R05.13.01.04 · 任务小类

保险理赔与核保

Insurance claims & underwriting

Process claims and underwriting files in core insurance systems.

20 条本项目编写的提案 · 分类 v1.1 · 新增基准运行 0 次。下方验证方式与部分得分规则是设计，不是执行结果。

典型应用: Guidewire · Duck Creek
小类 GUI 需求标签: HY · 混合

任务提案 · 20

展开查看完整原文与建议检查方式；两种界面均保留提案英文原文。

R05.13.01.04-T01 Open an auto claim with parties and exposures from FNOL documents

原始指令

Guidewire ClaimCenter (training instance, synthetic data) is open. From input/fnol_call_notes.txt and input/police_report.pdf, create the claim on policy PA-000418: loss date/time/location, cause 'Rear-end collision', insured driver, claimant and witness contacts, and exposures for insured vehicle damage and claimant bodily injury. Run coverage verification.

平台: web · 任意系统（网页）
应用: Guidewire ClaimCenter
交互表面: brow · 浏览器
GUI 需求 · 任务设定: G2 · GUI 必要
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: type · 文字与表单 click · 指向与点击 vis · 视觉判断
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 3 / 5

建议验证方式

Grader reads training DB: claim on correct policy, loss fields exact, 3 contacts with roles, 2 exposures with correct coverage types, coverage verified flag. Guidewire Cloud API scopes are withheld from the agent user, and history must show its UI session.

建议部分得分

25% loss details; 25% contacts and roles; 35% exposures and coverages; 15% verification.

R05.13.01.04-T02 Set initial reserves per reserving guidelines

原始指令

In ClaimCenter (training), claim 0000-31-2207 has 3 exposures. Set initial reserves per input/reserving_guide.pdf: vehicle damage from the appraisal estimate, rental at 30 days x daily limit, bodily injury by injury code table. One reserve exceeds your authority and must be submitted for approval, not forced.

平台: web · 任意系统（网页）
应用: Guidewire ClaimCenter
交互表面: brow · 浏览器
GUI 需求 · 任务设定: HY · 混合
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: type · 文字与表单 click · 指向与点击 multi · 跨应用
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 3 / 5

建议验证方式

Reserve transactions per exposure/cost type equal key amounts; the over-authority reserve is in 'pending approval' with approval activity; no other reserves.

建议部分得分

60% reserve amounts (pro rata over 3 exposures); 25% over-authority routed; 15% cost types correct.

R05.13.01.04-T03 Issue a repair payment net of deductible

原始指令

In ClaimCenter (training), pay the body shop for claim 0000-31-2207 vehicle exposure: estimate total from input/final_invoice.pdf, minus the $500 collision deductible, payee 'Reliable Auto Body (synthetic)' with the insured as joint payee per state rule, check method. Submit the check for approval; do not release it.

平台: web · 任意系统（网页）
应用: Guidewire ClaimCenter
交互表面: brow · 浏览器
GUI 需求 · 任务设定: HY · 混合
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: type · 文字与表单 click · 指向与点击
工作产物: WP08 · 应用 / 系统状态
条件: risk · 高风险 / 不可逆
提案难度: 3 / 5

建议验证方式

Check record: amount = invoice - 500 exactly, payees per rule, reserve line correct, status pending approval (not issued); reserves eroded correctly.

建议部分得分

40% amount; 25% payees; 20% reserve line; 15% not released.

R05.13.01.04-T04 Deny an exposure on a policy exclusion with a letter

原始指令

In ClaimCenter (training), claim 0000-44-1180 includes an exposure for a vehicle used for paid delivery. Review the policy form input/pa_policy_form.pdf and adjuster notes; if the commercial-use exclusion applies, close the exposure with outcome 'Coverage denied', cite the clause, zero the reserve, and generate denial letter template DL-02 to output/denial.pdf.

平台: web · 任意系统（网页）
应用: Guidewire ClaimCenter
交互表面: brow · 浏览器
GUI 需求 · 任务设定: HY · 混合
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: click · 指向与点击 type · 文字与表单 vis · 视觉判断
工作产物: WP08 · 应用 / 系统状态
条件: risk · 高风险 / 不可逆
提案难度: 4 / 5

建议验证方式

Exposure closed with outcome and note citing exclusion section; reserve 0; letter PDF contains claim number and clause text; other exposure open. Grader key: exclusion applies.

建议部分得分

35% correct coverage decision; 25% closure and reserve; 25% letter; 15% other exposure untouched.

R05.13.01.04-T05 Sketch a water-damaged floor and price the estimate in Xactimate

原始指令

In Xactimate (Windows, training license), create the estimate for claim WD-2210: sketch kitchen, hall and laundry from input/field_measurements.pdf (walls, doors, openings, 8 ft ceiling), then add line items for tear-out, drying equipment and replacement per input/scope_notes.txt using the price list ORLA8X_OCT26. Total RCV must land within 2% of reference.

平台: win · Windows
应用: Xactimate
交互表面: desk · 桌面 GUI
GUI 需求 · 任务设定: G2 · GUI 必要
GUI 需求 · 普通权限: G3 · 仅 GUI
交互原语: drag · 拖放 geom · 精确几何 type · 文字与表单 click · 指向与点击
工作产物: WP08 · 应用 / 系统状态
条件: licensed · 授权专业软件 long · 长流程
提案难度: 5 / 5

建议验证方式

ESX export parsed: room areas and perimeters within 1%; openings present; line items match scope (codes/quantities within 3%); RCV total within 2% of reference. ESX/XML sketch import is disabled for the training license and the VM has no scripting runtime, so the sketch must be drawn natively.

建议部分得分

35% sketch geometry; 30% line items; 25% RCV total within 2 pct of reference; 10% price list.

R05.13.01.04-T06 Write an auto damage estimate from photos

原始指令

In CCC ONE (training), write the estimate for VIN in input/vehicle.txt from the 14 damage photos in input/photos/: choose repair vs replace for each damaged panel per input/guidelines.pdf, add refinish and blend operations, and OEM vs alternative parts per policy. Total within 5% of the reference estimate.

平台: win · Windows
应用: CCC ONE
交互表面: desk · 桌面 GUI
GUI 需求 · 任务设定: G2 · GUI 必要
GUI 需求 · 普通权限: G3 · 仅 GUI
交互原语: vis · 视觉判断 click · 指向与点击 type · 文字与表单
工作产物: WP08 · 应用 / 系统状态
条件: licensed · 授权专业软件
提案难度: 4 / 5

建议验证方式

Exported estimate: damaged-panel set F1 >= 0.85 vs reference; repair/replace decisions per guideline; refinish/blend present; total within 5%. CCC ONE estimate import and API access are not available to the training user, so the estimate must be written in the client.

建议部分得分

35% panel set; 25% repair/replace; 15% refinish/blend; 25% total within 5 pct of reference.

R05.13.01.04-T07 Quote and bind a small-commercial BOP submission

原始指令

In Guidewire PolicyCenter (training), create a Businessowners submission for 'Lakeside Bakery LLC (synthetic)' from input/acord125_140.pdf: locations, buildings, class code, limits and optional coverages. Quote it, confirm the premium matches input/rating_worksheet.xlsx within $1, then bind with effective date 2026-11-01.

平台: web · 任意系统（网页）
应用: Guidewire PolicyCenter · Excel
交互表面: brow · 浏览器
GUI 需求 · 任务设定: G2 · GUI 必要
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: type · 文字与表单 click · 指向与点击 multi · 跨应用
工作产物: WP08 · 应用 / 系统状态
条件: risk · 高风险 / 不可逆
提案难度: 4 / 5

建议验证方式

Policy period bound; locations/buildings/class/limits per ACORD; premium within $1 of worksheet; effective date exact. Guidewire Cloud API scopes are withheld from the agent user, and history must show its UI session.

建议部分得分

40% submission data; 25% quoted premium match; 25% bound; 10% effective date.

R05.13.01.04-T08 Endorse an auto policy mid-term

原始指令

In PolicyCenter (training), process a policy change on PA-000522 effective 2026-10-20: add a 2024 Honda CR-V (VIN in input/change_req.pdf) with the same coverages as vehicle 1, remove driver 'Ben Ito (synthetic)', and quote. Bind the change and report the prorated premium change in output/premium.txt.

平台: web · 任意系统（网页）
应用: Guidewire PolicyCenter
交互表面: brow · 浏览器
GUI 需求 · 任务设定: G2 · GUI 必要
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: type · 文字与表单 click · 指向与点击
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 3 / 5

建议验证方式

Policy change job bound; vehicle added with coverages mirroring vehicle 1; driver removed; prorated change equals system and key. Guidewire Cloud API scopes are withheld from the agent user, and history must show its UI session.

建议部分得分

35% vehicle and coverages; 25% driver removed; 25% bound; 15% premium reported.

R05.13.01.04-T09 Renew a policy within underwriting authority

原始指令

In Duck Creek Policy (training), process the renewal of commercial auto policy CA-30019: apply the 6% filed rate change, set a schedule rating modification of -8% justified by input/loss_runs.pdf, and if the final premium change exceeds +15%, refer to a senior underwriter instead of issuing.

平台: web · 任意系统（网页）
应用: Duck Creek Policy
交互表面: brow · 浏览器
GUI 需求 · 任务设定: HY · 混合
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: type · 文字与表单 click · 指向与点击 multi · 跨应用
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 3 / 5

建议验证方式

Renewal transaction: rate change and schedule mod values; justification note; status issued or referred per key computed premium change.

建议部分得分

30% rate change; 30% schedule mod with note; 40% correct issue/refer outcome.

R05.13.01.04-T10 Clear an underwriting queue against the appetite guide

原始指令

In the Duck Creek underwriting workbench (training), 6 new submissions await review. Apply input/appetite_guide.pdf (eligible class codes, TIV limit, 3-year loss ratio, protection class). Decline out-of-appetite submissions with reason codes, refer one borderline TIV case to the manager, and accept the rest into quoting.

平台: web · 任意系统（网页）
应用: Duck Creek Policy
交互表面: brow · 浏览器
GUI 需求 · 任务设定: HY · 混合
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: click · 指向与点击 vis · 视觉判断 type · 文字与表单
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 3 / 5

建议验证方式

Submission statuses and reason codes equal key; referral activity on the borderline case; no decline without a reason code.

建议部分得分

70% decisions (pro rata); 20% reason codes; 10% referral.

R05.13.01.04-T11 Apply address changes in a green-screen policy system

原始指令

In a 3270 terminal emulator connected to a legacy policy-admin sandbox, apply the 15 mailing-address changes in input/changes.xlsx using screen POLICY-UPD (PF keys per input/screen_guide.pdf). Each policy's inquiry screen must show the new address; skip the 2 rows whose policy numbers are cancelled and log them in output/skipped.txt.

平台: win · Windows mac · macOS
应用: 3270 emulator · Excel
交互表面: desk · 桌面 GUI term · 终端
GUI 需求 · 任务设定: G3 · 仅 GUI
GUI 需求 · 普通权限: G3 · 仅 GUI
交互原语: type · 文字与表单 key · 快捷键 multi · 跨应用
工作产物: WP08 · 应用 / 系统状态
条件: multiapp · 多应用 tutorial · 阅读文档 / 教程
提案难度: 3 / 5

建议验证方式

Host DB: 13 addresses updated exactly; cancelled policies unchanged; skipped.txt lists those 2. The host exposes no database, FTP or API route, only the 3270 session, and the emulator's macro/scripting interface (HLLAPI, script files) is disabled, so updates must be keyed on POLICY-UPD.

建议部分得分

65% addresses (pro rata over 13); 20% cancelled skipped; 15% log.

R05.13.01.04-T12 Identify subrogation potential and open recovery records

原始指令

In ClaimCenter (training), review the 10 claims closed last month in group 'Auto East'. Using notes and police reports, open subrogation for claims where the other party was at fault (>= 50%) and a known carrier exists: create the subrogation record, recovery reserve equal to paid loss x fault share, and a demand-letter activity.

平台: web · 任意系统（网页）
应用: Guidewire ClaimCenter
交互表面: brow · 浏览器
GUI 需求 · 任务设定: HY · 混合
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: nav · 平移 / 缩放 / 滚动 vis · 视觉判断 type · 文字与表单
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 4 / 5

建议验证方式

Subrogation set equals key (4 claims); recovery reserves exact; activities present; no subrogation on others.

建议部分得分

50% claim set; 30% recovery reserves; 20% activities.

R05.13.01.04-T13 Refer suspicious claims to the SIU

原始指令

In Duck Creek Claims (training), apply the red-flag rules in input/siu_rules.md (loss within 30 days of inception, reported > 14 days late, 2+ prior claims in 12 months, inconsistent statements) to the 18 open claims in your queue. Refer those scoring >= 2 flags to SIU with a note listing the flags.

平台: web · 任意系统（网页）
应用: Duck Creek Claims
交互表面: brow · 浏览器
GUI 需求 · 任务设定: HY · 混合
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: nav · 平移 / 缩放 / 滚动 click · 指向与点击 type · 文字与表单
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 3 / 5

建议验证方式

SIU referral records equal key set; notes enumerate the flags matched; no referrals for others.

建议部分得分

60% referral set; 30% flags listed; 10% no extra referrals.

R05.13.01.04-T14 Assign catastrophe claims to field adjusters on a map

原始指令

After a hailstorm, 40 new property claims are unassigned in ClaimCenter (training). Using the assignment map view, drag claims to the 5 field adjusters so each adjuster's claims lie in their territory polygon, nobody exceeds 10 claims, and roof claims go only to adjusters with the 'roof certified' skill.

平台: web · 任意系统（网页）
应用: Guidewire ClaimCenter
交互表面: brow · 浏览器
GUI 需求 · 任务设定: G2 · GUI 必要
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: drag · 拖放 nav · 平移 / 缩放 / 滚动 vis · 视觉判断
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 4 / 5

建议验证方式

Assignments: every claim assigned once; claim locations inside the assignee's territory; <= 10 each; roof claims to certified adjusters. Guidewire Cloud API scopes are withheld from the agent user, and history must show its UI session.

建议部分得分

30% all assigned; 30% territory; 20% caps; 20% skill rule.

R05.13.01.04-T15 Control: perform the T08 policy change through the API

原始指令

Control pair of T08. Using PolicyCenter Cloud API sandbox credentials in input/pc_api.env, run the same mid-term change on a fresh copy of PA-000522 (add vehicle with mirrored coverages, remove driver, quote, bind) and print the premium change.

平台: lin · Linux mac · macOS win · Windows
应用: Guidewire Cloud API · Python
交互表面: api · API / SDK term · 终端
GUI 需求 · 任务设定: AP · API 足够
GUI 需求 · 普通权限: AP · API 足够
交互原语: code · 代码与命令
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 2 / 5

建议验证方式

Same end-state checks as T08.

建议部分得分

35% vehicle and coverages; 25% driver removed; 25% bound; 15% premium.

R05.13.01.04-T16 Rate a life application from physician and lab records

原始指令

In the life underwriting workbench (training), case L-55821 has an attending physician statement (input/aps.pdf, partly handwritten) and lab results (input/labs.pdf). Enter the medical findings, apply the debit/credit manual input/uw_manual.pdf (BMI, A1C, BP, family history), set the resulting rating class and table, and request one missing requirement.

平台: web · 任意系统（网页）
应用: life underwriting workbench
交互表面: brow · 浏览器
GUI 需求 · 任务设定: HY · 混合
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: vis · 视觉判断 type · 文字与表单 click · 指向与点击
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 4 / 5

建议验证方式

Case record: findings entered match key values; total debits/credits and rating class equal key; one requirement ordered (the missing one).

建议部分得分

35% findings; 35% rating class; 30% requirement ordered.

R05.13.01.04-T17 Reinstate a lapsed policy with an installment plan

原始指令

In Guidewire BillingCenter (training), policy HO-77310 lapsed for non-payment 9 days ago, within the 15-day reinstatement window. Apply the customer's payment from input/payment.txt to the delinquent amount, switch the account to the 10-pay installment plan, and trigger reinstatement without a lapse in coverage.

平台: web · 任意系统（网页）
应用: Guidewire BillingCenter · Guidewire PolicyCenter
交互表面: brow · 浏览器
GUI 需求 · 任务设定: HY · 混合
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: click · 指向与点击 type · 文字与表单
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 3 / 5

建议验证方式

Payment applied to delinquent invoice items; payment plan changed with new invoice schedule; reinstatement job bound with effective date equal to lapse date.

建议部分得分

30% payment applied; 35% installment plan; 35% reinstated without gap.

R05.13.01.04-T18 File a windshield claim and auto-approve under threshold

原始指令

In Duck Creek Claims (training), file first notice of loss for a windshield chip on policy PA-000611 from input/glass_fnol.txt, select glass vendor 'ClearView (synthetic)', and approve the repair since the quote ($89) is under the $150 auto-approval threshold with zero deductible.

平台: web · 任意系统（网页）
应用: Duck Creek Claims
交互表面: brow · 浏览器
GUI 需求 · 任务设定: HY · 混合
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: type · 文字与表单 click · 指向与点击
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 2 / 5

建议验证方式

Claim on right policy with glass coverage, vendor assignment, approved payment 89.00, deductible 0.

建议部分得分

40% claim details; 25% vendor; 35% approval and amount.

R05.13.01.04-T19 Log an adjuster call and create follow-up activities

原始指令

In ClaimCenter (training), on claim 0000-31-2207 add a note from input/call_summary.txt (topic 'Claimant contact'), then create 3 activities: obtain medical records (due in 14 days), follow up with claimant (7 days), supervisor review (3 days), assigned per input/assignments.txt.

平台: web · 任意系统（网页）
应用: Guidewire ClaimCenter
交互表面: brow · 浏览器
GUI 需求 · 任务设定: HY · 混合
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: type · 文字与表单 click · 指向与点击
工作产物: WP08 · 应用 / 系统状态
条件: 未声明
提案难度: 2 / 5

建议验证方式

Note with topic and text; 3 activities with subjects, due dates relative to today and assignees exact.

建议部分得分

30% note; 70% activities (due dates and assignees).

R05.13.01.04-T20 Handle an auto claim from first notice to closure

原始指令

In ClaimCenter (training), run claim lifecycle input/scenario_auto.md: FNOL with 2 vehicles, coverage check, reserves, appraisal assignment, rental authorization (max 21 days), repair and rental payments net of deductible, total-loss decision for the claimant vehicle via the valuation report, salvage assignment, subrogation, and closure of all exposures.

平台: web · 任意系统（网页）
应用: Guidewire ClaimCenter
交互表面: brow · 浏览器
GUI 需求 · 任务设定: G2 · GUI 必要
GUI 需求 · 普通权限: G2 · GUI 必要
交互原语: type · 文字与表单 click · 指向与点击 nav · 平移 / 缩放 / 滚动 vis · 视觉判断
工作产物: WP08 · 应用 / 系统状态
条件: long · 长流程 risk · 高风险 / 不可逆
提案难度: 5 / 5

建议验证方式

Training DB state equals scenario key at each stage: exposures, reserves, payments (amounts/payees), total-loss flag, salvage record, subrogation, closed statuses; no payments released beyond approval. Guidewire Cloud API scopes are withheld from the agent user, and history must show its UI session.

建议部分得分

30% FNOL and reserves; 25% payments; 30% total loss, salvage and subrogation; 15% closure.

已有研究映射

以下沿用研究目录中的基准与小类映射，不是逐题标注、执行记录或产品背书。

OSWorld 2.0

保险理赔与核保

任务提案 · 20

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已有研究映射

同工作流族的小类