/home/clawbot-insurance/
├── Soul.md
# Claims adjuster personality
├── Heartbeat.md # Current claim focus
├── System-Prompt.md # Base instructions + compliance rules│
├── Memory/│
├── Insurer/│
├── profile.json # Insurer details, lines of business│ │
├── policy-forms/ # Policy forms by line│
│ ├── coverage-rules/ # Coverage determination rules│
│ └── vendor-network/ # Approved vendors, contractors│ │
│ ├── Policies/│ │ ├── [POLICY-ID]/│ │ │ ├── policy-data.json # Policy details, coverage limits│ │ │
├── endorsements/ # Policy changes│ │ │ └── claim-history/ # Previous claims│ │ └── [POLICY-INDEX].json│ ││ ├── Claims/│ │ ├── [CLAIM-ID]/│ │ │ ├── metadata.json # Claim type, date, status│ │ │ ├── intake/ # FNOL data, initial report│ │ │ ├── documents/ # All claim documents│ │ │ ├── analysis/ # Document analysis results│ │ │ ├── coverage/ # Coverage determination│ │ │ ├── reserve/ # Reserve calculations│ │ │ ├── payments/ # Payment history│ │ │ └── communications/ # All correspondence│ │ └── [ACTIVE-CLAIMS-INDEX].json│ ││ └── Knowledge/│ ├── state-regulations/ # State-specific rules│ ├── fraud-indicators/ # Known fraud patterns│ ├── medical-codes/ # ICD-10, CPT codes│ └── repair-estimates/ # Benchmark pricing│├── Skills/│ ├── claims/│ │ ├── skill.json│ │ ├── claim-intake/ # First Notice of Loss│ │ ├── document-analyzer/ # Analyze medical records, estimates│ │ ├── coverage-verifier/ # Verify policy coverage│ │ ├── fraud-detector/ # Detect potentially fraudulent claims│ │ ├── reserve-calculator/ # Calculate claim reserves│ │ ├── payment-authorizer/ # Recommend/authorize payments│ │ └── customer-communicator/ # Handle insured inquiries│ ││ ├── system-integration/│ │ ├── guidewire-connector/ # Guidewire ClaimCenter│ │ ├── duckcreek-connector/ # Duck Creek Claims│ │ ├── lexisnexis-connector/ # Fraud detection│ │ └── payment-connector/ # Payment processing│ ││ └── security/│ ├── audit-logger/│ └── encryption-handler/│├── Workflows/│ ├── claims/│ │ ├── 01-claim-intake.yaml│ │ ├── 02-document-analysis.yaml│ │ ├── 03-coverage-verification.yaml│ │ ├── 04-fraud-screening.yaml│ │ ├── 05-reserve-calculation.yaml│ │ ├── 06-payment-processing.yaml│ │ └── 07-subrogation.yaml│ ││ └── monitoring/│ ├── fraud-monitor.yaml│ ├── reserve-review.yaml│ └── regulatory-reporting.yaml│├── Logs/│ ├── system/│ ├── claims/│ └── audit/│└── Scripts/ ├── setup-insurer.sh ├── backup-insurer.sh └── compliance-report.sh


