☂️ Insurance Operations · Claims Handling
Screen claims for fraud indicators fairly
Objective indicator checklists routing to SIU without profiling or delay-by-suspicion.
advanced~35 minClaims AdjustersUnderwritersInsurance Ops
Steps
- 1Apply written indicator lists consistently; score, don't vibe
- 2Route to SIU only above threshold — suspicion is not a delay justification
- 3Document indicators factually; never record conclusions in notes
- 4Track SIU referral hit-rate to keep indicators honest
- 5Protect legitimate claimants' experience metrics separately
- 6Retrain indicator sets annually against confirmed fraud patterns
Common Pitfalls
- ▲Slow-walking claims via endless 'investigation' without indicators
- ▲Indicators proxying for protected characteristics
Commands
Install with skills CLI
$ npx skills add aniruddhaadak80/skills --skill claims-handling-fraud-indicator-triageInstall globally
$ npx skills add aniruddhaadak80/skills --skill claims-handling-fraud-indicator-triage -gTags
#fraud#siu#ethics#insurance#claims-handling