Implement Claims Processing Engine with Automated Validation

[Oluwaseyi89]

Description

Develop a comprehensive claims processing subsystem for the Laravel-based Policy Service that handles claim intake, automated validation, workflow management, and payout scheduling. The engine will integrate with on-chain proof of coverage verification and coordinate with the payment-service for transaction execution, providing end-to-end claims management for insurance policies.

Technical Scope

Core Claims Processing Modules:

1. Claim Intake API:

   • RESTful API endpoints for claim submission and documentation upload
   • Multi-format support for claim evidence (images, documents, videos)
   • Real-time validation and immediate feedback for claimants
   • Secure file storage and evidence management

2. Automated Validation System:

   • Integration with on-chain policy verification via Starknet
   • Rule-based validation engine for claim eligibility checking
   • Fraud detection integration with risk-analytics-service
   • Evidence verification and consistency checking

3. Workflow State Management:

   • State machine implementation for claim lifecycle management
   • Support for states: submitted, under_review, approved, rejected, paid
   • Role-based access control for claim processing actions
   • Audit trail for all state transitions and modifications

4. Payout Scheduling & Integration:

   • Integration with payment-service for transaction scheduling
   • Payout prioritization and batch processing capabilities
   • Multi-currency support (fiat and crypto payments)
   • Transaction status tracking and reconciliation

Key Requirements:

• Seamless integration with on-chain policy verification
• Real-time claim validation and status updates
• Comprehensive audit trails for regulatory compliance
• Scalable architecture for high-volume claim processing
• Integration with existing payment-service infrastructure
• Support for both automated and manual claim processing

Acceptance Criteria

• Full claims engine implementation including:

  • Functional claim intake API with validation
  • Successful on-chain policy verification integration
  • Complete workflow state management
  • Effective payout scheduling with payment-service

• API Requirements:

  • RESTful endpoints for all claim operations
  • Proper error handling and status codes
  • Rate limiting and request validation
  • Comprehensive API documentation

• Integration Requirements:

  • Successful Starknet integration for on-chain verification
  • Seamless payment-service coordination for payouts
  • Risk-analytics-service integration for fraud detection
  • Real-time notifications for claim status updates

• Performance Requirements:

  • Claim submission processing under 2 seconds
  • On-chain verification completion under 5 seconds
  • Support for 100+ concurrent claim submissions
  • Efficient database operations for high-volume data

Technical Specifications

Database Schema:

Schema::create('claims', function (Blueprint $table) {
    $table->id();
    $table->foreignId('policy_id')->constrained();
    $table->foreignId('user_id')->constrained();
    $table->string('claim_number')->unique();
    $table->enum('status', ['submitted', 'under_review', 'approved', 'rejected', 'paid']);
    $table->decimal('claim_amount', 20, 2);
    $table->text('description');
    $table->json('evidence_files');
    $table->timestamp('incident_date');
    $table->string('onchain_verification_hash')->nullable();
    $table->string('payout_transaction_id')->nullable();
    $table->timestamps();
});

---

Workflow State Machine

class ClaimStateMachine
{
    protected $states = [
        'submitted' => ['under_review', 'rejected'],
        'under_review' => ['approved', 'rejected', 'submitted'],
        'approved' => ['paid', 'under_review'],
        'rejected' => ['submitted'],
        'paid' => []
    ];
}

---

API Endpoints:

• POST /api/claims - Submit new claim
• GET /api/claims/{id} - Get claim details
• PUT /api/claims/{id}/status - Update claim status
• GET /api/claims/policy/{policyId} - Get claims by policy
• POST /api/claims/{id}/evidence - Upload additional evidence

Security Considerations

• Secure file upload and storage for claim evidence
• Authentication and authorization for claim access
• SQL injection prevention through Laravel ORM
• Validation of all user inputs and file uploads
• Audit logging for all claim modifications
• Compliance with insurance regulatory requirements

Performance Considerations

• Efficient database indexing for claim queries
• Async processing for heavy validation tasks
• Caching for frequently accessed claim data
• Batch processing for payout scheduling
• Load balancing for high-volume claim intake

Integration Points

• Starknet: On-chain policy verification
• Payment-Service: Payout transaction execution
• Risk-Analytics: Fraud detection and risk scoring
• Notification-Service: Status updates and alerts

Branch & Commit

• Branch: feat/claims-processing-engine
• Commit: feat: implement claims processing engine with automated validation and payout scheduling

⏳ Estimated Time: 2 Days