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Automation Risk Analysis

Will “Claims Agent” 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 Agent” 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 Agent” 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

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

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

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

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

  • Report overpayments, underpayments, and other irregularities.

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

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

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

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

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

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

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

  • 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.

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

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

  • 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.

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

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

  • Collect evidence to support contested claims in court.

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

  • Obtain credit information from banks and other credit services.

  • Pay and process claims within designated authority level.

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

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

  • 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.

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

  • Attend mediations or trials.

  • Confer with legal counsel on claims requiring litigation.

Technologies & Software

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

Alternative Job Titles