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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. Use when asked to triage a claim, review a first notice of loss (FNOL), assess a new claim, decide fast-track vs adjuster routing, or screen a claim for SIU referral. Produces a structured triage note with coverage view, severity band, indicator screen, reserve range, and a routing recommendation.

skills/claims-triage/SKILL.md

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Nov 7, 2026
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# Claims Triage Skill

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.

## What This Skill Produces

- A coverage-trigger view against the actual policy wording (trigger, exclusions, conditions)
- A severity/complexity band with rationale
- A fraud-indicator screen — indicators only, never conclusions
- A first-pass reserve range (indemnity + expense), labelled as first-pass
- A routing recommendation (fast-track / adjuster / senior adjuster / SIU referral / coverage counsel) with SLA

## Required Inputs