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Automation Risk Analysis

Will “Claims Account Specialist” be Automated?

Historical Context: Oxford Study (2013)

Ranked #675 of 702. Estimated risk: 98.0%

Directly assessed by researchers as likely automatable
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AI Exposure Risk

56%

“Claims Account Specialist” will maybe be replaced by AI.

Based on the cognitive demands, communication requirements, and logical reasoning intrinsic to this occupation according to O*NET data, we project a 56% probability of disruption by generative AI and Large Language Models.

Automation & Robot Risk

33%

“Claims Account Specialist” will probably not be replaced by robots.

Evaluating the physical dexterity, repetitive motion tasks, and manual labor associated with this role, our analysis indicates a 33% likelihood of substitution by advanced robotics systems.

Personal & Financial Insights

Every occupation has a unique profile. For Claims Adjusters, Examiners, and Investigators, the Bureau of Labor Statistics and O*NET classify the day-to-day work broadly as: Review settled claims to determine that payments and settlements are made in accordance with company practices and procedures. Confer with legal counsel on claims requiring litigation. May also settle insurance claims.

Avg. Annual Salary $78,770
Avg. Hourly Wage $37.87
Available Jobs (US) 305,020
Job Title & Hierarchy Code (SOC) Claims Adjusters, Examiners, and Investigators #13-1031
Wage vs. National Median
ℹ️

Data is based on the reference occupation: “Claims Adjusters, Examiners, and Investigators”

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Core Skills & Abilities

  • Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.

  • Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.

  • Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.

  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.

  • Investigate and assess damage to property and create or review property damage estimates.

  • Present cases and participate in their discussion at claim committee meetings.

  • Attend mediations or trials.

  • Confer with legal counsel on claims requiring litigation.

  • Conduct detailed bill reviews to implement sound litigation management and expense control.

  • Obtain credit information from banks and other credit services.

  • Supervise claims adjusters to ensure that adjusters have followed proper methods.

  • Report overpayments, underpayments, and other irregularities.

  • Collect evidence to support contested claims in court.

  • Refer questionable claims to investigator or claims adjuster for investigation or settlement.

  • Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.

  • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.

  • Resolve complex, severe exposure claims, using high service oriented file handling.

  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.

  • Prepare reports to be submitted to company's data processing department.

  • Examine titles to property to determine validity and act as company agent in transactions with property owners.

  • Analyze information gathered by investigation and report findings and recommendations.

  • Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.

  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.

  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.

  • Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.

  • Communicate with reinsurance brokers to obtain information necessary for processing claims.

  • Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.

  • Examine claims forms and other records to determine insurance coverage.

  • Pay and process claims within designated authority level.

Technologies & Software

  • Gemini (Google)
  • CGI-AMS BureauLink Enterprise
  • StrataCare StrataWare eReview
  • Medical procedure coding software
  • Perplexity AI
  • ISO NetMap for Claims
  • CCC EZNet electronic communications network
  • MapScenes Evidence Recorder
  • Injury Sciences EDR InSight
  • CCC TL2000 Solution
  • Bill review software
  • Magnify Predictive Targeting System
  • LexisNexis RiskWise
  • Corporate Systems ClaimsPro
  • CSC Colossus
  • CCC Pathways Appraisal Quality Solution
  • Microsoft Outlook
  • Microsoft Word
  • Insurance claims fraud detection software
  • Property damage, bodily injury, and liability estimation software
  • Covansys ClaimConnect
  • Microsoft Publisher
  • Tropics Claims Reserve Management
  • CGI INSideOUT
  • CSC Automated Work Distributor AWD
  • Claims processing administration and management software
  • Napkin AI
  • Healthcare common procedure coding system HCPCS
  • Fair Isaac Claims Advisor
  • Simsol for Adjusters
  • Automatic Data Processing Estimating
  • Axonwave Fraud and Abuse Management System
  • BCCORP W5 for Adjusters
  • DeepSeek
  • First Notice Systems ClaimCapture
  • Automatic Data Processing Autosource
  • Turtle Creek Software Goldenseal Architect
  • Xactware Xactimate
  • Qwen (Alibaba)
  • ChatGPT (OpenAI)
  • QwikQuote software
  • Kimi (Moonshot AI)
  • 4n6xprt Systems StiffCalcs
  • CCC GuidePost Decision Support
  • Captiva InputAccel
  • Document management system software
  • PhotoModeler
  • Microsoft Office software
  • ADP software
  • CCC Pathways Image Management Solution
  • Gemini for Workspace
  • CSC Fault Evaluator
  • Mistral (Mistral AI)
  • Hyland OnBase Enterprise Content Management
  • Hummingbird Legal Bill Review
  • CAD Zone Insurance
  • Castek Insure3 Claims
  • BCCORP Burkitt W5
  • Datanex ClaimTrac
  • Llama (Meta)
  • Microsoft Copilot
  • Mozilla Firefox
  • AutoClaims Direct DirectLink
  • Alteryx AI
  • Agency Management Systems AMS 360
  • DataRobot
  • Apple Safari
  • MapScenes Pro
  • IBM Fraud and Abuse Management System
  • Bridium Claims 3
  • Medical condition coding software
  • Nova (Amazon)
  • ARSoftware WinSMAC
  • Automatic Data Processing Claims Manager & Dispatch
  • Tableau AI
  • Microsoft PowerPoint
  • ISO ClaimSearch
  • Meta Business AI
  • Computerized voice stress analyzer CVSA software
  • Business software applications
  • Microsoft Access
  • Grok (xAI)
  • Claude (Anthropic)
  • InSystems Calligo Document Management System
  • Microsoft Excel
  • Planful AI
  • Zoom
  • Fair Isaac SmartAdvisor
  • Visual Statement Investigator Suite
  • Clear Technology Tranzax
  • Bramerhill ClaimsTech
  • Brightwork Alyce Claims Systems
  • Handheld computers
  • Data collectors
  • Notebook computers
  • Desktop computers
  • Event data recorders
  • Personal digital assistants PDA
  • Scanners
  • Total stations
  • Measure markers
  • Personal computers
  • Tablet computers
  • Mobile wireless handheld communication devices
  • Field computers

Alternative Job Titles