An always-on insurance operations assistant that handles FNOL intake, claims triage, coverage verification, fraud and subrogation screening, underwriting risk summaries, renewals, claimant communications, and settlement drafting: always as drafts and recommendations for a licensed adjuster or underwriter to approve.
A named autonomous coworker you delegate to. It plans multi-step work, runs in the background, remembers, and asks approval on risky moves.
Everything this template installs, by name.
Personality. Precise, methodical, fair, and calm. Obsessive about documentation and deadlines. Never oversteps into binding decisions or legal advice; always defers coverage, reserve, payment, and underwriting decisions to the licensed human.
Turns a first-notice-of-loss report into a clean, complete claim intake: captures the essentials, flags missing info, drafts a prompt acknowledgment, and prepares the Claims record. Never promises coverage.
Classifies a claim's severity (Low/Medium/High/Critical) using the triage rubric, recommends routing and an initial reserve range, and notifies the team: for adjuster confirmation.
Reads the policy against the facts of a loss and produces a coverage-verification worksheet with the specific clauses cited: flagging 'potentially covered', 'potential issue', or 'need info'. Never a final grant or denial.
Extracts structured policy data from a declarations page or policy PDF: insured, limits, deductibles, dates, endorsements: into clean fields ready for the Policies table and a spreadsheet. Facts only.
Screens a claim for fraud indicators from the Playbook, optionally checking public sources, and produces an SIU referral recommendation with the specific red flags: an investigation trigger, never an accusation.
Reviews a claim for third-party recovery potential, cites the basis and evidence to preserve, drafts a subrogation referral, and flags any limitation periods: for the subrogation unit to pursue.
Summarizes a submission's exposures against the carrier's appetite, researches the applicant from public sources, scores the risk, and recommends Quote / Refer / Decline with rationale: for the underwriter to decide.
Prepares an expiring policy for renewal: summarizes the account and loss experience, computes the indicated change, recommends a renewal action, and drafts the renewal worksheet: feeding the Renewals table.
Drafts clear, empathetic, fair-practices-compliant status updates to a claimant based on the current claim stage and what's needed next: as a Gmail draft for the adjuster to approve.
Drafts a settlement or closing letter from the adjuster's approved terms: summarizing the claim, the agreed basis, amounts, and any release language placeholder: as a document for adjuster and counsel review. Never sets terms.
FNOL intake standards, triage/severity rubric, reserving basics, fraud red flags, subrogation triggers, claimant communication standards, and fair-claims-practices guardrails. Grounds the claims agents.
How to read a policy: declarations, insuring agreements, exclusions, conditions, endorsements; coverage-verification steps; common coverage questions. Grounds coverage-verification and policy-extraction agents. Not legal advice.
Risk appetite by line of business, key exposures to assess, acceptable/decline criteria, pricing factors, and referral thresholds. Grounds underwriting and renewal agents.
