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Automation Risk Analysis

Will “Workers' Compensation Claims Examiner” 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%

“Workers' Compensation Claims Examiner” 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%

“Workers' Compensation Claims Examiner” 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

  • Obtain credit information from banks and other credit services.

  • 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.

  • Attend mediations or trials.

  • 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.

  • Pay and process claims within designated authority level.

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

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

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

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

  • 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.

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

  • Confer with legal counsel on claims requiring litigation.

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

  • 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.

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

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

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

  • 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.

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

  • 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.

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

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

  • Collect evidence to support contested claims in court.

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

Technologies & Software

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

Alternative Job Titles