Premium audit exposure verification and classification practice
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DesignGOV-01
Premium audit AI policy and objectives
Set approved objectives, scope, prohibited actions, governance, evidence, escalation, and accountability for AI used in premium audit.
PilotGOV-02
Audit authority accountability and segregation
Separate insured-submitted facts, AI extraction, auditor judgment, classification decisions, premium calculation, approval, billing, and dispute handling.
OperateGOV-03
Use case boundary risk tier and prohibited actions
Define affected policies, audit types, decisions, AI influence, autonomy, financial consequence, human review, exclusions, and unacceptable outcomes.
ImproveGOV-04
Portfolio sequencing capacity and value
Sequence uses by accuracy, service, leakage, expense, jurisdiction, data readiness, workforce capacity, vendor dependency, and customer impact.
DesignPLN-01
Audit eligibility and requirement determination
Determine whether and when an audit is required using policy terms, jurisdiction rules, line, risk, premium, and program requirements.
PilotPLN-02
Audit type selection and conversion rules
Choose physical, virtual, telephone, mail, continuous, interim, or self-audit methods and document triggers for conversion or escalation.
OperatePLN-03
Risk based audit scope and sampling plan
Set materiality, records, locations, people, transactions, classifications, contractors, periods, samples, and fieldwork for each audit.
ImprovePLN-04
Jurisdiction manual and policy rule alignment
Use current approved manuals, filings, policy provisions, endorsements, rating rules, audit standards, and jurisdiction-specific requirements.
DesignDAT-01
Record request consent and secure intake
Request only necessary records through approved channels and preserve notices, authorization, receipt, custody, access, retention, and deletion.
PilotDAT-02
Record completeness period and entity validation
Confirm records cover the named insured, related entities, audit period, locations, payroll cycles, sales periods, operations, and requested detail.
OperateDAT-03
Source reconciliation and anomaly triage
Reconcile payroll reports, tax filings, general ledger, income statements, cash disbursements, certificates, contracts, and policy data.
ImproveDAT-04
Document extraction provenance and confidence
Trace extracted facts to page, field, source file, model and prompt version, confidence, exception, reviewer, correction, and final use.
DesignEXP-01
Payroll remuneration and sales verification
Verify actual payroll, remuneration, sales, receipts, units, area, admissions, or other audited exposure basis for the covered period.
PilotEXP-02
Inclusion exclusion and capped basis control
Apply approved inclusions, exclusions, limitations, overtime treatment, caps, minimums, and special remuneration or exposure rules.
OperateEXP-03
Officer owner partner and employee treatment
Determine auditable treatment for executive officers, members, partners, sole proprietors, employees, temporary labor, and other persons.
ImproveEXP-04
Subcontractor certificate and uninsured exposure review
Validate subcontractor work, certificates, policy periods, limits, operations, licensing, uninsured exposure, and applicable payroll or contract cost.
DesignCLS-01
Business operations and class code validation
Validate the insured operation, governing classification, standard exceptions, separate enterprises, general exclusions, and supporting evidence.
PilotCLS-02
Employee duty and payroll division evidence
Allocate employee payroll among classifications only when duties, time records, manual rules, and jurisdiction requirements support division.
OperateCLS-03
Location state and multistate allocation
Assign exposure to the correct location, state, risk, project, class, policy period, and multistate rule with documented tie-outs.
ImproveCLS-04
Business ownership entity and change review
Identify ownership, entity, acquisition, disposition, combination, name, FEIN, operational, or control changes affecting audit and rating treatment.
DesignCAL-01
Audited exposure and rate calculation
Calculate premium from approved audited exposure, classifications, rates, rounding, minimums, expense constants, taxes, fees, and other elements.
PilotCAL-02
Experience modification and rating plan application
Apply the correct experience modification, schedule rating, deductible, retrospective, premium discount, and approved rating-plan factors.
OperateCAL-03
Additional return and final premium reconciliation
Reconcile estimated, endorsed, reported, audited, written, earned, additional, return, billed, collected, and outstanding premium.
ImproveCAL-04
Endorsement billing posting and statistical reporting
Issue supported policy changes and synchronize billing, commission, receivable, cash, subledger, general ledger, unit statistical, and regulatory records.
DesignCOM-01
Audit finding explanation and workpaper support
Explain scope, facts, classifications, exposures, rules, calculations, differences, uncertainty, and next steps in clear customer-facing language.
PilotCOM-02
Insured producer confirmation and attestation
Obtain insured and producer confirmation without converting attestations into proof or allowing unverified changes to override audit evidence.
OperateCOM-03
Dispute appeal and re-audit workflow
Provide documented questions, evidence submission, reconsideration, appeal, independent review, re-audit, decision, notice, and escalation paths.
ImproveCOM-04
Correction refund collection and remediation
Correct affected transactions, issue refunds or collections, update records and reports, notify parties, preserve evidence, and monitor recurrence.
DesignAIA-01
Model data prompt and extraction validation
Test extraction, classification, anomaly, recommendation, calculation, and generative components using representative records and failure modes.
PilotAIA-02
Agent permissions communication and transaction limits
Prevent agents from requesting excess data, changing findings, sending final notices, posting premium, or resolving disputes outside authority.
OperateAIA-03
Vendor auditor quality security and continuity
Control auditor and technology vendors for competence, independence, service, privacy, security, change, evidence access, continuity, and exit.
ImproveAIA-04
Monitoring test audit and continuous improvement
Monitor audit quality, rework, conversion, disputes, leakage, cycle time, customer outcomes, model drift, vendor performance, and test-audit findings.