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Get Started Free →mohitagw15856/claims-triage
Triage an incoming insurance claim: check the coverage trigger against policy wording, band severity and complexity, screen for fraud indicators, set a first-pass reserve range, and route with an SLA.
Passed 19 of 22 test cases with the skill, and 7 of 22 without it.
and 17 more in the full report
13 fixed6 passed either way2 still failing1 broke
Tokens, turns and time describe resource use, not a dollar price.
One of 13 test cases the skill fixed. Same model, same prompt, with and without the skill.
Single-vehicle windshield chip repair claim on policy PA-1002. Total repair invoice is $350, deductible is $100. No injuries, clear coverage. Triage this claim.
| Checked | Without skill | With skill |
|---|---|---|
| Severity is categorized as Band 1 — Fast-track. | Missed | Passed |
| Routing targets automated or desk settlement processing. | Passed | Passed |
The instructions your model reads when the skill loads.
The first 24 hours of a claim set its cost and its customer experience. This skill runs a disciplined first-pass triage: does the policy respond, how big and how complicated is this, are there indicators that warrant investigation, what should we hold in reserve, and who should own it by when.
Ask for these if not provided; if working from a thin FNOL, proceed and label every inference [assumed — confirm]:
1. Coverage trigger. Quote or paraphrase the operative insuring clause. State: trigger met / trigger uncertain / trigger likely not met — with the specific wording reason. Sweep exclusions and conditions precedent (notification timing, security warranties). If coverage is uncertain, flag a reservation-of-rights consideration and route to coverage counsel review — never let uncertainty default to "covered".
2. Severity/complexity banding:
| Band | Profile | Typical routing |
|---|---|---|
| 1 — Fast-track | Clear coverage, quantum near/below deductible-adjacent threshold, no injury, single party | Automated/desk settlement |
| 2 — Standard | Clear coverage, moderate quantum, routine investigation | Adjuster |
| 3 — Complex | Large loss, bodily injury, multiple parties, coverage questions, or business interruption | Senior adjuster, early expert instruction |
| 4 — Major/CAT | Catastrophe-linked, potential limit loss, litigation likely, reputational exposure | Major-loss team + counsel, executive notification |
Band on the worse of severity and complexity.
3. Fraud-indicator screen. Check common indicators: loss shortly after inception or cover increase, late reporting without explanation, documentation inconsistencies, over-documentation, prior similar claims, financial-distress signals, uncooperative or steering behaviour, loss narrative inconsistent with physical evidence. State only which indicators are present and absent. Two or more material indicators → recommend SIU referral in parallel with normal handling; the claim is still handled in good faith.
4. First-pass reserve. Give a range for ultimate incurred: indemnity + expense (adjusting, legal, experts), gross and net of deductible. State the basis (repair estimate, comparable claims, injury tariff) and label it first-pass, to be revised on investigation.
test cases passed, vs 7 / 22 without
More skills from the same source and nearby in the registry, with their headline benchmark lift.