Insurance: Claims Fraud Signal Review with Claude Code: Result JSON Schema

A production playbook for claims fraud signal review in insurance operations using Claude Code: result json schema, run-scoped inputs, logs, typed results, and artifacts.

Audience: Insurance fraud investigation teams

The problem

Insurance fraud investigation teams need claims fraud signal review to run repeatedly against claim packets, photos, histories, provider records, and fraud indicators. In insurance operations, the pain is not one good answer; it is repeatability, auditability, exception handling, and evidence that survives handoff.

Implementation path

Define the outer result contract once, let the claims fraud signal review skill own body.data, and reject terminal output that does not match the expected schema.

Tradeoffs and failure modes

Schema enforcement adds upfront design work, but removes prompt parsing from the product surface. For claims fraud signal review, the practical test is whether a second run can be debugged, retried, and consumed by a product without reading the raw agent transcript.

Result shape

{
  "schema_version": "argo.result.v1",
  "summary": "claims fraud signal review completed",
  "body": { "type": "insurance_fraud_signal_review", "data": {}, "exceptions": [] },
  "artifacts": []
}

Run this on Argo