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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.

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

  • Confer with legal counsel on claims requiring litigation.

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

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

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

  • Collect evidence to support contested claims in court.

  • Report overpayments, underpayments, and other irregularities.

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

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

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

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

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

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

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

  • 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.

  • 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 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.

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

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

  • Attend mediations or trials.

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

  • Pay and process claims within designated authority level.

  • 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.

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

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

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

Technologies & Software

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

Alternative Job Titles