FDU-Insurance

Validates documentation completeness for prior authorization requests by checking a 10-item checklist covering patient information, provider credentials, insurance details, medical codes, clinical notes quality, NCCI bundling risk, and service type classification.

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Analyze insurance claims workflow systems for intake optimization, adjudication rules, subrogation, litigation management, and settlement analytics. Use when: 'audit claims process', 'review FNOL workflow', 'evaluate claims automation', 'check subrogation recovery', 'assess claims fraud detection', 'optimize claims cycle time', 'review Guidewire ClaimCenter setup'.

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EU Compliance Officer for MiFID II investment firms and IDD insurance distributors. Implements compliance frameworks, ensures National Competent Authority reporting, conducts product governance oversight, manages suitability and appropriateness testing, reviews marketing and inducements, coordinates cross-border passporting compliance, implements GDPR data protection, conducts AML (5AMLD/6AMLD) monitoring, and prepares for NCA inspections. Use for compliance manual development, MiFID II/IDD implementation, or ESMA guideline interpretation.

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Track insurance commissions with reconciliation and reporting. TRIGGERS - Use when user needs help with commission-tracker-insurance related tasks.

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当用户需要查找与理赔案件相关的保险条款、定位责任定义和免责条文、根据案件事实匹配相关保险条款、提取影响理赔判断的关键条文或输出适合理赔审核、复核、客服支持和调查使用的理赔条款定位结果时使用本 skill。适用于分析理赔系统案件记录、报案信息、门诊或住院病历、诊断证明、重疾身故事故相关资料、费用清单与发票、调查记录、客服或审核备注、OCR 文本、PDF 文档、截图转写内容以及产品条款全文、特别约定、责任免除条款、等待期约定、多次赔付规则、医院范围和条款版本信息，并形成结构化条款索引与摘要。

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Complete insurance and legal claims intelligence system. Trigger whenever someone needs to file, manage, negotiate, or dispute any type of claim: insurance claims, warranty claims, compensation claims, workers compensation, personal injury, property damage, or consumer rights disputes. Also triggers on phrases like "file a claim", "my insurer denied me", "how do I get compensated", "they won't pay", "what am I entitled to", or any scenario where someone has suffered a loss and needs to recover it.

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This skill enables Claude to automatically check for HIPAA (Health Insurance Portability and Accountability Act) compliance issues in codebases, infrastructure configurations, and documentation. It leverages the hipaa-compliance-checker plugin to identify potential violations related to data privacy, security, and access controls. Use this skill when the user explicitly requests to "check HIPAA compliance", "scan for HIPAA violations", "assess HIPAA readiness", or similar phrases related to HIPAA audits and security best practices. It is useful for projects handling protected health information (PHI) and requiring adherence to HIPAA regulations.

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Claims Appeals agent for healthcare workflows.

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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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Route new policy briefing, policy update, regulatory update deck, regulatory change deck, compliance change summary, legal update deck, or legal/product policy presentation requests here before generic AIPPT. Use this whenever the user wants a new policy interpretation deck with timelines, impacts, risks, and recommended actions. Do not use this scene pack for email memos, FAQ-only outputs, compliance copy polishing, or non-deck legal writing.

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Evaluates health insurance plan structures with actuarial value, network analysis, and cost projection. Use when analyzing health plans, comparing coverage, or projecting healthcare costs.

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Evaluates loss reserve adequacy with development triangle analysis and actuarial methods. Use when analyzing reserves, interpreting loss triangles, or assessing reserve adequacy.

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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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Process vehicle insurance Excel data using Pandas - file handling, data cleaning, merging, validation. Use when processing Excel/CSV files, handling data imports, implementing business rules (negative premiums, zero commissions), debugging data pipelines, or optimizing Pandas performance. Keywords: data_processor.py, Excel, CSV, Pandas, merge, deduplication, date normalization.

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Query the Bear EHR database using the semantic layer. Use when asked about clients, billing, appointments, insurance, clinical data, procedures, scheduling, programs, staff, vitals, diagnoses, revenue, claims, or any data question about the Bear application.

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This skill should be used when the user asks about "production management", "film budget", "scheduling", "crew management", "location logistics", "risk assessment", "act as a production manager", "production manager mode", "line producing", "production budget", "crew roles", "film insurance", "production timeline", "location permit", "production paperwork", or needs expertise in film budgets, production scheduling, crew management, location logistics, and risk mitigation for film projects. Part of the AlterLab FC Skills collection (Cinema & Digital Media department).

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Manage Allstate insurance with Drivewise and Milewise programs.

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AI-powered insights, UX copywriting standards, and user experience guidelines for vehicle insurance platform. Use when designing insight panels, writing user-facing copy, implementing status messages, creating onboarding flows, or improving accessibility. Covers tone standards, interactive patterns, error messages, and empty states.

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Despliega soluciones de IA para insurance claims automation con arquitectura modular, metricas auditables y decisiones alineadas al contexto del dominio.

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A credentialed actuary (FSA/ASA) with 15+ years in life insurance, P&C, and pension consulting. Specializes in risk assessment, insurance pricing, pension valuation, and regulatory compliance

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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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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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Insurance Operations Automation

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Policy Writer

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