Insurance Operations Automation
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Comprehensive insurance operations framework for AI agents. Covers the full insurance lifecycle — underwriting, claims, policy management, renewals, compliance, and broker operations.
Guides your AI agent through insurance-specific workflows with industry benchmarks, regulatory requirements, and automation priorities.
| Metric | Personal Lines Target | Commercial Target |
|---|---|---|
| Combined Ratio | 95-98% | 88-95% |
| Loss Ratio | 60-70% | 55-65% |
| Expense Ratio | 25-32% | 28-35% |
| Claims Settlement Time | <48h (auto) | <14 days |
| Policy Issuance Time | <15 min | <24h |
| Renewal Rate | >85% | >80% |
| Quote-to-Bind Ratio | >25% | >15% |
| NPS | >40 | >35 |
| Process | Hours/Month (50-person broker) | Agent-Ready? | Expected Savings |
|---|---|---|---|
| Quote comparison | 160h | Yes — now | $140K-$280K/yr |
| FNOL intake | 120h | Yes — now | $105K-$210K/yr |
| Policy document generation | 80h | Yes — now | $70K-$140K/yr |
| Renewal processing | 100h | Yes — now | $87K-$175K/yr |
| Compliance checks | 60h | Yes — now | $52K-$105K/yr |
| Subrogation identification | 40h | Partial | $35K-$70K/yr |
| Complex claims adjustment | 200h | Human-in-loop | $50K-$100K/yr |
Underwriting Agent:
You are an underwriting assessment agent. For each submission:
1. Extract all risk factors from the application
2. Score each factor against the risk matrix (1-10 scale)
3. Calculate composite risk score (weighted by line of business)
4. Flag any referral triggers (prior losses >3 in 5yr, credit <600, high-hazard occupation)
5. Recommend: Auto-approve / Refer to senior / Decline with reason
6. Generate underwriting memo with supporting data
Claims Triage Agent:
You are a claims triage agent. For each FNOL:
1. Extract: date of loss, type, description, estimated amount, policyholder details
2. Verify active coverage and applicable endorsements
3. Assign severity: Green (<$2K auto-process) / Yellow ($2K-$25K adjuster) / Red (>$25K or fraud flags)
4. Check fraud indicators against the 15-point SIU trigger list
5. Set initial reserve based on claim type benchmarks
6. Route to appropriate handler with priority score
Month 1: Deploy intake + quote comparison agents. Target: 70% of personal lines quotes handled autonomously.
Month 2: Add claims triage + policy document generation. Target: FNOL processing <5 minutes, auto-approval for Green claims.
Month 3: Compliance monitoring + renewal automation. Target: 85%+ renewal rate, zero compliance gaps.
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Complete architecture reference for the A3 insurance platform — file locations, data flow, conventions, microservice map, and fullstack patterns
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Drafts U.S. commercial real estate access and indemnity (right-of-entry) agreements for pre-closing due diligence. Covers license grants, non-invasive vs invasive testing gates, insurance/endorsement requirements, indemnity with discovery carve-outs, restoration and lien remedies, confidentiality, and anti-indemnity guardrails. Trigger: access agreement, right of entry, due diligence access, Phase I/II, invasive testing, pre-PSA site inspection.
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当用户需要对意外险投保问卷进行专业、结构化的核保审查，提取职业类别、工作环境、作业内容、危险活动参与情况、交通出行习惯、特殊工作暴露及其他可能影响意外险承保判断的高风险信息，并生成适合意外险核保、补问流转和风险分层处理的结构化分析结果时使用本 skill。
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Inspect, schema, and fill true AcroForm PDFs using sciClaw's pdf_form_inspect, pdf_form_schema, and pdf_form_fill tools. Use when: (1) checking whether a PDF is a real fillable AcroForm, (2) listing form field names, types, and choices, (3) filling a supported form from structured values, (4) preparing reviewable insurance, legal, administrative, or clinical form drafts, (5) reporting skipped fields or unused input keys after a fill. Do not use for scanned PDFs, OCR tasks, or XFA-only forms.
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Guide actuarial analysis for insurance pricing. TRIGGERS - Use when user needs help with actuarial-analysis related tasks.
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Analyzes actuarial modeling systems for loss reserving accuracy, premium pricing methodology, mortality/morbidity tables, stochastic modeling, and capital adequacy per SOA and Solvency II standards. USE THIS SKILL WHEN: - You need to review or audit actuarial models (reserving, pricing, capital) - Someone asks about loss triangle analysis or reserve adequacy - You are evaluating IBNR calculations, chain ladder methods, or Bornhuetter-Ferguson - A project involves insurance pricing, GLM rating models, or ratemaking - You need to assess Solvency II SCR calculations or RBC compliance - Someone mentions actuarial opinions, ASOP compliance, or SOA standards - You are reviewing stochastic models, ESG configurations, or DFA frameworks - A codebase uses actuarial libraries (chainladder, lifetables, ChainLadder R package) TRIGGER PHRASES: "actuarial", "loss reserving", "IBNR", "chain ladder", "premium pricing", "mortality table", "Solvency II", "capital adequacy", "ratemaking", "GLM pricing", "risk-based capital", "reserve analysis", "actuarial opinion"
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