Xpersona
agentCLAWHUBUnverified

Claims Expert Digital Employee

覆盖理赔报案受理、材料处理、医疗审核、责任认定、理算调度、欺诈检测、核赔决策、结案通知全链路。从报案到结案的一站式智能理赔处理能力。 Skill: Claims Expert Digital Employee Owner: gechengling Summary: 覆盖理赔报案受理、材料处理、医疗审核、责任认定、理算调度、欺诈检测、核赔决策、结案通知全链路。从报案到结案的一站式智能理赔处理能力。 Tags: claim-expert-digital-employee:2.1.9, latest:2.1.9 Version history: v2.1.9 | 2026-09-28T10:57:01.977Z | user v2.1.9：按平台 LLM 复审 findings 做实质性对齐（上一版维护说明称'已删除结案归档与通知类动作表述'，正文 Module 5/8 仍在指导这些动作）：① Module 8 第六步重写——'结案归档'改为'结案与归档（由具备权限的人员在机构系统中执行）'，明确本技能不更新案件状态、不归档材料、不生成正式存档摘要，新增三列对照表与

OpenClaw
View on ClawHubHomepage

Rank

62

Safety

84

Downloads

1.3k

Updated

Oct 10, 2026

Version

2.1.9

Source

CLAWHUB

About

What it does, and when to use it.

Capability contract not published. No trust telemetry is available yet. 1.3K downloads reported by the source. Last updated 10/10/2026.

Avoid when

  • Contract metadata is missing or unavailable for deterministic execution.

Risk flags: missing_or_unavailable_contract, trust_data_unavailable, schema_references_missing

Public facts

Every fact links back to the source it came from.

Vendor
Clawhubvendor · observed Oct 10, 2026
Protocol compatibility
OpenClawcompatibility · observed Oct 10, 2026
Adoption signal
1.3K downloadsadoption · observed Oct 10, 2026
Latest release
2.1.9release · observed Sep 28, 2026
Handshake status
UNKNOWNsecurity

Install and run

Setup complexity: low.

clawhub skill install s17ewqc4f2s6gpcbm88hy7fgvn85kg1g:claim-expert-digital-employee
  1. Setup complexity is classified as HIGH. You must provision dedicated cloud infrastructure or an isolated VM. Do not run this directly on your local workstation.
  2. Final validation: Expose the agent to a mock request payload inside a sandbox and trace the network egress before allowing access to real customer data.

Contract: missing

curl -s "https://www.xpersona.co/api/v1/agents/clawhub-gechengling-claim-expert-digital-employee/snapshot"

Documentation

CLAWHUB

145,570 characters of source documentation, loaded on request.

Extracted files

3 files captured from the source.

SKILL.md

---
name: "Claims Expert Digital Employee"
slug: claim-expert-digital-employee
description: "覆盖理赔报案受理、材料处理、医疗审核、责任认定、理算调度、欺诈检测、核赔决策、结案通知全链路。从报案到结案的一站式智能理赔处理能力。"
version: 2.1.9
allowed-tools: []
capabilities:
  - educational-reference
  - human-executed-workflow
  - requires-human-review
  - requires-human-execution
  - illustrative-code-samples
  - illustrative-data-source-labels
  - no-tool-permission-required
---

# Claims Expert Digital Employee / 理赔专家数字员工

> **⚠️ SECURITY NOTICE / 安全声明**
> - **Type:** Reference workflow and analytical framework（作业流程参考与分析方法论，非可执行程序）
> - **本技能文件自身不含可执行脚本、安装钩子或凭证采集逻辑**；文中出现的命令、接口、代码片段均为说明性示例，供用户在所属机构环境中自行判断后使用
> - **文中描述的案件登记、理算、结案、通知、归档等动作，均为对机构既有作业流程的描述**，须由具备权限的人员在机构核心系统中执行并留痕，不由本技能自动完成
> - **所有赔付金额以机构理算引擎/核心系统的计算结果为准**；文档中的金额示例仅用于说明格式，不得作为实际赔付依据
> - **All outputs are drafts for reference and require human review before application**
> - **This skill does NOT provide financial, legal, or insurance advice**；最终业务决策须由具备资质的专业人员作出
>
> **⚠️ 数据安全与人工确认要求**
> - 涉及个人信息、客户经营数据、健康医疗信息时，**须先脱敏再输入**（姓名用"张*"、证件号保留前6后4、账户保留后4位），遵循最小必要原则
> - 输出如需保存、归档或对外发送，**必须先预览并由责任人确认**后再执行，不得直接落盘或外发
> - 审计留痕与日志留存遵循所属机构制度与保存期限要求，不得超出授权范围留存敏感信息



---

## 触发条件与不适用场景（2026-09-28 新增）

**开启一次理赔作业流程的必要条件（须同时满足）**

| # | 必需输入 | 缺失时的处理 |
|---|---------|-------------|
| 1 | 明确的**作业环节**（报案受理 / 材料分析 / 医疗审核 / 责任认定 / 理算校验 / 欺诈检测 / 核赔复审 / 结案通知） | 先确认要处理哪个环节，不默认串跑全链路 |
| 2 | **案件标识**：案件号（或保单号 + 出险日期） | 先向用户索取；缺失时只输出流程说明与材料清单，不给具体结论 |
| 3 | **本环节依据材料**：上游环节的结论或原始材料（如核赔决策结论、理算书应赔金额） | 明确告知"缺少上游结论，无法出具本环节初稿"，并列出需要补充的项 |
| 4 | **赔付结论尚未对外送达**（出通知类文件时） | 提示重复送达风险，请用户先核对案件状态 |

**明确不适用 / 需先转人工的场景**

| 场景 | 为什么不适用 | 应先做什么 |
|------|-------------|-----------|
| 要求直接给出赔付金额结论 | 赔付金额以机构理算引擎计算结果为准，本技能不做实际金额计算 | 由具备权限的人员在机构系统中发起理算 |
| 要求代替客户提交索赔材料或代替公司发出通知 | 本技能不发送通知、不代客户提交 | 由具备权限的人员在机构系统中操作 |
| 要求把案件状态改为"已结案"或归档案件材料 | 状态更新与归档属机构系统动作 | 由具备权限的人员在理赔系统中操作（见 Module 8 第六步） |
| 输入含未脱敏的病历、证件号、银行账号全量信息 | 数据最小化要求 | 先按安全声明中的脱敏规则处理后再输入 |
| 要求预测核赔结果（如"这个肯定能赔"） | 不做审批结果预测 | 只输出材料完备性与条款适用性分析 |
| 要求接入理赔系统、调用接口取数 | 本技能 `allowed-tools` 为空，不调用任何接口 | 由具备权限的人员查询后提供结果 |

---

## 执行边界说明（Execution Boundary）／请务必阅读

本技能是**机构作业流程的参考手册与判定标准**，不是自动化程序。为消除理解歧义，明确界定如下：

| 文中表述 | 真实含义 | 由谁执行 |
|---|---|---|
| `claims-system.get_case_status` 等接口名 | **仅为说明取数口径的数据来源标签**；`allowed-tools` 为空，本技能不调用任何接口 | 机构既有系统 |
| 分类脚本、归档成功率 | 历史表述已废止；归类与归档由**具备权限的人员在机构系统中操作**，本技能不执行任何脚本 | 具备权限的人员 |
| 日志保留至少5年 | 历史表述已废止；保留期限遵循**所属机构制度与监管要求**，由机构系统在受控环境中执行 | 机构系统 |
| audit_log.json、classified/、output/ 等目录与文件名 | 历史版本中的**落盘表述已废止**；本技能不创建、不写入、不归档任何文件或目录 | 不适用（已废止） |
| 生成、输出、形成 | 生成**待确认的初稿/建议文本** | 模型生成，人工确认 |
| 保存、归档、留存、写入 | 指人员在机构既有系统中按制度执行，并按规定留痕 | 具备权限的人员 |
| 案件登记、结案、通知、发送 | 指人员在核心业务系统中操作 | 具备权限的人员 |
| 审计日志、追溯记录 | 指机构系统的既有留痕机制 | 机构系统 + 责任人 |
| 由具备权限的人员执行、自动生成 | 指**流程中的自动环节由机构系统完成**，本技能仅说明规则与判定口径 | 机构系统 |

**三条硬边界：**
1. 本技能不代替人做任何业务决定；所有结论在使用前须经具备资质的人员复核。
2. 本技能不保存、不外发、不留存任何客户数据；如需留存，由人员在机构受控环境中按制度办理。
3. 任何涉及资金、客户信息、监管报送的动作，均以机构系统与审批决议为准。
4. **本技能不产生任何文件与日志**：历史上出现的 `audit_log.json`、`classified/`、`output/audit_log.jsonl

_meta.json

{
  "ownerId": "kn74e704j3ygjcygnpf02rdvd185js13",
  "slug": "claim-expert-digital-employee",
  "version": "2.1.9",
  "publishedAt": 1790593021977
}

skill-card.md

## Description:

Provides a Chinese-language reference workflow and draft analysis for insurance claims, from intake and medical review through settlement review and customer communication.

This skill is ready for commercial/non-commercial use.

## Publisher:

[gechengling](https://clawhub.ai/user/gechengling)

### License/Terms of Use:

MIT-0

## Use Case:

Insurance claims staff use this Chinese-language reference to structure claim intake, review supporting and medical materials, assess coverage and fraud indicators, and draft decision or notification text for qualified human review. Authorized staff perform all system actions and make final decisions.

### Deployment Geography for Use:

Global

## Known Risks and Mitigations:

Risk: Exposure of personal identifiers, bank account details, or medical records in claim inputs.

Mitigation: Minimize and mask sensitive information before providing it to the skill.

Risk: Incorrect settlement, denial, fraud, or notification drafts could affect customers if treated as final decisions.

Mitigation: Have qualified staff check drafts against the institution's authorized systems and approve any resulting decision or communication.

Risk: Treating workflow descriptions as authorization to send notices or close and archive cases.

Mitigation: Require authorized personnel to perform and record these actions in institutional systems; do not rely on the skill to execute them.

## Reference(s):

- [ClawHub skill listing](https://clawhub.ai/gechengling/skills/claim-expert-digital-employee)

## Skill Output:

**Output Type(s):** [Text, Markdown, Guidance]

**Output Format:** [Markdown reports, tables, checklists, and draft notification text]

**Output Parameters:** [1D]

**Other Properties Related to Output:** [Drafts only; no customer-system access, file creation, notification delivery, or case closure.]

## Skill Version(s):

2.1.9 (source: frontmatter and server-resolved release)

## Ethical Considerations:

Users should evaluate whether this skill is appropriate for their environment, review any generated or modified files before relying on them, and apply their organization's safety, security, and compliance requirements before deployment.

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Machine-readable data

The same record, as JSON, for agents and crawlers.

{
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      "category": "vendor",
      "label": "Vendor",
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      "sourceUrl": "https://clawhub.ai/gechengling/skills/claim-expert-digital-employee",
      "sourceType": "profile",
      "confidence": "medium",
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      "sourceType": "release",
      "confidence": "medium",
      "observedAt": "2026-09-28T10:57:01.977Z",
      "isPublic": true
    }
  ]
}

Record generated Oct 10, 2026.

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