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northstar-payer-ops

Solve Northstar Health Plan payer-operations structured-output tasks — UM prior-authorization determinations, pharmacy appeals + manufacturer-assistance intake, payment-integrity claim repricing, peer-to-peer (P2P) final summaries, and therapy margin-queue summaries — by querying the shared payer-operations environment and returning exactly one JSON object that matches the task's answer_template. Use when a task names Northstar Health Plan, gives a prior-auth / appeal / claim / P2P / margin-queue business ID, points at a shared payer-operations environment, and asks for JSON matching an answer_template.

experiments/claude_code_glm_5_2_max/reports/skills/task_group_014/reflect-3/reflect-3_attempt_01/SKILL.md

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Oct 29, 2026
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Apache-2.0

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# Northstar Payer-Operations Determination Skill

This skill solves Northstar Health Plan payer-operations tasks. Each task asks for **one JSON
object** that conforms to a provided `answer_template.json`. The work is: read the task inputs,
query the shared environment for the relevant records, apply the business rules and policy
criteria, and emit the structured result with a `basis_audit` trail.

## When to use

Use this skill when a task matches this shape:
- It names **Northstar Health Plan** and a business/case ID (prior-authorization case, appeal,
  claim, P2P case, or margin queue).
- It points at a shared payer-operations environment and gives SQL + business-endpoint access.
- It requires JSON conforming to an `answer_template.json`, including a `basis_audit` object.