKey },
      body: JSON.stringify({ data: { attributes: { reason: evidence.reason } } }),
    });
  }
  await attachEvidence(claim.attributes.id, evidence);
  return { status: "reopened", claimNumber };
}

The reopen endpoint requires a reason — log the evidence type and source so the audit trail explains why the claim was reopened.

Output

A complete ClaimCenter workflow integration ships with all of the following:

• A FNOL function with a configurable dedup key (per loss-cause line) that returns { status: "created" | "deduplicated", claimNumber }.
• Reserve-setting that runs before any payment in the same cost category, with a transfer/adjustment helper for raising or lowering reserves safely.
• Payment creation that recognizes the PendingApproval status and emits an escalation event rather than blocking the calling thread.
• A isReadyToSettle() gate that inspects reserves and required activities before allowing the close endpoint to be called.
• A reopen handler that distinguishes late evidence (reopen) from a genuinely new loss event (new claim).
• A claim-event log capturing every transition with correlation_id, idempotency_key, and reason.

Examples

Example 1 — FNOL with dedup

const result = await intakeFnol({ policyNumber, lossDate, lossCauseCode, reporter, description });
if (result.status === "deduplicated") {
  return { claimNumber: result.claimNumber, message: "Loss already on file; reporter added" };
}
return { claimNumber: result.claimNumber, message: "New claim opened" };

Example 2 — Reserve, payment, escalation

await setReserve(claimId, { amount: 50000, costCategory: "medical" });
const payment = await createPayment(claimId, { amount: 35000, costCategory: "medical", payee });
if (payment.status === "pending-approval") {
  await notify("supervisor", { claimId, paymentId: payment.id, amount: 35000 });
}

Example 3 — Settlement readiness check

const { ready, blockers } = await isReadyToSettle(claimId);
if (!ready) return { status: "not-ready", blockers };
await closeClaim(claimId, { reason: "settled" });

Error Handling

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