{
  "id": "workflow:claims-processing-audit",
  "_kind": "Workflow",
  "_file": "workflows/workflows/workflows-insurance.yaml",
  "_cluster": "workflows",
  "attributes": {
    "displayName": "Claims Processing Audit",
    "workflowKind": "governance",
    "triggerType": "scheduled",
    "typicalCadence": "monthly",
    "complexity": "cross-team",
    "description": "Audits the insurance claims processing pipeline for accuracy and\nregulatory compliance -- sampling adjudicated claims for correct\ncoverage-determination logic, verifying reserve calculations against\nactuarial guidelines, reviewing automated-decision model outputs for\nbias indicators, validating state-specific regulatory rule application,\nand reconciling paid amounts against policy limits and deductible\nschedules. Produces audit finding reports, model fairness assessments,\nand regulatory compliance scorecards. Excludes claims adjudication\nitself.\n"
  },
  "outgoingEdges": [
    {
      "from": "workflow:claims-processing-audit",
      "to": "role:data-scientist",
      "kind": "involves_role",
      "attributes": {}
    },
    {
      "from": "workflow:claims-processing-audit",
      "to": "role:security-reviewer",
      "kind": "involves_role",
      "attributes": {}
    },
    {
      "from": "workflow:claims-processing-audit",
      "to": "role:planner",
      "kind": "involves_role",
      "attributes": {}
    },
    {
      "from": "workflow:claims-processing-audit",
      "to": "skill-area:python-data-pipelines",
      "kind": "requires_skill_area",
      "attributes": {}
    },
    {
      "from": "workflow:claims-processing-audit",
      "to": "skill-area:observability-pipeline",
      "kind": "requires_skill_area",
      "attributes": {}
    },
    {
      "from": "workflow:claims-processing-audit",
      "to": "domain:insurance",
      "kind": "applies_to_domain",
      "attributes": {}
    },
    {
      "from": "workflow:claims-processing-audit",
      "to": "domain:finance",
      "kind": "applies_to_domain",
      "attributes": {}
    },
    {
      "from": "workflow:claims-processing-audit",
      "to": "responsibility:data-quality-monitoring",
      "kind": "triggers_responsibility",
      "attributes": {}
    },
    {
      "from": "workflow:claims-processing-audit",
      "to": "responsibility:regulatory-filing",
      "kind": "triggers_responsibility",
      "attributes": {}
    },
    {
      "from": "workflow:claims-processing-audit",
      "to": "org-unit:compliance-team",
      "kind": "performed_by_org_unit",
      "attributes": {}
    },
    {
      "from": "workflow:claims-processing-audit",
      "to": "org-unit:analytics-team",
      "kind": "performed_by_org_unit",
      "attributes": {}
    }
  ],
  "incomingEdges": [
    {
      "from": "stack-profile:insurance-claims-processing",
      "to": "workflow:claims-processing-audit",
      "kind": "follows_workflow"
    }
  ]
}