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.

The occupation of "Claims Adjusters, Examiners, and Investigators" has an automation risk of 51.0%, with a base risk calculated at 51.7%. This moderate risk level reflects a balance between tasks that are routine and easily automated, and those requiring human judgment or interpersonal skills. With advancements in artificial intelligence and process automation, insurers are increasingly automating standard processes for handling, reviewing, and processing claims. This is especially true for straightforward cases that follow established procedures or rely on structured information. As a result, the core of many claims assessment activities is susceptible to partial or substantial automation. The three most automatable tasks in this occupation are highly routine and rule-based. For example, examining claims forms and other records to determine insurance coverage can largely be accomplished by algorithms programmed to follow insurance policy guidelines. Similarly, analyzing information gathered during investigations and reporting findings and recommendations is conducive to automation through data analytics and standardized reporting tools. Finally, paying and processing claims within designated authority levels often involves checking criteria against predefined rules, a function well suited to automation software. Together, these tasks represent a significant portion of daily activities that could be efficiently handled by software, thereby contributing to the occupation's overall automation risk. Despite this, several tasks remain relatively resistant to automation, underscoring the continued need for human involvement. Notably, negotiating claim settlements or recommending litigation when settlements cannot be reached requires nuanced judgment, interpersonal negotiation skills, and occasionally creativity—capacities where machines still lag behind humans. Similarly, communicating with former associates to verify employment records or collecting sensitive background information on individuals or businesses involves trust-building and discretion, skills that are inherently people-centric. Obtaining credit information from banks and credit services often demands bespoke communication and relationship management. Bottleneck skills such as Originality, measured at 2.6%, highlight areas where human thought, innovative problem-solving, and unique judgment provide significant value and serve as a natural constraint on full automation of the role.