Claims Handling Fraud Indicator Triage

---
name: claims-handling-fraud-indicator-triage
description: "Objective indicator checklists routing to SIU without profiling or delay-by-suspicion."
---
# Screen claims for fraud indicators fairly

> Objective indicator checklists routing to SIU without profiling or delay-by-suspicion.

**Track:** ☂️ Insurance Operations · **Domain:** Claims Handling · **Level:** advanced · **~35 min**

**Who this is for:** Claims Adjusters, Underwriters, Insurance Ops, Brokers

## When to Use This Skill

Objective indicator checklists routing to SIU without profiling or delay-by-suspicion.
Use it whenever a matching task appears in conversation — the agent loads these instructions on demand.

## Steps

1. Apply written indicator lists consistently; score, don't vibe
2. Route to SIU only above threshold — suspicion is not a delay justification
3. Document indicators factually; never record conclusions in notes
4. Track SIU referral hit-rate to keep indicators honest
5. Protect legitimate claimants' experience metrics separately
6. Retrain indicator sets annually against confirmed fraud patterns

## Common Pitfalls

- Slow-walking claims via endless 'investigation' without indicators
- Indicators proxying for protected characteristics

## Commands

**Install with skills CLI**
```bash
npx skills add aniruddhaadak80/skills --skill claims-handling-fraud-indicator-triage
```

**Install globally**
```bash
npx skills add aniruddhaadak80/skills --skill claims-handling-fraud-indicator-triage -g
```

---

Part of [aniruddhaadak80/skills](https://github.com/aniruddhaadak80/skills) · Browse all at https://skills.sh/aniruddhaadak80/skills