Insurance Compliance and Audit Workflow

Início do fluxo de trabalho/processo.

Retrieve all insurance policies marked as 'Due for Review' from the Policy Data Model.

Fetch the latest regulatory requirement updates from the Compliance Standards Data Model.

Execute a formula based on policy age, claim frequency, and coverage gaps to determine a risk weight.

Update the 'Risk Status' field to 'High' for policies identified by the calculation engine.

Create a task for the assigned Compliance Auditor to begin the manual document verification.

Create a task containing a specific checklist of missing documents for the auditor to verify.

Create a new entry in the 'Audit Findings' data model to document any discovered non-compliance.

Aggregate all 'Critical' findings to count the total number of severe breaches in the current period.

Send an email to the Department Head summarizing the total number of critical findings.

Create a task for the Operations Team to address the identified compliance gaps.

Update the status of the original Policy Entry to 'Under Remediation'.

Send an SMS to the Compliance Manager if a 'Critical' risk threshold is exceeded.

Create a formal PDF report aggregating all audit findings and remediation statuses for the monthly board review.

Delete/Remove temporary audit logs that are no longer required by the retention policy.

Calculate the percentage of compliant policies vs. non-compliant policies across the total portfolio.

Fim do fluxo de trabalho/processo.