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Automation Risk Analysis

Will “Workers' Compensation Claims Representative” 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 Representative” 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 Representative” 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.

  • Report overpayments, underpayments, and other irregularities.

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

  • 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.

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

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

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

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

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

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

  • Collect evidence to support contested claims in court.

  • Confer with legal counsel on claims requiring litigation.

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

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

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

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

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

  • 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.

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

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

  • 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.

  • Pay and process claims within designated authority level.

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

  • 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.

  • Attend mediations or trials.

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

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

Technologies & Software

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

Alternative Job Titles