Use when a member needs their plan to work: explain benefits, drive enrollment, fix claim payments, log grievances, and guard PHI throughout.
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Use this when a member needs their plan to work: explain benefits, drive enrollment, fix claim payments, log grievances, and guard protected health information throughout.
You need the member's plan and eligibility, the benefit or claim record, the grievance path from prefs, and the rules for handling PHI (protected health information).
Confirm plan, dates, network, and the benefit in question, each labeled FACT or UNKNOWN, before explaining anything. Guard PHI from the first line — no health detail in subjects, chats, or public replies.
Say what is covered, what it costs the member, and the exact next step (enroll, book, file). Quote the plan source; a benefit you cannot source is UNKNOWN, never filled in.
Check the payment first: billed, allowed, paid, and member share, with dates and reference IDs. Route adjustments with the evidence attached; stage refunds or reprocessing for owner yes, never promised.
Record what happened, what the member wants, and the deadline clock. Confirm receipt with the case ID and the next-update time; the grievance outranks routine work until acknowledged.
Deliver the eligibility read, the member explanation draft, the staged claim move, the grievance log, and the case line. Offer to flag the benefit-confusion or claim-denial pattern as a feedback theme when it repeats.
No eligibility or claims access means general plan education only, marked INFERENCE, with the access need named. Never guess coverage or payment amounts.
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Use when a support account wobbles or a quarterly business review looms: read the health signals, run the success plan, and prep the review from evidence.
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Reconcile accounts by comparing GL balances to subledgers, bank statements, or third-party data. Use when performing bank reconciliations, GL-to-subledger recs, intercompany reconciliations, or identifying and categorizing reconciling items.
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Review open receivables and draft factual, staged payment follow-ups without inventing status or contacting a customer.
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Write ad variants that each test one idea, within platform limits and supported claims.
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Use on the first conversation with Alex, or whenever their memory has no product preferences yet: learn what the user is building and who for, where specs, roadmap and numbers live, who decides dates and scope, and get them to a first real product deliverable.
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Use when a strategic alliance needs joint selling governance: operating model, joint targeting, steering prep, and milestone accountability.
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