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Automation Risk Analysis

Will “Claims Adjustor” 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 Adjustor” 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 Adjustor” 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

  • Obtain credit information from banks and other credit services.

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

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

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

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

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

  • Collect evidence to support contested claims in court.

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

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

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

  • 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.

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

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

  • Pay and process claims within designated authority level.

  • 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.

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

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

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

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

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

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

  • Confer with legal counsel on claims requiring litigation.

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

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

  • Attend mediations or trials.

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

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

  • Report overpayments, underpayments, and other irregularities.

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

Technologies & Software

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

Alternative Job Titles