Claims Triage Skill

The first 24 hours of a claim set its cost and its customer experience. This skill runs a disciplined first-pass triage: does the policy respond, how big and how complicated is this, are there indicators that warrant investigation, what should we hold in reserve, and who should own it by when.

What This Skill Produces

• A coverage-trigger view against the actual policy wording (trigger, exclusions, conditions)
• A severity/complexity band with rationale
• A fraud-indicator screen — indicators only, never conclusions
• A first-pass reserve range (indemnity + expense), labelled as first-pass
• A routing recommendation (fast-track / adjuster / senior adjuster / SIU referral / coverage counsel) with SLA

Required Inputs

Ask for these if not provided; if working from a thin FNOL, proceed and label every inference [assumed — confirm]: