⚡AgentSkills
☂️ 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

  1. 1Apply written indicator lists consistently; score, don't vibe
  2. 2Route to SIU only above threshold — suspicion is not a delay justification
  3. 3Document indicators factually; never record conclusions in notes
  4. 4Track SIU referral hit-rate to keep indicators honest
  5. 5Protect legitimate claimants' experience metrics separately
  6. 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-triage
Install globally
$ npx skills add aniruddhaadak80/skills --skill claims-handling-fraud-indicator-triage -g

Tags

#fraud#siu#ethics#insurance#claims-handling

Related skills

Structured intake, coverage verification, documentation, and settlement discipline.

☂️ Insurance Operations·~40m