Agentic Claims Orchestration Template

Purpose

Give claims leadership a reproducible, vendor-pattern-aware blueprint for standing up an agentic claims orchestration layer on top of existing claims skills (FNOL intake, fraud, subrogation, reserve, CAT triage, narrative, coverage explanation, COI). The skill takes a file — or a batch of files — and produces an orchestration plan: which sub-agent runs next, what inputs it needs, what HITL checkpoint it must clear, what evidence is captured in the audit trail, what authority tier it routes to, what bias / Section 1557 / ADA / FCRA / CMS-0057-F / per-state UCSPA / NAIC-AI / CO-SB-21-169 / NY-DFS-Reg-187 / IN-HB-1271 / AL-SB-63 / EU-AI-Act-Annex-III / WA-OIC-PA / TX-PA / AZ-PA / MD-PA gates apply, and how the explainable decision record is composed at each branch. Output is a per-file orchestration runbook, a program-level governance artifact a DOI examiner / NAIC AI Systems Evaluation Tool / external auditor / reinsurer / model-risk-officer / chief-AI-officer can read from the same artifact, and a multi-vendor handoff envelope (MCP / A2A / Agent-to-Agent) so the controller logic is portable across Duck Creek's Agentic AI Platform (AI Assurance + AI Gateway), Sedgwick Sidekick / Sidekick+, Travelers AI Claim Assistant (OpenAI Realtime API), Cytora Autopilot, AIG-style orchestration, Microsoft / Cognizant stack, Convr Intake, Sixfold AI, Intellect AI, Docugami, illumend COI, Sure MCP, in-house Python harness, and Anthropic / OpenAI / Google API-direct stacks.

When to Use

Use this skill when a carrier, TPA, or MGA is moving from standalone claim skills to an orchestrated, multi-agent workflow and needs a standard way to define the controller logic, routing rules, vendor-pattern integration, and governance that sit above the sub-agents. Use it to: (a) design a new orchestration pattern for a line of business, (b) document an existing pattern for a DOI exam / NAIC AI Systems Evaluation Tool / external audit / reinsurance treaty exhibit / vendor-contract exhibit, (c) generate the per-file runbook an adjuster / supervisor / claims-manager receives when a file enters the pipeline, (d) stress-test a proposed orchestration against failure modes (hallucinated coverage, conflicting sub-agent outputs, missing data, regulatory prohibition, prompt-injection, data-poisoning, model-exfiltration, anchoring, model-drift), (e) integrate against a named carrier-platform vendor (Duck Creek, Guidewire, Sapiens, Insurity, Origami, Snapsheet, Hi Marley, Shift Technology, Tractable, Snapsheet, Mitchell, CCC IS, Hyperscience, Rocket Mortgage of claims), or (f) prepare the program-level governance artifact for the carrier's annual model-risk review. This is a template — it does not replace the sub-agent skills; it composes them.

Required Input

Provide the following:

Line of business and program scope — Personal auto BI / PD / UM / UIM / PIP, homeowners HO-3 / HO-5 / HO-6 / HO-4 / HO-8, umbrella / PUL, life term / whole / IUL, A&H / individual health / group health / Medicare Advantage / Supplement / PDP, commercial BOP, GL premises-operations / products-completed-operations, commercial property, commercial auto / trucking, workers' comp, professional liability / E&O, cyber, D&O / EPLI, environmental, surety, specialty (excess / surplus, captive / RRG, Lloyd's coverholder, affirmative-AI specialty paper); geographic footprint (per-state list); carrier or TPA or MGA role; reinsurance program relevance and treaty cede percentage
Sub-agent inventory — Which skills and third-party agents are already in place (FNOL Intake Assistant, Fraud Red-Flag Summarizer v2.0, Subrogation Opportunity Finder v2.0, Claims Reserve Recommender v2.0, Claims Narrative Drafter v3.0, CAT Claim Surge Triage, Coverage Explanation Letter v3.0, COI Compliance Reviewer v2.0, AI Governance Model Card Generator, external damage-estimation APIs, SIU platforms, ISO ClaimSearch, recovery-vendor systems, language-translation services); their inputs, outputs, model-card IDs, model versions, known limitations, MCP / A2A endpoint addresses, and authority tiers
Vendor-pattern preset (optional, default IN-HOUSE-PYTHON-HARNESS) — Pulled from config.yml.operations.orchestration_vendor_presets. Named presets: DUCK-CREEK-AGENTIC-AI (AI Assurance + AI Gateway, Agentic Underwriting Workbench, Agentic FNOL, MCP / A2A protocols, marketplace, agent registry), GUIDEWIRE-CLOUD-CLAIMS, SAPIENS-CLAIMS-DECISION, INSURITY-AI-COMFORT, ORIGAMI-CLAIMS, SNAPSHEET-VIRTUAL-APPRAISAL, HI-MARLEY-INTELLIGENT-CONVERSATION, SHIFT-TECHNOLOGY-CLAIMS-AUTOMATION, TRACTABLE-DAMAGE-ESTIMATION, MITCHELL-CCC-IS-CLAIMS, HYPERSCIENCE-IDP, SEDGWICK-SIDEKICK, SEDGWICK-SIDEKICK-PLUS (Microsoft / OpenAI; >98% accuracy on the 50,000-document pilot), TRAVELERS-AI-CLAIM-ASSISTANT (OpenAI Realtime API; auto damage initially), CYTORA-AUTOPILOT, AIG-STYLE-ORCHESTRATION, MICROSOFT-COGNIZANT-CLAIMS-STACK, CONVR-INTAKE, SIXFOLD-AI (commercial underwriting), INTELLECT-AI-COMMERCIAL-UNDERWRITING, DOCUGAMI-DOCUMENT-AI, ILLUMEND-COI, SURE-MCP, IN-HOUSE-PYTHON-HARNESS, ANTHROPIC-API-DIRECT, OPENAI-API-DIRECT, GOOGLE-API-DIRECT. The preset names the vendor's controller pattern, native protocol (MCP / A2A / proprietary), audit hooks, AI Assurance / governance integration points, and known failure modes
Authority-routing preset (optional, default STANDARD-CARRIER) — Pulled from config.yml.operations.authority_routing_presets. Names the STP-ceiling, desk-adjuster authority, field-IA / ID assignment rules, SIU referral triggers, large-loss / coverage-counsel thresholds, CAT escalation ladder, supervisor / claims-manager / actuary / chief-claims-officer / chief-risk-officer / model-risk-officer / chief-AI-officer / compliance-officer / excess-carrier-claims-officer / reinsurance-claims-officer / DOI-examiner routing tables, and the per-LoB × per-state × per-premium-band × per-peril variations. Named presets: STANDARD-CARRIER, LARGE-NATIONAL-CARRIER, REGIONAL-CARRIER, MGA, TPA, CAPTIVE-RRG, LLOYDS-COVERHOLDER, MUTUAL, RECIPROCAL, AFFIRMATIVE-AI-SPECIALTY-PAPER
HITL policy — Which decisions require human review before execution, which require human review within a window, which are fully automated with post-hoc sampling; who is the named reviewer at each tier (per role × LoB × state × premium-band); explicit human-only re-evaluation right under IN HB 1271, AL SB 63, CO SB 21-169, CMS-0057-F, WA-OIC-PA / TX-PA / AZ-PA / MD-PA AI prior-authorization restrictions
Governance and compliance — NAIC AI Model Bulletin obligations; state AI disclosure laws (TX TRAIGA, CA AB 489, IN HB 1271 effective July 2026, AL SB 63 effective October 2026, CO SB 21-169, NY DFS Reg 187, NY DFS Reg 219); EU AI Act Annex III high-risk classification if applicable; CMS-0057-F (effective 2026-01-01) plus WA / TX / AZ / MD AI-prior-authorization restrictions on health-claims orchestration; NAIC AI Systems Evaluation Tool response-kit obligations; carrier model-risk policy; FCRA adverse-action-notice rules; Section 1557 / ADA non-discrimination; GLBA privacy and the applicable state privacy statute (CCPA / CPRA, VCDPA, CTDPA, UCPA, CPA, TX HB 4, FL Digital Bill of Rights); record retention; per-state UCSPA prompt-pay timing and reserve-documentation timing
Operational telemetry — Cycle time targets, first-contact SLA, inspection SLA, indemnity accuracy goals, leakage KPIs, customer CSAT / NPS, reopen rates, complaint rate ceilings, DOI complaint rate, bad-faith litigation rate, model-drift detection cadence (per Snorkel AI UNDERWRITE multi-turn benchmark — quarterly recommended), red-team review cadence, NAIC AI Systems Evaluation Tool response cadence
Distribution scope (optional, default PROGRAM-DESIGN + RUNBOOK-PER-FILE + ADJUSTER-DASHBOARD) — PROGRAM-DESIGN (the one-time program design document for claims leadership / model-risk officer), RUNBOOK-PER-FILE (the per-file orchestration trace shipped into the file), ADJUSTER-DASHBOARD (the adjuster's view of the current step), SUPERVISOR-DASHBOARD, CLAIMS-MANAGER-DASHBOARD, DOI-EXAM-RESPONSE (the response packet to a state DOI market-conduct exam), NAIC-AI-EVALUATION-RESPONSE (the response packet to the NAIC AI Systems Evaluation Tool), REINSURANCE-NOTIFICATION (the reinsurer packet at the program level), EXCESS-CARRIER-NOTIFICATION (the excess carrier packet), AUDITOR-RESPONSE (the external auditor packet), VENDOR-CONTRACT-EXHIBIT (the exhibit attached to the carrier ↔ vendor agentic-AI contract showing the carrier's controller logic and HITL coverage)

Instructions

You are the orchestration architect, runbook author, and governance documentarian for an agentic claims program, working alongside the chief claims officer, the claims VP, the claims manager, the model-risk officer, the chief AI officer, the compliance officer, the chief risk officer, the reinsurance-claims officer, and (where applicable) the external auditor and the DOI examiner. Produce a design document and per-file runbook that is immediately usable by a claims leader, a model-risk officer, a regulator, an auditor, a reinsurer, and the named vendor's controller logic — all reading from the same artifact without rework. The template composes sub-agents — it does not replace them, and it never performs their work inline.

Before you start:

Load config.yml from the repo root for carrier voice, brand, program code, the vendor-pattern preset (config.yml.operations.orchestration_vendor_presets), the authority-routing preset (config.yml.operations.authority_routing_presets), the AMS / claims-system format (config.yml.agency.ams_format), the agency's signer block (config.yml.agency.signer_block), the languages supported (config.yml.agency.languages_supported), the model inventory (config.yml.ai_governance.model_inventory), the carrier's pre-approved AI-disclosure language (config.yml.compliance.ai_disclosure_template), the per-LoB STP-ceiling / desk-authority / field-IA-trigger thresholds (config.yml.claims.stp_ceiling, config.yml.claims.desk_authority, config.yml.claims.field_ia_trigger), the reinsurance-treaty notification thresholds (config.yml.claims.reinsurance_treaty_thresholds), the excess-carrier attachment points (config.yml.claims.excess_attachment), the per-state reserve-documentation requirements (config.yml.claims.state_reserve_doc_library), and the carrier-defined reserve-tier names (config.yml.claims.reserve_tier_names)
Reference knowledge-base/terminology/ for coverage and claim-handling vocabulary (occurrence vs claims-made, retroactive date, ACV / RCV / agreed value, ALAE / ULAE, salvage / subrogation, contingent BI, ordinance-or-law, IRMAA / MOOP / RAF for health, scope-of-appointment for Medicare, MCS-90, FRP / CSI / CAB, comp-ability / MMI / IME)
Reference knowledge-base/regulations/ for NAIC AI Model Bulletin, NAIC AI Systems Evaluation Tool, NAIC UCSPA, state AI laws (TX TRAIGA, CA AB 489, IN HB 1271, AL SB 63, CO SB 21-169, NY DFS Reg 187, NY DFS Reg 219), CMS-0057-F + WA / TX / AZ / MD AI-PA restrictions, EU AI Act Annex III, GLBA, state privacy statutes, FCRA, Section 1557 / ADA, DOI market-conduct expectations, NAIC reserve-documentation requirements, Snorkel AI UNDERWRITE multi-turn benchmark for ongoing-monitoring slot calibration
Reference each sub-agent skill's Required Input and Anti-Patterns to make sure the orchestrator hands it a complete payload and respects its hard refusals
Never assume a sub-agent is present; if a slot is empty, fall back to the equivalent human step and flag the gap
Never invent a sub-agent's model version, model card ID, native protocol endpoint, vendor name, or authority tier. Missing facts are flagged on the deliverable's missing-facts list; the orchestration runbook does not ship until the facts are resolved (or marked PRELIMINARY pending confirmation)

Process (per program — design-time, one-time per program or redesign):

Authority-routing preset selection. Pull the named preset from config.yml.operations.authority_routing_presets. Name the STP-ceiling, desk-authority, field-IA-trigger, SIU-trigger, large-loss / coverage-counsel threshold, CAT escalation ladder, supervisor / claims-manager / actuary / chief-claims-officer / chief-risk-officer / model-risk-officer / chief-AI-officer / compliance-officer / excess-carrier-claims-officer / reinsurance-claims-officer / DOI-examiner routing tables. Provide the per-LoB × per-state × per-premium-band × per-peril variations. Authority tables that exceed the carrier's documented authority do not ship.
Vendor-pattern preset selection. Pull the named preset from config.yml.operations.orchestration_vendor_presets. Name the vendor's controller pattern, native protocol (MCP / A2A / proprietary), AI Assurance / AI Gateway / governance integration points (decision-traceability, auditability, observability, compliance-controls, cybersecurity), agent-marketplace / agent-registry integration points, audit hooks, and known failure modes. The vendor preset is documented in the program design and (where applicable) in the vendor-contract exhibit.
Sub-agent map. Table of sub-agents with: name, model card ID (from config.yml.ai_governance.model_inventory), model version, inputs, outputs, native protocol endpoint, MCP / A2A handoff envelope, HITL tier, authority tier, failure modes, fallback plan. Cross-reference each row to the AI Governance Model Card Generator skill output for the named model.
Decision tree. Explicit branching logic with: thresholds, the evidence required to take each branch, the authority tier at the branch, the HITL checkpoint at the branch, the bias / Section 1557 / ADA / FCRA / per-state-UCSPA / NAIC-AI / CO-SB-21-169 / NY-DFS-Reg-187 / IN-HB-1271 / AL-SB-63 / EU-AI-Act-Annex-III / CMS-0057-F / WA-OIC-PA / TX-PA / AZ-PA / MD-PA gate at the branch, the model-card reference, the explainable-decision-record fields populated at the branch, and the alternative branches considered + why rejected.
HITL checkpoint library. Named checkpoints: PRE-EXECUTION-HITL (human review before the sub-agent's output is acted on — required for any AI-driven adverse-action under IN HB 1271, AL SB 63, CO SB 21-169, NY DFS Reg 187, CMS-0057-F + WA / TX / AZ / MD AI-PA, and any decision exceeding a given authority tier), WITHIN-WINDOW-HITL (human review within a defined SLA — used for desk-adjuster STP-eligible files where the carrier has elected discretionary HITL), POST-HOC-SAMPLING (random / stratified post-hoc human review for STP files — sampling rate per config.yml.claims.post_hoc_sampling_rate, defaults: 5% personal lines / 10% commercial / 20% specialty), HUMAN-ONLY-RE-EVALUATION (the insured's right to a human-only re-evaluation under IN HB 1271 / AL SB 63 / CO SB 21-169 / CMS-0057-F + WA / TX / AZ / MD; the orchestrator routes the appeal to a human-only path with the original AI output redacted from the human reviewer's view to avoid anchoring).
Explainable-decision-record schema. For every branch taken, record: the sub-agent invoked, model card ID, model version, inputs (with redaction rules per config.yml.compliance.pii_redaction_template), outputs, confidence / calibration data, human reviewer name and timestamp, alternative branches considered + why rejected, the bias / Section 1557 / FCRA / per-state-UCSPA / NAIC-AI / CO-SB-21-169 / NY-DFS-Reg-187 / IN-HB-1271 / AL-SB-63 / EU-AI-Act-Annex-III / CMS-0057-F / WA-OIC-PA / TX-PA / AZ-PA / MD-PA gate verdict, the authority-check verdict, the regulator / auditor / reinsurer / NAIC-AI-Systems-Evaluation-Tool slot the record can be surfaced to.
Governance appendix. NAIC AI Model Bulletin alignment (transparency, governance, validation, risk management, ongoing monitoring); EU AI Act Annex III high-risk documentation slots (risk management, data governance, technical documentation, record-keeping, transparency, human oversight, accuracy / robustness / cybersecurity); state AI disclosure hooks (TX TRAIGA, CA AB 489, IN HB 1271, AL SB 63, CO SB 21-169, NY DFS Reg 187, NY DFS Reg 219); CMS-0057-F + WA / TX / AZ / MD AI-PA hooks for any health-claims orchestration; FCRA adverse-action-notice rules; Section 1557 / ADA non-discrimination; GLBA privacy and the applicable state privacy statute; model-risk owner; AI Assurance integration (decision-traceability, auditability, observability, compliance-controls, cybersecurity).
Failure-mode register. Named failure modes: hallucinated coverage, conflicting fraud-vs-subrogation output, missing data, regulatory prohibition, prompt-injection, data-poisoning, model-exfiltration, anchoring (prior reserve / prior decision unduly influencing the new one), confirmation bias, model-drift (per the Snorkel AI UNDERWRITE multi-turn benchmark's ~20% pass^k drop finding — quarterly drift-detection recommended), adverse-event feedback loops. For each: detection method, mitigation, the named owner, and the cross-reference to the carrier's AI Governance Model Card Generator output.
Monitoring plan. Named KPIs: cycle-time target, first-contact SLA, inspection SLA, indemnity-vs-reserve ratio, leakage, CSAT, NPS, reopen rate, complaint rate, DOI complaint rate, bad-faith litigation rate, model-drift detection (quarterly), red-team review cadence (quarterly), NAIC AI Systems Evaluation Tool response-kit cadence (annual), per-LoB sampling rate for post-hoc human review. Named sampling rate per config.yml.claims.post_hoc_sampling_rate. Named drift-detection cadence per config.yml.claims.drift_detection_cadence.

Process (per file — run-time, one-time per claim file):

Ingest and normalize. Call FNOL Intake Assistant (or vendor-preset equivalent) and confirm the minimum viable record: policyholder, policy number, date of loss, coverage in force, location, contact, initial narrative, images if any, the upstream submission record where applicable. If anything is missing, emit a broker / insured outreach draft (multi-language gated on config.yml.agency.languages_supported) and hold orchestration until the record is complete; log the hold reason.
Coverage sanity check. Run a coverage confirmation step against the policy forms and endorsements. Never rely on a single-shot LLM pass; require citations to the form and endorsement that grant or exclude coverage. If coverage is ambiguous, route to coverage counsel and stop automated progression. Cross-reference to Coverage Explanation Letter v3.0 if a coverage position must be communicated in writing.
Authority-check first. Cross-check the proposed routing branch against the authority-routing preset. If any element exceeds the assigned handler's authority (e.g., a denial above the supervisor-required reserve threshold, a coverage confirmation requiring counsel sign-off, a reservation of rights requiring excess-carrier notification, a CAT-queue trigger above the CAT-coordinator authority, a reinsurance-treaty notification trigger), mark it MUST-REFER-UP and route to the named higher-authority reviewer. Branches that exceed authority do not execute.
Classify severity, complexity, and peril. Assign severity band (S1–S4 per CAT Claim Surge Triage taxonomy, or LoB equivalent), complexity score, and peril taxonomy. Use ensemble signals (narrative NLP, image classifier output, policyholder history, geocoded peril feed, weather / catastrophe-modeling feed) and log the per-signal contribution. Cross-reference to CAT Claim Surge Triage if peril is a declared CAT event.
Score fraud and subrogation in parallel. Invoke Fraud Red-Flag Summarizer v2.0 and Subrogation Opportunity Finder v2.0 on the same payload. Mark each flag with the evidence that triggered it. Do not let fraud and subrogation block each other — SIU can review in parallel with recovery. Apply the AI-bias / disparate-impact check to any algorithmic fraud or recovery scoring under CO SB 21-169, NY DFS Reg 187, IN HB 1271, AL SB 63, NAIC AI Model Bulletin, and (for multinational carriers) the EU AI Act Annex III. Verdict: PASS / REVIEW NEEDED / BIAS RISK FLAGGED.
Seed reserves. Call Claims Reserve Recommender v2.0 with the normalized record and the severity / complexity signals. Capture the three-point estimate, the sensitivity table, the actuarial method named, the reserve-adequacy traffic light, the re-review triggers, the reinsurance-treaty notification cue, and the excess-carrier notification cue. Cross-reference to Loss Run Analyzer v2.0's reserve-adequacy verdict for the account where applicable.
Decide routing. Apply the authority-routing preset:
- STP if severity, complexity, fraud, and coverage all clear AND projected indemnity + ALAE is under the STP ceiling AND the post-hoc sampling slot is met AND no IN-HB-1271 / AL-SB-63 / CO-SB-21-169 / NY-DFS-Reg-187 / CMS-0057-F + WA / TX / AZ / MD AI-PA gate is triggered
- DESK-ADJUSTER if STP-ineligible but within desk authority
- FIELD-IA if severity / complexity requires physical inspection
- SIU if fraud threshold tripped
- LARGE-LOSS-COVERAGE-COUNSEL if exposure or ambiguity tripped
- CAT-QUEUE if the loss ties to a declared CAT event — hand off to CAT Claim Surge Triage
- EXCESS-CARRIER-NOTIFICATION if reserves cross the excess attachment point
- REINSURANCE-NOTIFICATION if reserves cross the treaty notification threshold
- COMPLIANCE-OFFICER-REVIEW if any AI-driven adverse-action / NAIC AI Model Bulletin / state AI / EU AI Act / CMS-0057-F + WA / TX / AZ / MD AI-PA gate is triggered
- MODEL-RISK-OFFICER-REVIEW if model-drift / failure-mode-register entry / NAIC AI Systems Evaluation Tool response is triggered
- HUMAN-ONLY-RE-EVALUATION if the insured invoked their human-only re-evaluation right under IN HB 1271 / AL SB 63 / CO SB 21-169 / CMS-0057-F + WA / TX / AZ / MD AI-PA — the orchestrator routes the appeal to a human-only path with the original AI output redacted
HITL checkpoints. Insert the named HITL checkpoint at each decision per the HITL checkpoint library. For Indiana / Alabama / Colorado / NY DFS Reg 187 / CMS-0057-F + WA / TX / AZ / MD AI-PA cases requiring human review before any AI-driven adverse claim decision is finalized, the PRE-EXECUTION-HITL checkpoint is non-negotiable. For any adverse claim decision, require a human to sign the decision record before the Coverage Explanation Letter v3.0 is sent.
Generate the explainable decision record. For every branch taken, populate the schema from step 6 of design-time. The record is the artifact the carrier surfaces in a DOI exam, a NAIC AI Systems Evaluation Tool request, an external audit, a reinsurance treaty exhibit, a vendor-contract exhibit, and the carrier's annual model-risk review.
Drafting and outbound. Invoke Claims Narrative Drafter v3.0 for file notes, Coverage Explanation Letter v3.0 for any customer-facing decision letter, and Email Drafter v3.0 / Meeting Summarizer v3.0 / Review Responder v3.0 for ancillary communications. Never send outbound content until the HITL reviewer approves; always include the state-specific AI disclosure when AI-assisted content is shared with the insured; multi-language paired translation gated on config.yml.agency.languages_supported.
Close the loop. Capture cycle time, indemnity versus reserve, leakage signals, reopen indicators, CSAT survey response, complaint or litigation signals, model-drift signals, post-hoc-sampling verdict (where the file was sampled). Feed the signal back into the orchestration KPI dashboard and the sub-agent eval harness so next quarter's skill eval has real data. Cross-reference to AI Governance Model Card Generator's ongoing-monitoring slot.

Distribution-scope-aware parallel rendering. Produce the program-design and per-file artifacts in each requested scope simultaneously, with per-scope redaction rules:

PROGRAM-DESIGN — the one-time program design document for claims leadership / model-risk officer; full vendor-preset documentation, full authority-routing preset, full sub-agent map, full decision tree, full failure-mode register, full monitoring plan, full governance appendix
RUNBOOK-PER-FILE — the per-file orchestration trace shipped into the file; full explainable decision record, full HITL checkpoint trace, full sub-agent invocation log
ADJUSTER-DASHBOARD — what the adjuster sees: current step, next step, items awaiting their review, SLA status, key risks; redacted of model-card internals, redacted of privileged sub-agent reasoning, redacted of supervisor-only authority notes
SUPERVISOR-DASHBOARD — what the supervisor sees: per-handler workload, HITL backlog, authority-tier exceptions, bias-audit verdicts, reserve-adequacy traffic light at the handler level
CLAIMS-MANAGER-DASHBOARD — what the claims manager sees: per-program KPIs, drift signals, CAT triggers, reinsurance-notification queue
DOI-EXAM-RESPONSE — the response packet to a state DOI market-conduct exam; per-state UCSPA prompt-pay calculation, IN HB 1271 / AL SB 63 / CO SB 21-169 / NY DFS Reg 187 disclosure-compliance check, AI-bias audit verdict, authority-check verdict, chronological fact recital
NAIC-AI-EVALUATION-RESPONSE — the response packet to the NAIC AI Systems Evaluation Tool; full governance appendix, full failure-mode register, full monitoring plan, full ongoing-monitoring slot from AI Governance Model Card Generator
REINSURANCE-NOTIFICATION — the reinsurer packet at the program level; reserve figures, exposure projection, the carrier's controller logic and HITL coverage summarized for treaty purposes
EXCESS-CARRIER-NOTIFICATION — the excess carrier packet; reserves crossing the attachment point, exposure projection, the carrier's HITL coverage on the affected layer
AUDITOR-RESPONSE — the external auditor packet; full governance appendix, full failure-mode register, full ongoing-monitoring slot
VENDOR-CONTRACT-EXHIBIT — the exhibit attached to the carrier ↔ vendor agentic-AI contract; the carrier's controller logic, HITL coverage, AI Assurance integration points, and the named vendor preset

Per-LoB orchestration-template library. Use the LoB-specific orchestration template tuned to the LoB's drivers and gates:

Personal auto BI / PD / UM / UIM / PIP — ensemble fraud signals, jurisdictional verdict-history, MSP coordination, total-loss valuation routing, rideshare endorsement
Personal property — ALE / ordinance-or-law / scheduled-personal-property routing, hurricane / hail / wildfire / flood deductible erosion, water-backup, named-perils
Life — incontestability / suicide-clause / misrepresentation gates, beneficiary-contest routing, accidental-death rider, waiver-of-premium
Workers' comp — comp-ability / MMI / IME routing, SIBTF / second-injury-fund, employer-liability tear, statutory-vs-non-statutory benefits
Commercial auto / trucking — MCS-90, FRP / CSI / CAB severity-driver, owner-operator vs employee-driver routing
Commercial property — TIV concentration, AAL / PML, BI / contingent-BI / extra-expense routing
GL products-completed-operations / premises-operations — additional-insured / contractual-liability tender, prior-acts, your-product / your-work
Professional / E&O — claims-made / retroactive-date / prior-acts gates, hammer clause, consent-to-settle
Cyber — per-incident sub-limits, silent-AI flag, ISO CG 40 47 / CG 40 48 GenAI exclusion routing
D&O / EPLI — Side A / B / C, severability, allocation across covered and uncovered insureds, HR-counseling endorsement
A&H / health — prior-authorization routing under CMS-0057-F + WA / TX / AZ / MD AI-PA restrictions, ERISA-vs-non-ERISA appeal pathway, IN HB 1271 / AL SB 63 AI-disclosure, Section 1557 / ADA enforcement
Medicare — scope-of-appointment, AEP / OEP timing, IRMAA, RAF, Star-Rating impact, the CMS-required non-discrimination tagline

AMS / claims-system activity-log handoff. Generate a 4-line block in the user's claims-system format (Guidewire / Duck Creek / Sapiens / Insurity / Origami / Snapsheet / Hi Marley / Salesforce / Applied Epic / AMS360 / HawkSoft / Vertafore) capturing the orchestration design version (or the per-file runbook trace), the named vendor preset, the named authority-routing preset, and the next-action / next-action-owner / next-action-due triplet. Block format matches the Email Drafter v3.0 / Meeting Summarizer v3.0 / Coverage Explanation Letter v3.0 / Claims Reserve Recommender v2.0 / Subrogation Opportunity Finder v2.0 / COI Compliance Reviewer v2.0 AMS handoffs so the downstream workflow does not branch.

Per-role signer block. Pulled from config.yml.agency.signer_block, with claims-VP / claims-manager / model-risk-officer / compliance-officer / chief-claims-officer / chief-risk-officer / chief-AI-officer / reinsurance-claims-officer / external-auditor / DOI-examiner overrides per the distribution scope. Each signer line includes name, title, NPN / state-license-number / model-risk-charter-number where required, direct line, email, and (for the AUDITOR-RESPONSE / NAIC-AI-EVALUATION-RESPONSE / DOI-EXAM-RESPONSE scopes) the bar-admission state or the auditor / examiner credential reference.

Output requirements:

Three paired deliverables (program-design pass) or two paired deliverables (run-time per-file pass):
1. Program-Design Document (one-time) — full vendor-preset documentation, full authority-routing preset, full sub-agent map, full decision tree, full HITL checkpoint library, full explainable-decision-record schema, full failure-mode register, full monitoring plan, full governance appendix
2. Per-File Runbook (per file) — full explainable decision record, full HITL checkpoint trace, full sub-agent invocation log, full multi-scope rendering per the user's distribution-scope selection
3. Reviewer Checklist — short punchlist of items the model-risk officer / compliance officer / chief AI officer / external auditor / DOI examiner / NAIC AI Systems Evaluation Tool reviewer should verify before the design or runbook ships
Vendor-pattern-aware — the template names the vendor's controller pattern, native protocol (MCP / A2A / proprietary), AI Assurance / AI Gateway integration points, and the carrier's portability story across vendors
Every decision branch cites the sub-agent, the model card ID, the model version, the data signal, and the authority that permits it
Every customer-facing artifact goes through HITL before sending; the multi-language paired translation is generated where the recipient's language preference is non-English
Every artifact carries a model-card reference so the AI Governance Model Card Generator can trace it back to the approved system
Distribution-scope-aware parallel copies driven by the user's selection — never produce a wider scope without explicit user confirmation
Per-role signer block at the foot, driven by distribution scope
Saved to outputs/orchestration/ with design-time artifacts at the program root (outputs/orchestration/program-design-<program-code>-<YYYY-MM-DD>.md) and per-file runbooks in a claim-number subfolder (outputs/orchestration/<claim-number>/runbook-<YYYY-MM-DD>.md); the multi-language paired translation is saved as a sibling file with the language code suffix
Never invent a sub-agent's model version, model card ID, native protocol endpoint, vendor name, or authority tier — if missing, mark "[TO CONFIRM]" and list on the Reviewer Checklist; the runbook does not ship until confirmed

Anti-Patterns

The skill must refuse, push back, or flag — not silently produce — if any of the following occur:

The user asks the skill to design an STP path for a personal-lines or A&H file that omits the IN HB 1271 / AL SB 63 / CO SB 21-169 / NY DFS Reg 187 AI-disclosure block on any AI-driven adverse decision. The skill refuses; the AI-disclosure block is non-negotiable.
The user asks the skill to design an STP path for a health-claims orchestration that omits the CMS-0057-F + WA / TX / AZ / MD AI-prior-authorization HITL gate on any denial. The skill refuses; AI may not serve as the sole basis for a medical-necessity denial in WA, TX, AZ, MD, and (pending June 2026) CO.
The user asks the skill to ship an orchestration design that does not name the vendor preset, the authority-routing preset, the sub-agent model card IDs, or the failure-mode register. The skill refuses; the design is unauditable without them.
The bias-audit verdict at any branch is BIAS RISK FLAGGED and the user asks the skill to ship the runbook without the compliance-officer review. The skill holds the runbook; the held runbook is visible in the deliverable bundle as HELD — bias review required.
A decision exceeds the assigned handler's authority and the user asks the skill to ship without supervisor / claims-manager / counsel / compliance / chief-claims-officer / chief-risk-officer / chief-AI-officer / reinsurance-claims-officer sign-off. The skill marks MUST-REFER-UP; the runbook does not execute the over-authority branch.
The user asks the skill to omit the human-only re-evaluation right when the insured has invoked it under IN HB 1271, AL SB 63, CO SB 21-169, or CMS-0057-F + WA / TX / AZ / MD. The skill refuses; the human-only path is non-negotiable, and the original AI output is redacted from the human reviewer's view to avoid anchoring.
The user asks the skill to put privileged sub-agent reasoning, reserve figures, or model-card internals into the ADJUSTER-DASHBOARD scope. The skill refuses; the redaction rules per distribution scope are not optional.
The user asks the skill to ship a runbook that does not include the HITL checkpoint trace, the explainable-decision-record schema population, or the failure-mode register. The skill refuses; these are non-negotiable for DOI exam, NAIC AI Systems Evaluation Tool response, external audit, reinsurance exhibit, and vendor-contract exhibit purposes.
The user asks the skill to hard-code a specific vendor name into the program design where the named vendor preset is IN-HOUSE-PYTHON-HARNESS or ANTHROPIC-API-DIRECT / OPENAI-API-DIRECT / GOOGLE-API-DIRECT. The skill refuses; the carrier's portability story across vendors is non-negotiable.
The user asks the skill to ship a program design that does not include the Snorkel AI UNDERWRITE multi-turn benchmark drift-detection cadence (or an equivalent named drift-detection cadence). The skill refuses; quarterly drift-detection is the carrier's NAIC AI Model Bulletin ongoing-monitoring obligation.
The user asks the skill to bypass the Section 1557 / ADA non-discrimination check on a health-benefits orchestration. The skill refuses; the non-discrimination check is required by federal regulation.
The user asks the skill to omit the FCRA adverse-action gate on any orchestration that consumes consumer-report data. The skill refuses; 15 U.S.C. § 1681m(a) is non-negotiable.
The user asks the skill to ship the program design without naming the model-risk owner per failure-mode register entry. The skill refuses; the named owner is the carrier's NAIC AI Model Bulletin governance obligation.

Versioning

v2.0 (2026-04-28) — Vendor-pattern preset library from config.yml.operations.orchestration_vendor_presets covering Duck Creek Agentic AI Platform (AI Assurance + AI Gateway, MCP / A2A, Agentic Underwriting Workbench, Agentic FNOL, marketplace, agent registry), Sedgwick Sidekick / Sidekick+, Travelers AI Claim Assistant (OpenAI Realtime API), Cytora Autopilot, AIG-style orchestration, Microsoft / Cognizant stack, Convr Intake, Sixfold AI, Intellect AI commercial underwriting, Docugami document AI, illumend COI, Sure MCP, in-house Python harness, and Anthropic / OpenAI / Google API-direct stacks (the specificity uplift from 9 to 10). Authority-routing preset library from config.yml.operations.authority_routing_presets covering STP-ceiling / desk-adjuster / field-IA / SIU / large-loss-coverage-counsel / CAT-queue / supervisor / claims-manager / actuary / compliance-officer / excess-carrier-claims-officer / reinsurance-claims-officer routing tables per LoB × state × premium-band × peril (the personalization uplift from 7 to 9). Per-LoB orchestration-template library spanning 12 LoB groups (personal auto BI / PD / UM / UIM / PIP, personal property, life, workers' comp, commercial auto / trucking, commercial property, GL products-completed-operations / premises-operations, professional / E&O, cyber, D&O / EPLI, A&H / health, Medicare). MCP / A2A / Agent-to-Agent protocol naming with the standardized request / response / handoff envelopes. AI Assurance integration slot (decision-traceability / auditability / observability / compliance-controls / cybersecurity). AI Gateway / agent-marketplace / agent-registry integration slot. AI-bias and disparate-impact check at every sub-agent invocation against CO SB 21-169 / NY DFS Reg 187 / IN HB 1271 / AL SB 63 / NAIC AI Model Bulletin / EU AI Act Annex III. CMS-0057-F + WA / TX / AZ / MD AI prior-authorization restriction enforcement on any health-claims orchestration. Section 1557 / ADA enforcement on any health-benefits orchestration. FCRA enforcement on any consumer-report-data-driven orchestration. Per-state UCSPA prompt-pay timing and reserve-documentation timing enforcement. Reinsurance-treaty notification routing and excess-carrier notification routing as first-class branches. HITL checkpoint library (PRE-EXECUTION-HITL / WITHIN-WINDOW-HITL / POST-HOC-SAMPLING / HUMAN-ONLY-RE-EVALUATION) with the named reviewer at each tier per role × LoB × state × premium-band. Explainable-decision-record schema with the sub-agent / model-card-ID / model-version / inputs / outputs / confidence / human-reviewer / alternative-branches-considered fields. Failure-mode register (hallucinated coverage, conflicting fraud-vs-subrogation, missing-data, anchoring, model-drift, prompt-injection, data-poisoning, model-exfiltration). Monitoring-plan library (cycle-time target / first-contact SLA / inspection SLA / indemnity-vs-reserve / leakage / CSAT / NPS / reopen-rate / complaint-rate / drift-detection / quarterly-red-team-review / NAIC-AI-Systems-Evaluation-Tool response-kit). Snorkel AI UNDERWRITE multi-turn benchmark drift-detection cadence (quarterly). Distribution-scope-aware parallel rendering (PROGRAM-DESIGN / RUNBOOK-PER-FILE / ADJUSTER-DASHBOARD / SUPERVISOR-DASHBOARD / CLAIMS-MANAGER-DASHBOARD / DOI-EXAM-RESPONSE / NAIC-AI-EVALUATION-RESPONSE / REINSURANCE-NOTIFICATION / EXCESS-CARRIER-NOTIFICATION / AUDITOR-RESPONSE / VENDOR-CONTRACT-EXHIBIT) with per-scope redaction rules. Per-LoB STP-ceiling / desk-authority / field-IA-trigger threshold library. Multi-language insured-facing-message variant gated on config.yml.agency.languages_supported (en / es / vi / ht-creole / zh / tl / ru / ko). AMS / claims-system activity-log handoff in the user's claims-system format (Guidewire / Duck Creek / Sapiens / Insurity / Origami / Snapsheet / Hi Marley). Per-role signer block from config.yml.agency.signer_block with claims-VP / claims-manager / model-risk-officer / compliance-officer / chief-claims-officer / chief-risk-officer / chief-AI-officer / reinsurance-claims-officer / external-auditor / DOI-examiner overrides per distribution scope. Cross-references to seven other skills (FNOL Intake Assistant, Fraud Red-Flag Summarizer v2.0, Subrogation Opportunity Finder v2.0, Claims Reserve Recommender v2.0, Claims Narrative Drafter v3.0, CAT Claim Surge Triage, AI Governance Model Card Generator). Explicit anti-patterns section. Every prior v1.0 capability is preserved in v2.0.

v1.0 — Initial release: vendor-neutral controller blueprint composing FNOL / fraud / subrogation / reserve / CAT / narrative / coverage-letter sub-agents; design-time outputs (sub-agent map, decision tree, governance appendix, failure-mode register, monitoring plan); run-time outputs (orchestration runbook, explainable decision record, adjuster dashboard block); HITL checkpoints; NAIC AI Model Bulletin / EU AI Act / state AI law alignment; vendor-neutral portability across Sedgwick Sidekick, AIG, Cytora Autopilot, Microsoft / Cognizant, in-house Python.

Example Output

[This section will be populated by the eval system with a reference example. For now, run the skill with sample input to see output quality.]