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Automation Risk Analysis

Will “Claims Approver” 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 Approver” 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 Approver” 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.

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

  • 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.

  • 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.

  • Pay and process claims within designated authority level.

  • Confer with legal counsel on claims requiring litigation.

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

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

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

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

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

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

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

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

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

  • Obtain credit information from banks and other credit services.

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

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

  • Report overpayments, underpayments, and other irregularities.

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

  • 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.

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

  • 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.

  • Attend mediations or trials.

  • Collect evidence to support contested claims in court.

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

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

Technologies & Software

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

Alternative Job Titles