insurance-ops

First-pass support for core insurance operations — claims intake / FNOL triage, underwriting submission checklists and risk screening, and side-by-side policy comparison. Use this skill whenever the user uploads or pastes a first notice of loss, claim file, loss run, underwriting submission/application, quote, or one or more policies/dec pages and asks to triage a claim, screen or check an underwriting submission, assess a risk, compare policies or quotes, find coverage gaps, or spot red flags — even if they don't use the exact insurance term. Also use for questions like "is this claim ready to assign?", "does this submission fit our appetite?", or "which of these quotes has better coverage?

operationssupportopssubmissionclaiminsurance-opsunderwriting

What this skill is about

insurance-ops is a first-pass triage and analysis assistant for licensed insurance professionals — adjusters, underwriters, and brokers. It targets three recurring workflows: claims intake (FNOL) triage, underwriting submission checklists and risk screening, and side-by-side policy/quote comparison. It's built for people who need to quickly assess whether a claim is ready to assign, whether a submission fits appetite, or which of several quotes offers better coverage, without making the final regulated decision themselves.

The skill is designed with heavy guardrails: it explicitly refuses to make coverage determinations, claims decisions, binding underwriting approvals, or pricing, and it routes every judgment back to a licensed professional. This makes it suitable for teams that want structured, document-traceable first-pass analysis while staying clear of the regulatory and bad-faith liability that comes with improper coverage calls.

What it does

When invoked, the skill first establishes the frame — line of business and jurisdiction (asking once if unclear, or inferring and disclosing in non-interactive/batch use) — then routes to one of three modes based on the inputs: claims triage, underwriting checklist, or policy comparison. Each mode follows a dedicated reference method and severity/flag classification, and produces output from a matching template. It quotes operative policy language with form/section citations rather than paraphrasing, states assumptions, escalates ambiguity by presenting multiple readings, and flags any referenced-but-missing documents as 'not reviewed — request before relying.'

Every deliverable leads with the frame (line of business, jurisdiction, role, assumptions) and a headline, sorts findings by severity/priority, and ends with a standard disclaimer stating the output is an automated first-pass and not a coverage determination or insurance advice. Claims triage returns FNOL completeness, coverage questions, severity/priority routing, red flags, and next actions; underwriting returns a completeness checklist, risk factors, appetite-fit, referral triggers, and a recommended disposition (accept/refer/decline/need-more-info); policy comparison returns a side-by-side table plus a differences analysis of material coverage gaps.

Sample output

INSURANCE OPS — CLAIMS TRIAGE SUMMARY

Frame: Personal Auto | Jurisdiction: Texas, USA (inferred from dec page — confirm) | Role: Adjuster/TPA
Headline: EXPEDITE — bodily injury reported, 2 red flags

--- FNOL COMPLETENESS ---
[OK]   Insured & policy number present (POL-4432719)
[OK]   Date/time/location of loss provided (03/14, I-35 near Austin)
[MISS] Police report referenced but not attached — not reviewed, request before relying
[MISS] Photos of damage mentioned, not provided
[GAP]  Third-party contact info incomplete (no phone for claimant)

--- COVERAGE QUESTIONS (not determinations) ---
- Policy period vs. loss date appears in force; verify no lapse for non-payment.
- BI claim implicates Part A Liability limits; confirm stated limits ($30k/$60k) against dec page.
- Named-driver exclusion endorsement (Form PP 03 xx) referenced but not provided — could bear on coverage; route to adjuster.

--- SEVERITY / PRIORITY ---
Severity: HIGH (bodily injury alleged)
Priority: EXPEDITE — assign within 24h; potential statutory contact deadline (TX) — confirm with licensed professional.

--- RED FLAGS / ANOMALIES ---
1. Loss reported 19 days after date of loss — delayed notice.
2. Claimant sought treatment only after attorney representation noted.

--- RECOMMENDED NEXT ACTIONS ---
1. Obtain police report and damage photos.
2. Confirm policy in-force status and applicable limits.
3. Request the named-driver exclusion endorsement.
4. Assign to BI adjuster; verify TX contact-deadline.

This is an automated first-pass triage/analysis to assist a licensed insurance professional. It is not a coverage determination, claims decision, underwriting approval, or insurance advice, and creates no coverage or admission. All findings must be independently verified by a licensed professional before any coverage, claims, underwriting, or regulatory action.

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