INSURANCE COMPLIANCE AND AUDIT WORKFLOW

Created by ChecklistGuro (https://checklistguro.com)

[ ] Fetch Pending Audits: Retrieve all insurance policies marked as 'Due for Review' from the Policy Data Model.
[ ] Retrieve Compliance Regulations: Fetch the latest regulatory requirement updates from the Compliance Standards Data Model.
[ ] Calculate Risk Score: Execute a formula based on policy age, claim frequency, and coverage gaps to determine a risk weight.
[ ] Flag High-Risk Policies: Update the 'Risk Status' field to 'High' for policies identified by the calculation engine.
[ ] Assign Compliance Officer: Create a task for the assigned Compliance Auditor to begin the manual document verification.
[ ] Generate Deficiency Checklist: Create a task containing a specific checklist of missing documents for the auditor to verify.
[ ] Create Audit Finding Entry: Create a new entry in the 'Audit Findings' data model to document any discovered non-compliance.
[ ] Summarize Audit Findings: Aggregate all 'Critical' findings to count the total number of severe breaches in the current period.
[ ] Notify Department Head: Send an email to the Department Head summarizing the total number of critical findings.
[ ] Remediation Task: Create a task for the Operations Team to address the identified compliance gaps.
[ ] Update Policy Status: Update the status of the original Policy Entry to 'Under Remediation'.
[ ] Urgent Alert SMS: Send an SMS to the Compliance Manager if a 'Critical' risk threshold is exceeded.
[ ] Generate Monthly Compliance Report: Create a formal PDF report aggregating all audit findings and remediation statuses for the monthly board review.
[ ] Archive Expired Audit Logs: Delete/Remove temporary audit logs that are no longer required by the retention policy.
[ ] Calculate Compliance Percentage: Calculate the percentage of compliant policies vs. non-compliant policies across the total portfolio.

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