Skill: 1kalin/afrexai-insurance-claims (version 1.0.0)

# Insurance Claims Processor Process, analyze, and optimize insurance claims. Covers property, liability, workers' comp, auto, and professional indemnity. ## What This Does Takes raw claim details and produces: - Structured claim summary with policy coverage mapping - Liability assessment with supporting/weakening factors - Reserve estimate with confidence range - Subrogation opportunity analysis - Red flag detection (fraud indicators, coverage gaps) - Settlement recommendation with negotiation range - Regulatory compliance checklist by jurisdiction ## Usage Provide claim details in any format — adjuster notes, policyholder statement, incident report, photos, or free text. The agent structures everything. ### Quick Claim Analysis ``` Analyze this claim: [paste details] ``` ### Full Processing ``` Process claim for: - Policy type: [commercial general liability / property / WC / auto / PI] - Incident date: [date] - Reported date: [date] - Claimant: [name/entity] - Description: [what happened] - Claimed amount: [if known] - Policy limits: [if known] - Jurisdiction: [state/country] ``` ## Claim Analysis Framework ### 1. Coverage Determination - Map incident to policy provisions - Identify applicable endorsements and exclusions - Flag coverage disputes early - Check occurrence vs claims-made triggers ### 2. Liability Assessment Score 1-10 on insured liability exposure: - **1-3**: Strong defense position, deny or minimal settlement - **4-6**: Mixed liability, negotiate - **7-10**: Clear insured liability, reserve and settle Factors evaluated: - Comparative/contributory negligence (jurisdiction-specific) - Statutory obligations - Contractual indemnity provisions - Prior loss history pattern ### 3. Reserve Estimation Three-point estimate: - **Low**: Best case with strong defense - **Mid**: Most likely outcome - **High**: Worst case including litigation costs Include: - Indemnity reserve - Defense costs (inside/outside limits) - Allocated loss adjustment expense (ALAE) - Unallocated loss adjustment expense (ULAE) ### 4. Fraud Detection Red flags scored by severity: - Claim timing patterns (Monday morning, policy inception proximity) - Prior claim frequency - Documentation inconsistencies - Witness availability issues - Financial stress indicators - Description vs damage inconsistency ### 5. Subrogation Analysis - Third-party recovery potential - Evidence preservation requirements - Statute of limitations by jurisdiction - Cost-benefit of pursuit ### 6. Settlement Strategy - Opening position and authority range - Mediation vs litigation cost comparison - Jurisdiction-specific verdict ranges - Structured settlement considerations for large claims ## Industry-Specific Modules ### Property Claims - Replacement cost vs actual cash value - Business interruption calculations (gross earnings, extra expense) - Ordinance or law coverage triggers - Catastrophe event coordination ### Workers' Compensation - Compensability determination - Return-to-work timeline - Medical treatment guidelines by state - Permanent disability rating estimates ### Professional Liability - Discovery rule and statute of repose - Prior acts coverage analysis - Consent to settle provisions - Panel counsel selection criteria ### Auto/Fleet - Comparative fault allocation - UM/UIM stacking analysis - Medical payment coordination - Total loss threshold calculations ## Compliance Checklist Generator Produces jurisdiction-specific compliance timeline: - Acknowledgment deadlines - Investigation completion requirements - Payment timing obligations - Required notices and disclosures - Bad faith exposure triggers ## Output Format Every analysis produces: 1. **Executive Summary** — 3-line claim snapshot 2. **Coverage Analysis** — provisions, exclusions, disputes 3. **Liability Score** — 1-10 with reasoning 4. **Reserve Recommendation** — low/mid/high with breakdown 5. **Red Flags** — fraud indicators if any 6. **Action Items** — next steps with deadlines 7. **Settlement Range** — if applicable --- Built by [AfrexAI](https://afrexai-cto.github.io/context-packs/) — AI agent context packs for every industry. Get the full **Insurance & Risk Management Context Pack** with claims processing, underwriting automation, policy analysis, and actuarial modeling: [AfrexAI Storefront](https://afrexai-cto.github.io/context-packs/) Calculate what AI agents save your claims operation: [AI Revenue Calculator](https://afrexai-cto.github.io/ai-revenue-calculator/)


Security scan verdicts — ClawScan: clean | static analysis: clean | VirusTotal: clean | SkillSpector: clean (LOW)