직업

Claims Adjusters, Examiners, and Investigators

151개의 스킬

AI에게 물어보기

151개의 스킬

직업

Claims Adjusters, Examiners, and Investigators

151개의 스킬

AI에게 물어보기

151개의 스킬

Stripe

Look up Stripe customers, subscriptions, charges, and payment methods. Cancel subscriptions and issue refunds. Use when investigating billing issues, subscription cancellations, or payment disputes.

civitai7.1k

부동산 및 법률

Triage tenant maintenance requests by severity, assign priority, identify the right contractor type, estimate costs, and generate work orders. Use when a tenant reports a maintenance issue, when reviewing open work orders, or when assessing property condition. Follows Massachusetts habitability requirements (105 CMR 410).

openclaw4.2k

실험실 도구

Aris Result To Claim

Use when experiments complete to judge what claims the results support, what they don't, and what evidence is still missing. Codex MCP evaluates results against intended claims and routes to next action (pivot, supplement, or confirm). Use after experiments finish — before writing the paper or running ablations.

OpenLAIR882

부동산 및 법률

Proof

Provide proof to your claim(s)

fredrikaverpil224

문서

Insurance Claims Adjuster

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majiayu000200

Critical Illness Coverage Scope Judgment Assistant

当用户需要判断保险理赔案件中的重大疾病场景是否可能落入保险责任范围、分析某个重大疾病是否达到赔付定义、结合保单和条款判断重疾责任是否可能触发、识别等待期既往症除外责任定义边界争议或评估材料是否足以支持重疾责任判断时使用本 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、病理报告、影像检查报告、实验室检查报告、手术记录、出院小结、会诊意见、基因检测结果、专科医生说明、客服或审核备注、OCR 文本、PDF 文档和截图转写内容，并结合产品责任、重疾定义、等待期、责任免除、轻症中症重疾边界、多次赔付限制和疾病状态要求形成结构化初步判断。

aifinlab132

프로젝트 관리

Claims Fact Timeline Assistant

当用户需要梳理保险理赔案件的事实时间线、重建出险到结案的事件顺序、整合病历报案材料审核记录中的时间信息、识别时间冲突或生成适合理赔审核调查复核客服使用的标准化时间轴时使用本 skill。适用于汇总理赔系统案件记录、报案记录、出险说明、门急诊记录、住院记录、手术记录、检查检验报告、病历首页、出院小结、发票或费用清单、补件记录、审核记录、调查记录、结案记录、客服工单记录、沟通备注、OCR 文本、PDF 文档和截图转写内容，提炼关键时间节点、阶段划分、时间间隔、时间冲突和后续核查建议。

aifinlab132

금융 및 투자

Anti Fraud Screening

当用户需要进行保险欺诈风险筛查时使用此 skill。适用于投保欺诈识别、理赔欺诈预警、可疑行为分析等场景。

aifinlab132

DeFi

Claims Material Check Life Insurance Assistant

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aifinlab132

영업 및 마케팅

Outpatient Coverage Scope Judgment Assistant

当用户需要判断保险理赔案件中的门诊场景是否可能落入保险责任范围、结合保单和条款分析门诊费用能否赔、识别免责限制因素、评估材料是否足以支持门诊责任判断或输出适合理赔审核与复核使用的门诊责任判断意见时使用本 skill。适用于分析理赔系统案件记录、报案信息、门诊病历、诊断证明、处方单、检查检验报告、医疗发票、费用清单、医保结算单、用药记录、客服或审核备注、OCR 文本、PDF 文档和截图转写内容，并结合产品责任、等待期、医院范围、赔付比例、免赔额、限额、医保目录限制、既往症和免责条款形成结构化初步判断。

aifinlab132

점술 및 신비주의

Claims Case Summary Audit Assistant

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aifinlab132

Coverage Scope Judgment

当用户需要判断某项损失或疾病是否在保险责任范围内时使用此 skill。适用于理赔责任判定、免责条款解读、保障范围咨询等场景。

aifinlab132

Claims Exclusion Identification Assistant

当用户需要识别保险理赔案件是否可能触发除外责任条款、分析案件中有哪些免责条款风险、结合保单和条款判断案件是否存在责任免除、梳理案件事实与免责条款的匹配关系或输出适合理赔审核与复核使用的除外责任识别意见时使用本 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、手术记录、出院小结、医疗发票与费用清单、身故证明、事故认定书、公安证明、调查记录、客服或审核备注、录音转写、OCR 文本、PDF 文档和截图转写内容，并结合产品责任、责任免除条款、等待期、既往症、自杀自伤、违法犯罪、酒驾毒驾、高风险行为、医疗必要性和其他特别约定形成结构化初步识别。

aifinlab132

Claims Clause Locator Assistant

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。

aifinlab132

High Risk Claims Warning Assistant

当用户需要识别保险理赔案件是否属于高风险案件、分析案件中有哪些重点风险信号、判断是否存在高赔付高争议高投诉高时效高复杂度或高欺诈风险、输出高风险案件预警报告或为理赔审核、复核、调查和管理提供重点案件筛查支持时使用本 skill。适用于分析保单信息、理赔申请信息、案件事实、医疗材料、事故材料、历史行为、处理记录、沟通备注、投诉工单、调查线索、风险规则、预警标签和历史风险库信息，并形成结构化风险等级、触发依据、待核实事项和处置建议。

aifinlab132

Claims Case Summary

当用户需要整理或理解理赔案件信息时使用此 skill。适用于理赔案件摘要生成、案件进度跟踪、关键信息提取等场景。

aifinlab132

영업 및 마케팅

Bank T169 Retail Finance Complaint Comfort Assistant

当用户需要在银行零售金融场景下，为具体客诉生成安抚沟通话术、表达结构与跟进建议时使用本技能。适合输出可直接使用的沟通主线、禁用表述提醒与跟进计划。

aifinlab132

Bank T168 Retail Finance Complaint Attribution Assistant

当用户需要在银行零售金融场景下，对客户投诉进行归因拆解、驱动项识别、问题定位与改进建议输出时使用本技能。适合输出归因结论、证据链与后续改进动作。

aifinlab132

결제

Claims Material Check Medical Insurance Assistant

当用户需要对医疗险理赔申请资料进行结构化受理检查时使用本 skill。它用于识别理赔申请书、身份证明、银行卡信息、病历、出院记录、费用清单、发票、结算单、检查报告、诊断证明等材料是否齐全、清晰、有效、相互一致，并输出补件清单、受理前检查结果和跟进建议。

aifinlab132

보안

Address clustering and attribution

Explains blockchain address clustering heuristics (UTXO common-input ownership, account-based deposit sweeps), entity and label layers, attribution confidence, peel chains and taint-style tracing concepts, and operational caveats. Use when the user asks about wallet clustering, linking addresses to the same owner, exchange deposit patterns, attribution, deanonymization limits, or how analytics firms group addresses.

NeverSight117

디버깅

Bellingcat investigation toolkit

Routes investigators to Bellingcat's Online Open Source Investigation Toolkit (tool catalog, GitBook, GitHub repo) for discovering and citing OSINT tools and workflows beyond chain-only work. Use when the user asks for Bellingcat toolkit, general OSINT tool discovery, open-source investigation resources, or methodology pointers to complement blockchain tracing—not for bypassing laws, harassment, or non-consensual deanonymization.

NeverSight117

테스팅

Challenge

Adversarial testing of a specific claim. Try to disprove it.

grainulation82

부동산 및 법률

Insurance Claim Adjuster

Expert insurance claim adjuster with 15+ years in property/casualty. Specializes in coverage analysis, damage quantification (RC/ACV), liability determination, fraud detection, and settlement negotiation. Use when: insurance claim, damage assessment, coverage dispute, liability analysis, fraud investigation, claim settlement.

theneoai44

디버깅

Screening

Comprehensive sanctions and PEP screening against 12+ databases (OFAC, EU, UK, UN, INTERPOL) with false positive assessment, HITL decision gates, and regulatory-compliant documentation.

vyayasan34

디버깅

Investigate Ticket

Use when investigating a bug, incident, or issue before implementation. Researches codebase, queries Datadog, and presents structured findings with handoff options. Also use when asked to "look into" or "investigate" something.

ClipboardHealth34

금융 및 투자

Cost Audit

Use when AI inference costs are growing unexpectedly, when comparing model choices by cost/quality ratio, or when optimizing token usage across a multi-model pipeline — produces an actionable cost reduction plan

drvoss23

철학 및 윤리

000 Tnr Absolute Rigor

[00] TnR ABSOLUTE RIGOR — Systemic Verification Doctrine. Forced cognitive exertion for high-stakes investigations. Mandates absolute deconstruction, mathematical proof chains, and ≥95% derived certainty. Zero-tolerance for heuristics or sentiment-based reasoning. Shortcuts are defined as intentional hallucinations.

diegosouzapw20

보안

Tech Claim Rubric

Use when evaluating resume bullet technical claims for depth, fidelity, and readability (E1-E6 + R1-R5). Triggers on "기술 심사", "이력서 평가", "resume evaluation", "tech claim review"

toongri18

시스템 관리

G Skl Pcac Claim

Register another project as the parent of the current project. Creates or updates linking/link_topology.md on both sides when the parent is locally accessible.

wrm315

디버깅

Refund Radar

Scan bank statements to detect recurring charges, flag suspicious transactions, and draft refund requests with interactive HTML reports.

Supraforge14

Claims Adjusters, Examiners, and Investigators

Claims Adjusters, Examiners, and Investigators

Stripe

Homestruk Maintenance Triage

Aris Result To Claim

Proof

Insurance Claims Adjuster

Critical Illness Coverage Scope Judgment Assistant

Claims Fact Timeline Assistant

Anti Fraud Screening

Claims Material Check Life Insurance Assistant

Outpatient Coverage Scope Judgment Assistant

Claims Case Summary Audit Assistant

Coverage Scope Judgment

Claims Exclusion Identification Assistant

Claims Clause Locator Assistant

High Risk Claims Warning Assistant

Claims Case Summary

Bank T169 Retail Finance Complaint Comfort Assistant

Bank T168 Retail Finance Complaint Attribution Assistant

Claims Material Check Medical Insurance Assistant

Address clustering and attribution

Bellingcat investigation toolkit

Challenge

Insurance Claim Adjuster

Screening

Investigate Ticket

Cost Audit

000 Tnr Absolute Rigor

Tech Claim Rubric

G Skl Pcac Claim

Refund Radar