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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

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

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

  • Pay and process claims within designated authority level.

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

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

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

  • Collect evidence to support contested claims in court.

  • 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.

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

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

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

  • 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 claims forms and other records to determine insurance coverage.

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

  • Confer with legal counsel on claims requiring litigation.

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

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

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

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

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

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

  • 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.

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

  • Attend mediations or trials.

  • 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.

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

Technologies & Software

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

Alternative Job Titles