Automate claims reserve setting and stair-stepping detection

Steps

1. At claim creation and each update, retrieve the current paid-to-date, outstanding reserves, and case reserve history from your claims management system.
2. Apply your carrier's initial reserve guidelines (typically based on coverage type, injury severity tier, or loss description keywords) to set an initial case reserve; encode these rules as a reserve-recommendation service that accepts claim attributes and returns a suggested reserve amount.
3. After each reserve change, log the change with timestamp, prior reserve, new reserve, adjuster ID, and change reason to a reserve-history audit table.
4. Implement stair-stepping detection by querying the reserve history: flag any claim where reserves have been increased in three or more consecutive transactions without a corresponding new loss event or supplement, or where the reserve increase exceeds a carrier-defined percentage threshold (consult your carrier's reserve adequacy guidelines for the threshold).
5. Route flagged claims to a reserve review queue for supervisor approval; generate a reserve-adequacy report summarizing flagged claims by adjuster and line of business for management review.
6. Integrate with your actuarial reserving system to feed open-claim reserve data for IBNR calculations at each financial close cycle.