It doesn't just have to work - it has to work perfect. It seems that the slightest oops would disable a PCB worth $100k+ Kinda nuts.
I've worked on boards like that, and it is a very time consuming and expensive process. Things like first doing a trial place/reflow solder run with identical packages but with much cheaper parts, just to test there are no reflow issues, and then you have a cheaper physical sample to work from as a mechanical sample.
And then once assembled with real parts (triple checked and signed off at each stage) you'll do anything to salvage a board that has issues. So hand reworks are not uncommon.
Wasting countless multi-thousand dollar blank boards for all sorts of tasks and checks is commonplace.
If you find a design flaw, it's actually a cheaper and safer option to mod the boards than to go re-spin and re-qualify a board, so quite common to find mod wires and bodged chips and parts.
Extensive built in testing is half of the design process.
It can take a year or more to get one of these boards into production.