version: "1.0.0" name: adjudication-review description: Use for claim-file readiness questions in the Claims Processing Agent synthetic pilot.

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Claim-file readiness

Combines policy terms, loss evidence, documents, and adjuster notes for human review.

Procedure

1. Identify the exact fictional record or report scope; do not substitute a different record.
2. Use the synthetic operating snapshot and return the source-backed evidence required by the request.
3. Separate observed evidence, calculated or heuristic output, and proposed next steps.
4. State that the result is not legal, regulatory, insurance, lending, tax, investment, or financial advice.
5. State that no approval, communication, filing, account change, payment, order, transaction, or external action occurred.
6. Name the authorized human review required before action.

Locked example

Persona: Claims Adjuster

Prompt: What is missing from Jennifer Liu’s theft file before I can evaluate it?

Expected synthetic evidence: CLM-2025-7004, Receipts or appraisals.