CT
Claims Triage
🔵 Stable🕐 updated 2026-07-14
🔷 SkillSpec L3
pm-insurance
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.
What to give it
▸Loss description — what happened, when, where, reported when
▸Policy details — line of business, wording or key clauses, limits, deductible, period
▸Claimed amount or damage description — even rough
▸Claimant / insured history — if available (prior claims, tenure)
✅ The bar it holds itself to
Every skill in this library self-verifies — these are this skill's own quality checks, straight from its definition.
✓Coverage view cites specific wording, not just line of business
✓Severity band has a stated rationale and used the worse of severity/complexity
✓Fraud screen lists indicators present *and* checked-but-absent — no conclusion stated
✓Reserve is a range with a stated basis, labelled first-pass, gross and net shown
✓Routing includes an SLA and concrete first actions
✓Assumptions from a thin FNOL are labelled `[assumed — confirm]`
✓Regulatory support-not-determination line is included
⚠️ What it refuses to do
Do not state a fraud conclusion — state indicators and route to SIU; the word is "indicator", never "fraudulent"
Do not let a SIU referral pause good-faith handling of the claim
Do not default an uncertain trigger to "covered" or "denied" — flag it for coverage review with the wording question stated
Do not give a single-point reserve on day one — give a range with basis
Do not invent policy terms — if the wording isn't provided, ask, or label the clause `[to confirm against wording]`
Install
npx pm-claude-skills add --agent claude # or codex · cursor · gemini · hermes
# or one-line MCP (every skill, any client):
claude mcp add pm-skills -- npx -y pm-claude-skills-mcpRelated skills
🔌 Embed this skill
Drop this on your blog, docs, or site — it renders a "Run this skill" card:
<div data-pm-skill="claims-triage"></div>
<script src="https://mohitagw15856.github.io/pm-claude-skills/embed.js" async></script>💬 Discussion
Claims Triage is one of 599 open-source professional AI agent skills — all SkillSpec L3.
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