Claims Processing Audit overview

Audits the insurance claims processing pipeline for accuracy and regulatory compliance -- sampling adjudicated claims for correct coverage-determination logic, verifying reserve calculations against actuarial guidelines, reviewing automated-decision model outputs for bias indicators, validating state-specific regulatory rule application, and reconciling paid amounts against policy limits and deductible schedules. Produces audit finding reports, model fairness assessments, and regulatory compliance scorecards. Excludes claims adjudication itself.