InsurTech Claims Triage Tool Routing Brief

Role: Lead InsurTech Solutions Architect specializing in agentic workflows and automated policy adjudication.

Context

• Insurance Carrier: {{insurance_carrier}}
• Operating Policy Line: {{policy_line}}
• Claims Backend Platform: {{claims_management_api}}
• Fraud Detection Engine: {{fraud_engine}}
• Autonomous Settlement Ceiling: {{payout_limit}}
• Regulatory Territory: {{regulatory_jurisdiction}}

Task

Draft a tool-calling and function-orchestration brief that enables an AI claims agent to query policy status, request fraud scores from {{fraud_engine}}, and route adjudicated settlements in {{claims_management_api}}.

Method

1. Define the lifecycle stages of {{policy_line}} claims to determine discrete agent capabilities.
2. Author JSON schemas for querying policy coverage, submitting incident data, and checking fraud indices.
3. Establish dependency graphs showing which read functions must successfully resolve before payout tools unlock.
4. Specify strict type constraints for claimant identifiers and loss category enumerations.
5. Implement condition gates that route claims exceeding {{payout_limit}} to human adjusters.
6. Define error recovery routines when {{fraud_engine}} fails to return a confidence score.
7. Align settlement payloads with statutory claims disclosure requirements in {{regulatory_jurisdiction}}.

Constraints

• MUST restrict autonomous payout dispatch functions to amounts strictly at or below {{payout_limit}}.
• MUST NOT allow the settlement tool to trigger without a valid cryptographic token from {{fraud_engine}}.
• Schema parameters must enforce explicit currency decimal formatting.
• Responses from failed tool calls must provide actionable error codes to guide agent re-planning.

Output format

1. Function Calling Pipeline

High-level sequence diagram narrative detailing agent tool selection (maximum 150 words).

2. Core Tool Schema Specifications

Formal JSON Schemas for: verify_coverage, evaluate_fraud_score, and authorize_claim_payout.

3. Orchestration Guardrails

Matrix defining trigger conditions, parameter boundaries, and hard stop thresholds.

4. Jurisdiction Compliance Summary

Brief verification checklist demonstrating conformance with {{regulatory_jurisdiction}} regulations.

Self-review

• Verify that {{insurance_carrier}} and {{claims_management_api}} are integrated into the architecture.
• Confirm that the payout limit constraint cannot be bypassed by argument mutation.
• Check that all tool schemas have detailed description attributes for the calling model.