Social Insurance Process Transformation Sandbox

Simulate, Test & Deliver Next-Gen Public Claims

A high-fidelity transformation environment grounded in authentic user research. Hypothesise policy and digital changes, stress-test workflows against synthetic cohort personas, and project measurable business outcomes across Salesforce Public Sector Solutions (PSS) and Agentforce AI.

10-Stage Social Insurance Claims Lifecycle

End-to-end statutory workflow from initial injury lodgement to safe return-to-work cessation

10 Stages Standardised
Stage 01 Lodgement Multi-channel Intake
Stage 02 Allocation Triage & Routing
Stage 03 Investigation Employer & Wages
Stage 04 Determination 10-Day SLA Gate
Stage 05 RTW Plan Duty Matrix
Stage 06 Recovery Allied Health Care
Stage 07 IME Medical Specialist Review
Stage 08 Payments Wages & Invoices
Stage 09 Disputes Conciliation
Stage 10 Cessation Closure & RTW

Grounded Ecosystem Cohort Personas

Synthesised from qualitative research & uploaded evidence (Zero PII)
Select Persona 4 Cohorts
AT
Alex Turner Claimant (Construction)
JL
Jordan Lee Assessment Officer
ES
Emily Brown Care Coordinator
JC
Dr James Chen Treating Physiotherapist

Conversation with Alex Turner

Qualitative Interview Extraction
Mode: Current State Baseline
Grounded in qualitative source interviews (Source Inputs/2)
YO
You Hi Alex, can you explain the major frustrations and friction points you are facing with your current claim process?
AT
Alex Turner Sentiment: 3/10

Mate, it's just a completely opaque process. I'm sitting here with a fractured ankle and a bad back, trying to heal, and I have absolutely no idea what is happening with my claim. My boss said he lodged the paperwork, but I only sporadically hear from the insurer.

I keep getting bounced around, and every time I call, I seem to get different information from different people. I just want to feel in control and know when I can get back to work and provide for my family, but right now I feel like I'm at the mercy of a massive bureaucracy. The paperwork is tedious and confusing, and frankly, I'm stressed.

Propose a Process Change Hypothesis

Decompose any policy amendment, digital feature, or AI integration onto the 10 claims stages

Salesforce PSS & Agentforce
Select a Curated Transformation Scenario:
Active Transformation Hypothesis: "No hypothesis applied yet. Go back to the 'Hypothesise' stage to set one."
Workshop Cohort Future State
JL
Jordan Lee Assessment Officer
AT
Alex Turner Claimant (Construction)
ES
Emily Brown Care Coordinator
JC
Dr James Chen Treating Physiotherapist

Workshop with Jordan Lee

Future-State Design Feedback
Mode: Hypothesis Active
Simulated Scenario: Synthesising real-time design feedback (Source Inputs/6)
JL
Jordan Lee (Assessment Officer)

Ask me how the proposed change affects my daily triage workload, 10-day determination SLA, or case management processes. I will evaluate it under Salesforce PSS and manual baseline structures.

Target Architecture & Interim Process Studio: Interim vs End-State Modeler
"Configure operational levers, toggle Salesforce OOTB vs Manual legacy processes, and simulate dynamic statutory SLAs."

Interim Rollout Phases

Presets

Instantly switch between baseline, interim transitions, and target end-state.

Hypothesis Inputs

Select capabilities recommended from your active hypothesis in Stage 3:

Stage Configurator

Stage 1
Salesforce OOTB Solution
Description of OOTB capability.
Effort: Medium Impact: High

10-Stage Process Lifecycle

Manual OOTB Custom

Process Simulator Live Trace

Full end-to-end claim progression, turnaround time per stage, and participants.

10 Events
Process Stage Process Type Simulation Event & System Layer Participant
Live Simulation KPIs
Real-time
Determination SLA 10-Day Gate
0.0 Days
10-Day SLA Compliant

Statutory requirement for initial claim acceptance decision.

End-to-End Cycle Time Total Duration
0.0 Days
-0.0 Days vs Legacy Baseline

Cumulative calendar days from intake to RTW closure.

Case Manager Effort Admin Hours
0.0 Hours
-0% Admin Overhead

Hours spent on manual calculations and evidence chasing.

Claimant Sentiment 50%
50%

Calculated from communication frequency and wage anxiety.

Implementation Effort Complexity
0.0 pts
0 / 10 processes automated

Cumulative delivery points across enabled capabilities.

Multi-Phase Transformation Scorecard & Architecture Roadmap

Future State Business Outcomes & Multi-Phase Architecture

Comprehensive evaluation of scheme performance and architecture transitions across Baseline, Interim Phase 1, Interim Phase 2, and Target Future State.

Multi-Phase Metric Comparison Matrix

Benchmarking operational performance across all 4 rollout phases

4 Phases Modeled
Process Metric Baseline (Manual) Interim Phase 1 Interim Phase 2 Target End-State

10-Stage Rollout Architecture Transition Matrix

Stage-by-stage inventory of manual vs Salesforce OOTB capabilities across rollout phases

Manual Salesforce OOTB
Claims Stage Baseline Interim Phase 1 Interim Phase 2 Target End-State
Format: Australian English | Zero PII | Target: Salesforce Public Sector Solutions (PSS)