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Automation Risk Analysis

Will “Insurance 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%

“Insurance 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%

“Insurance 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

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

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

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

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

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

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

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

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

  • Pay and process claims within designated authority level.

  • Confer with legal counsel on claims requiring litigation.

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

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

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

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

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

  • Attend mediations or trials.

  • Collect evidence to support contested claims in court.

  • Obtain credit information from banks and other credit services.

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

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

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

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

  • 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.

  • 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.

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

  • Report overpayments, underpayments, and other irregularities.

Technologies & Software

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

Alternative Job Titles