When to Use
- Explain P&C lines, coverages, and how commercial vs personal programs differ
- Walk through underwriting workflow: appetite, submission, quote, bind, endorsements
- Clarify policy mechanics: occurrence vs claims-made, limits, deductibles, exclusions, triggers
- Describe claims lifecycle from FNOL through investigation, reserving, settlement, litigation
- Frame reinsurance structures and catastrophe risk transfer at overview level
- Compare distribution models (agent, broker, MGA, direct) and typical economics
- Interpret underwriting and profitability metrics (loss ratio, expense ratio, combined ratio)
- Outline state insurance regulation concepts (DOI oversight, rate/form filing)—not legal advice
- Support business cases, operating reviews, or due diligence with P&C domain context
When NOT to Use
- Life, health, annuity, or long-term care product design and pricing depth → dedicated life/health skills if available; otherwise note limitation
- Loss development triangles, IBNR methods, credibility studies, or appointed-actuary sign-off →
actuary - Legal interpretation of policy wording, coverage disputes, or regulatory enforcement →
commercial-counsel - Corporate FP&A, investor metrics, or non-insurance financial modeling →
financial-analyst(if installed) - SOC 2 / ISO control mapping without insurance operations context →
compliance-engineer - Executive strategy without insurance domain detail →
business-consultant - Enterprise risk registers unrelated to underwriting/claims →
security-risk-analyst(if installed) - AML/financial crime or sanctions programs →
aml-compliance,financial-intelligence-unit
Related skills
| Need | Skill |
|---|---|
| Pricing, reserving, triangles, IBNR, assumption governance | actuary |
| Contract review, policy wording disputes, regulatory interpretation | commercial-counsel |
| Business case, operating model, transformation | business-consultant |
| Technical control evidence, audit packages | compliance-engineer |
| GRC program charter and gap plans (non-insurance-specific) | compliance-specialist |
| IFRS 17 / insurance contract measurement (accounting) | ifrs |
| Financial statements and close packs | financial-statements (if installed) |
| Vendor and cyber third-party risk | vendor-cyber-risk-analyst |
| Anti-false-positive alert triage (fraud/claims analytics) | anti-false-positive-decision-making |
Core Workflows
1. Engagement scoping
Before analysis:
- Segment — Personal vs commercial; admitted vs surplus; program vs single policy
- Line of business — Property, GL, WC, auto, umbrella, specialty, package
- Decision — Quote, renewal, claims handling, reinsurance placement, regulatory filing context
- Jurisdiction — State(s), filing status, experience mod (WC), territory
- Materiality — Limits, deductibles, cat exposure, class codes, prior loss history
See references/pc_insurance_scope_and_lines.md.
2. Underwriting and risk selection
- Define appetite and declination triggers (class, geography, limit profile)
- Ingest submission: application, loss runs, SOV, financials, inspections
- Apply rating variables and manual vs filed factors; document debits/credits
- Set terms: limits, deductibles/SIR, endorsements, subjectivities
- Price to target loss ratio and combined ratio; note reinsurance and cat load
- Bind with clear conditions; track endorsements and mid-term changes
See references/underwriting_and_risk_selection.md.
3. Policy coverage and forms
- Identify coverage part (CG, CP, CA, WC, etc.) and edition date
- Map insuring agreement, exclusions, conditions, and endorsements
- Confirm trigger (occurrence vs claims-made) and retro dates where applicable
- Reconcile limits (per occurrence, aggregate, sublimits) and deductibles/SIR
- Flag common gaps (ordinance/law, BI waiting period, employee injury exclusions)
- Escalate wording disputes to
commercial-counsel
See references/policy_coverage_and_forms.md.
4. Claims lifecycle
- FNOL — capture facts, policy verification, coverage preliminary
- Assign adjuster; establish reserves (case, IBNR directionally—detail with
actuary) - Investigate liability and damages; manage vendors and counsel
- Negotiate settlement; subrogation and salvage where applicable
- Close with file documentation; feed experience to underwriting
See references/claims_lifecycle_and_handling.md.
5. Reinsurance and catastrophe
- Classify peril and geographic cat accumulation
- Select structure: quota share, surplus, per-risk XOL, cat XOL, cat bonds (overview)
- Align retentions and reinstatements to capital and rating agency context
- Coordinate with pricing cat load and aggregate monitoring
See references/reinsurance_and_catastrophe.md.
6. Metrics, regulation, and operations
- Compute and interpret loss, expense, and combined ratios
- Separate attritional vs cat and large-loss development in narrative
- Outline DOI filing, market conduct, and financial examination concepts
- Map distribution economics (commission, MGA overrides, profit sharing)
See references/metrics_regulatory_and_operations.md.
Deliverable standards
| Deliverable | Minimum content |
|---|---|
| Underwriting summary | Risk description, appetite fit, terms, pricing rationale, open items |
| Coverage memo | Form edition, triggers, limits/deductibles, key exclusions, gaps |
| Claims status | FNOL facts, coverage position (preliminary), reserves, next steps |
| Reinsurance brief | Structure, layer, retention, reinstatement, cat aggregation note |
| Metrics commentary | Period ratios, drivers, cat/large loss callouts, actions |
Always label preliminary coverage positions and regulatory comments as not legal or actuarial advice; escalate to qualified professionals for filings, sign-off, and disputes.
When to load references
- Scope and LOBs →
references/pc_insurance_scope_and_lines.md - Underwriting →
references/underwriting_and_risk_selection.md - Policy and coverage →
references/policy_coverage_and_forms.md - Claims →
references/claims_lifecycle_and_handling.md - Reinsurance and cat →
references/reinsurance_and_catastrophe.md - Metrics and regulation →
references/metrics_regulatory_and_operations.md