🤖 BARBIE MODE ACTIVATED 💗    Your adblocker was detected!    Comic Sans has been applied as cosmic punishment 💅    Ads keep this database FREE — please whitelist replacedbyrobot.info!    ✨ Everything is pink and that's entirely your fault ✨    🌸                     🤖 BARBIE MODE ACTIVATED 💗    Your adblocker was detected!    Comic Sans has been applied as cosmic punishment 💅    Ads keep this database FREE — please whitelist replacedbyrobot.info!    ✨ Everything is pink and that's entirely your fault ✨    🌸                     
Automation Risk Analysis

Will “Insurance Fraud Investigator” be Automated?

Historical Context: Oxford Study (2013)

Ranked #675 of 702. Estimated risk: 98.0%

Directly assessed by researchers as likely automatable
Advertisement

A robot took your ad!

Ads keep this free database of 57,000+ jobs alive. Please whitelist replacedbyrobot.info — we promise our ads are tasteful!

AI Exposure Risk

56%

“Insurance Fraud Investigator” 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 Fraud Investigator” 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”

Advertisement

A robot took your ad!

Ads keep this free database of 57,000+ jobs alive. Please whitelist replacedbyrobot.info — we promise our ads are tasteful!

Core Skills & Abilities

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

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

  • 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.

  • Attend mediations or trials.

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

  • Obtain credit information from banks and other credit services.

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

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

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

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

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

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

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

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

  • Report overpayments, underpayments, and other irregularities.

  • 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.

  • Pay and process claims within designated authority level.

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

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

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

  • Collect evidence to support contested claims in court.

  • 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.

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

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

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

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

Technologies & Software

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

Alternative Job Titles