Sample Insurance Audit Binder

A tangible, audit-ready sample binder for insurance AI models. Includes policies, procedures, workflows, mapped obligations, evidence artifacts, approvals, and monitoring excerpts.

EU AI Act ISO 23894 NIST AI RMF EIOPA
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Executive Summary

Use Case: Claims Fraud Detection (Anonymized) · Line of Business: P&C – Motor · Model: Gradient Boosting

This sample illustrates how RiskAI produces audit-ready evidence: policy→procedure→workflow mapping, regulatory coverage, test results, approvals, and post-market monitoring.

Binder Contents

1. Model Overview & Ownership
  • Business context & KPIs
  • Data sources & lineage
  • Risk tier & intended use
  • RACI & roles
2. Regulatory & Control Mapping
  • EU AI Act, ISO 23894, NIST AI RMF, EIOPA
  • Policy→Procedure→Workflow links
  • Evidence IDs & artifacts
3. Validation Evidence
  • Fairness & robustness tests
  • Performance benchmarks
  • Explainability reports
4. Approvals & Sign-offs
  • 1st/2nd/3rd line approvals
  • Approval gate outputs
  • Immutable audit trail
5. Monitoring & Incidents
  • Drift/bias/quality thresholds
  • Alerts & incident runbooks
  • Corrective actions (CAPA)
6. Appendix
  • Model cards & logs
  • Workflow definitions
  • Raw artifacts (PDF/CSV/JSON)

Model Overview & Ownership

Model Register / Intake Screenshot Placeholder
  • Owner: Head of SIU
  • Risk Tier: High (Insurance)
  • KPIs: Precision@Top10%, AUC, AHT impact, FPR
  • Lineage: Claims, policy, external enrichment (PII redacted)
EVID-101

Regulatory & Control Mapping (Excerpt)

Control ID Policy → Procedure (Workflow) Framework Mapping Status Evidence
POL-01 Risk Tiering → Tiering Intake (Model Register) EU AI Act Art. 6; ISO 23894 5.3 Implemented EVID-101
POL-05 Bias & Fairness → Bias Test Suite (BiasCheck Pre-Prod) EU AI Act Art. 10; NIST Measure Implemented EVID-204
POL-09 Human Oversight → Approval Gate (Prod Gate) EU AI Act Art. 14; EIOPA oversight Implemented EVID-315
POL-12 Post-Market Monitoring → Monitor & Incidents (Ops Monitor) EU AI Act Art. 61; NIST Manage In Review EVID-441

Note: Full binder includes sub-controls, approver roles, and artifact references.

Validation Evidence — Bias & Robustness

Bias Test Report / Metrics Snapshot Placeholder

Timestamp: 2025-07-12 14:20 UTC

Result: PASS — group disparity < 3% (threshold 5%)

Artifacts: PDF report, JSON metrics

Approvals: 1st Line ✔ · 2nd Line ✔

EVID-204
Explainability & Performance (Excerpt)
Explainability: SHAP global & local reports archived (IDs XAI-2041..2048)
Performance: AUC 0.89 (baseline 0.84); Precision@Top10% 0.71
Stress: Drift scenarios show < 2% KPI degradation

Approvals & Sign-offs

Approval Workflow & e-Signatures Placeholder

Approvers: Model Owner (1st), Risk (2nd)

Artifacts: Signed PDF, approval metadata

Audit: Immutable log entry AL-315-B

EVID-315

Monitoring & Incidents

Monitoring Dashboard & Alert Record Placeholder

Signal: Data drift (covariate shift)

Action: Escalation per runbook; retraining request opened

Outcome: CAPA recorded; thresholds updated

EVID-441
Runbook Excerpt
Trigger: Drift score > 0.35 for 2 consecutive intervals
Steps: Notify SIU → Freeze auto-STP → RCA → Retraining plan → Approval gate
Records: Incident INC-441-07, CAPA CAP-441-09

Appendix — Workflow Definitions

BiasCheck — Pre-Prod

Inputs: Validation dataset, protected attrs config

Outputs: PDF, JSON metrics, approvals

Gate: Blocks deploy on fail

Approval Gate — Prod

Approvers: 1st/2nd line; 3rd as needed

Outputs: Signed PDF, log ID

Gate: Mandatory before deploy

Monitoring — Ops

Signals: Drift, bias, quality, incidents

Outputs: Alerts, incident record, CAPA

SLA: Severity-based escalation

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