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Automation Risk Analysis

Will “Insurance Claims Adjuster” 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 Claims Adjuster” 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 Claims Adjuster” 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

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

  • Obtain credit information from banks and other credit services.

  • 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.

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

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

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

  • Confer with legal counsel on claims requiring litigation.

  • 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.

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

  • 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.

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

  • Attend mediations or trials.

  • Report overpayments, underpayments, and other irregularities.

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

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

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

  • Collect evidence to support contested claims in court.

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

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

  • 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.

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

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

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

Technologies & Software

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

Alternative Job Titles