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Will AI Replace Claims Adjusters, Examiners, and Investigators?
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.
43out of 100
Medium Risk
AI Risk Score
43/100
Risk Level
Medium
Job Zone
4/5
Advanced
Total Tasks Analyzed
21
🤖 What AI Can Do
- ▸Examine claims forms and other records to determine insurance coverage.
- ▸Analyze information gathered by investigation and report findings and recommendations.
- ▸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.
- ▸Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- ▸Investigate and assess damage to property and create or review property damage estimates.
- ▸Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
👤 What Requires Humans
- ▸Confer with legal counsel on claims requiring litigation.
- ▸Present cases and participate in their discussion at claim committee meetings.
Task Breakdown
🤖AI Can Automate (11)
- Examine claims forms and other records to determine insurance coverage.
- Analyze information gathered by investigation and report findings and recommendations.
- 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.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Investigate and assess damage to property and create or review property damage estimates.
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Report overpayments, underpayments, and other irregularities.
👤Requires Humans (2)
- Confer with legal counsel on claims requiring litigation.
- Present cases and participate in their discussion at claim committee meetings.
⚡AI-Assisted (8)
- Pay and process claims within designated authority level.
- 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.
- Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- 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.
- Collect evidence to support contested claims in court.
- Attend mediations or trials.
Key Skills Analysis
Reading ComprehensionAI-Vulnerable
Importance: 4.12/5.00
Active Listening
Importance: 4.00/5.00
Critical ThinkingAI-Resistant
Importance: 4.00/5.00
Speaking
Importance: 3.88/5.00
Judgment and Decision MakingAI-Resistant
Importance: 3.75/5.00
WritingAI-Vulnerable
Importance: 3.62/5.00
Complex Problem SolvingAI-Resistant
Importance: 3.50/5.00
Monitoring
Importance: 3.38/5.00
Social PerceptivenessAI-Resistant
Importance: 3.38/5.00
Active LearningAI-Resistant
Importance: 3.25/5.00
CoordinationAI-Resistant
Importance: 3.25/5.00
NegotiationAI-Resistant
Importance: 3.12/5.00
Service OrientationAI-Resistant
Importance: 3.12/5.00
Systems AnalysisAI-Vulnerable
Importance: 3.00/5.00
Time ManagementAI-Resistant
Importance: 3.00/5.00
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Frequently Asked Questions
Based on our analysis, Claims Adjusters, Examiners, and Investigators have a medium risk of AI replacement with a score of 43/100. While some tasks can be assisted by AI, the core responsibilities require human judgment and skills.
Last updated: 2026-03-28· Data from O*NET 30.2 & Frey/Osborne automation research