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Automation Risk Analysis

Will “Claims Representative” 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 Representative” 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 Representative” 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

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

  • 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.

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

  • Report overpayments, underpayments, and other irregularities.

  • 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.

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

  • 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.

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

  • 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.

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

  • Pay and process claims within designated authority level.

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

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

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

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

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

  • Attend mediations or trials.

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

  • Obtain credit information from banks and other credit services.

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

  • Collect evidence to support contested claims in court.

  • Confer with legal counsel on claims requiring litigation.

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

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

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

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

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

Technologies & Software

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

Alternative Job Titles