AI exposure: 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.
Reading this score
computed40.7% of this occupation's weighted task load is exposed, which puts Claims Adjusters, Examiners, and Investigators at the 72th percentile of 923 occupations. The capability is largely there. Its average task scores 2.7 out of 4 on what a current system can produce, and the frictions that hold other jobs in place are comparatively weak here.
What holds the line here is context. Across this occupation's 29 tasks it averages 2.14 out of 3, the highest of the five friction dimensions. In plain terms, the work depends on knowledge the model cannot hold. Much of this job runs on things that were never written down: what this particular organisation does, what happened last week, what the person across the table actually meant. That context is the barrier, and it erodes as systems are given more access.
The most exposed thing this job does is Examine claims forms and other records to determine insurance coverage, at 86.7%. The least is Contact or interview claimants, doctors, medical specialists, or employers to get additional..., at 0.0%. A gap of 86.7% between two parts of the same job is the reason this index publishes at task level. An occupation-wide number would have hidden both.
Within business and financial operations occupations, this one is less exposed than the median of 47.5% across the group's 48 roles, with 35 scoring higher. Being in an exposed family does not make a particular job exposed, and the reverse holds too.
What would move this score. Of 29 tasks, 15 are currently banded exposed, 9 assisted and 5 untouched. For that distribution to shift materially would take a change in who is permitted to sign the work, which is a question for regulators rather than for engineers. The score is re-computed every quarter against a fresh capability reference, and the change is published rather than quietly applied.
Task by task
29 tasks, O*NET 31.0| Task | Exposed | Assisted | Untouched | Importance | Band |
|---|---|---|---|---|---|
| Examine claims forms and other records to determine insurance coverage. | 86.7% | 13.3% | 0.0% | 4.79 | exposed |
| 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. | 73.3% | 26.7% | 0.0% | 4.68 | exposed |
| Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability. | 73.3% | 26.7% | 0.0% | 4.67 | exposed |
| Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation. | 73.3% | 26.7% | 0.0% | 4.57 | exposed |
| Prepare reports to be submitted to company's data processing department. | 73.3% | 26.7% | 0.0% | 3.70 | exposed |
| Examine titles to property to determine validity and act as company agent in transactions with property owners. | 73.3% | 26.7% | 0.0% | 3.70 | exposed |
| Refer questionable claims to investigator or claims adjuster for investigation or settlement. | 66.7% | 33.3% | 0.0% | 4.29 | exposed |
| Report overpayments, underpayments, and other irregularities. | 66.7% | 33.3% | 0.0% | 3.81 | exposed |
| Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis. | 60.0% | 40.0% | 0.0% | 4.29 | exposed |
| Resolve complex, severe exposure claims, using high service oriented file handling. | 50.0% | 25.0% | 25.0% | 4.49 | exposed |
| Obtain credit information from banks and other credit services. | 50.0% | 25.0% | 25.0% | 2.94 | exposed |
| Pay and process claims within designated authority level. | 45.0% | 30.0% | 25.0% | 4.75 | exposed |
| Conduct detailed bill reviews to implement sound litigation management and expense control. | 45.0% | 30.0% | 25.0% | 4.01 | exposed |
| Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit. | 45.0% | 30.0% | 25.0% | – | exposed |
| Present cases and participate in their discussion at claim committee meetings. | 40.0% | 35.0% | 25.0% | 3.94 | exposed |
| Analyze information gathered by investigation and report findings and recommendations. | 37.5% | 37.5% | 25.0% | 4.76 | assisted |
| Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. | 35.0% | 40.0% | 25.0% | 4.39 | assisted |
| Attend mediations or trials. | 35.0% | 40.0% | 25.0% | 3.71 | assisted |
| Communicate with reinsurance brokers to obtain information necessary for processing claims. | 35.0% | 40.0% | 25.0% | 3.95 | assisted |
| Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies. | 29.2% | 33.3% | 37.5% | 4.43 | assisted |
| Investigate and assess damage to property and create or review property damage estimates. | 20.0% | 55.0% | 25.0% | 4.63 | assisted |
| 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. | 18.3% | 31.7% | 50.0% | 4.74 | assisted |
| Negotiate claim settlements or recommend litigation when settlement cannot be negotiated. | 18.3% | 31.7% | 50.0% | – | assisted |
| Confer with legal counsel on claims requiring litigation. | 16.7% | 33.3% | 50.0% | 4.41 | assisted |
| Supervise claims adjusters to ensure that adjusters have followed proper methods. | 13.3% | 11.7% | 75.0% | 4.17 | untouched |
| Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims. | 0.0% | 0.0% | 100.0% | 4.62 | untouched |
| Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review. | 0.0% | 0.0% | 100.0% | 4.59 | untouched |
| Collect evidence to support contested claims in court. | 0.0% | 0.0% | 100.0% | 4.26 | untouched |
| Contact or interview claimants, doctors, medical specialists, or employers to get additional information. | 0.0% | 0.0% | 100.0% | 4.04 | untouched |
Task text and importance ratings sourced from O*NET 31.0. Shares computed. The occupation score is the importance-weighted mean. 2 task(s) lacked a usable O*NET weight and are shown but excluded from the weighting.
Where the score comes from
judgedEvery task is scored through the standardised work activities it maps to. These are this occupation’s averages on the six rubric dimensions. Capability is what AI can do; the other five are what stands in the way.
| Dimension | Mean | Scale |
|---|---|---|
| Capability | 2.71 | 0-4 |
| Embodiment | 0.48 | 0-3 |
| Presence | 1.12 | 0-3 |
| Accountability | 1.62 | 0-3 |
| Context | 2.14 | 0-3 |
| Verification cost | 1.93 | 0-3 |
What this means in practice
Where most of a role's weighted task load is exposed, the work that survives is usually the part of the job nobody wrote into the job description: deciding what should be produced rather than producing it, and being answerable for the result. The tasks lowest on this page are a better guide to where to spend your time than any general advice about the future of work.
Occupations either side of this one
The four closest scores in the same occupational family, then the four closest anywhere in the index.
Read this carefully. Exposure is not displacement. A high score means current AI systems can produce this work, not that anyone will stop paying a person to do it. Adoption depends on economics, regulation and inertia that this index deliberately does not model. How the score is built.