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Automation Risk Analysis

Will “Claims Auditor” 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 Auditor” 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 Auditor” 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

  • Attend mediations or trials.

  • 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.

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

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

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

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

  • Collect evidence to support contested claims in court.

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

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

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

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

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

  • Report overpayments, underpayments, and other irregularities.

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

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

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

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

  • Obtain credit information from banks and other credit services.

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

  • Pay and process claims within designated authority level.

  • 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.

  • Confer with legal counsel on claims requiring litigation.

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

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

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

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

  • 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.

Technologies & Software

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

Alternative Job Titles