Claims Examiners, Property and Casualty Insurance
SOC: 13-1031.01 · Job Zone 4 (Considerable preparation)
Review settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures. Report overpayments, underpayments, and other irregularities. Confer with legal counsel on claims requiring litigation.
AI Impact Summary
Claims Examiners, Property and Casualty Insurance faces moderate AI displacement risk with a score of 41/100. Significant displacement is estimated between 2038 and 2046. Of 16 analyzed tasks, 6 are highly automatable, particularly in routine_cognitive. Strong protective factors — including social intelligence, creativity, or regulatory barriers — significantly reduce effective risk.
Protective Factors
Total protective discount: 25.8%
Skill Analysis
AI-Vulnerable Skills (6)
High reliance on Reading Comprehension is a risk area. Consider developing complementary AI-resistant skills to maintain value.
High reliance on Information Ordering is a risk area. Consider developing complementary AI-resistant skills to maintain value.
Mathematics is AI-vulnerable but has moderate importance in this role. AI tools may handle this; focus on higher-value skills.
Mathematics is AI-vulnerable but has moderate importance in this role. AI tools may handle this; focus on higher-value skills.
Memorization is AI-vulnerable but has moderate importance in this role. AI tools may handle this; focus on higher-value skills.
Programming is AI-vulnerable but has moderate importance in this role. AI tools may handle this; focus on higher-value skills.
AI-Resistant Skills (7)
Negotiation is AI-resistant — strengthening this skill provides durable career protection.
Social Perceptiveness is AI-resistant — strengthening this skill provides durable career protection.
Complex Problem Solving is AI-resistant — strengthening this skill provides durable career protection.
Coordination is AI-resistant — strengthening this skill provides durable career protection.
Persuasion is AI-resistant — strengthening this skill provides durable career protection.
Instructing is AI-resistant — strengthening this skill provides durable career protection.
Manual Dexterity is AI-resistant — strengthening this skill provides durable career protection.
AI-Augmented Skills (5)
Recommendations
Skills to Develop
These skills are at risk from AI automation. Claims Examiners, Property and Casualty Insurance professionals should diversify beyond them.
- Reading Comprehension
High reliance on Reading Comprehension is a risk area. Consider developing complementary AI-resistant skills to maintain value.
- Information Ordering
High reliance on Information Ordering is a risk area. Consider developing complementary AI-resistant skills to maintain value.
- Mathematics
Mathematics is AI-vulnerable but has moderate importance in this role. AI tools may handle this; focus on higher-value skills.
- Mathematics
Mathematics is AI-vulnerable but has moderate importance in this role. AI tools may handle this; focus on higher-value skills.
- Memorization
Memorization is AI-vulnerable but has moderate importance in this role. AI tools may handle this; focus on higher-value skills.
Skills to Leverage
These human-centric skills remain difficult for AI to replicate. Double down here.
- Negotiation
Negotiation is AI-resistant — strengthening this skill provides durable career protection.
- Social Perceptiveness
Social Perceptiveness is AI-resistant — strengthening this skill provides durable career protection.
- Complex Problem Solving
Complex Problem Solving is AI-resistant — strengthening this skill provides durable career protection.
- Coordination
Coordination is AI-resistant — strengthening this skill provides durable career protection.
- Persuasion
Persuasion is AI-resistant — strengthening this skill provides durable career protection.
Tools to Adopt
AI can amplify these skills. Learn the tools that augment rather than replace your work.
- Writing
Writing will be enhanced by AI. Develop expertise in using AI tools for this skill to increase productivity.
- Critical Thinking
Critical Thinking will be enhanced by AI. Develop expertise in using AI tools for this skill to increase productivity.
- Judgment and Decision Making
Judgment and Decision Making will be enhanced by AI. Develop expertise in using AI tools for this skill to increase productivity.
- Active Learning
Active Learning will be enhanced by AI. Develop expertise in using AI tools for this skill to increase productivity.
- Systems Analysis
Systems Analysis will be enhanced by AI. Develop expertise in using AI tools for this skill to increase productivity.
Task Breakdown
16 tasks analyzed
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.
Supervise claims adjusters to ensure that adjusters have followed proper methods.
Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
Resolve complex, severe exposure claims, using high service oriented file handling.
Pay and process claims within designated authority level.
Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
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.
Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
Confer with legal counsel on claims requiring litigation.
Conduct detailed bill reviews to implement sound litigation management and expense control.
Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
Report overpayments, underpayments, and other irregularities.
Present cases and participate in their discussion at claim committee meetings.
Communicate with reinsurance brokers to obtain information necessary for processing claims.
Prepare reports to be submitted to company's data processing department.
| Task | Category | AI Capability | Risk Score | Time % |
|---|---|---|---|---|
| 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. | Non-Routine Analytical | 45 | 45.0 | 15% |
| Supervise claims adjusters to ensure that adjusters have followed proper methods. | Non-Routine Interpersonal | 20 | 23.0 | 5% |
| Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies. | Non-Routine Analytical | 70 | 55.0 | 8% |
| Resolve complex, severe exposure claims, using high service oriented file handling. | Non-Routine Analytical | 45 | 45.0 | 10% |
| Pay and process claims within designated authority level. | Routine Cognitive | 90 | 85.2 | 8% |
| Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. | Non-Routine Analytical | 70 | 55.0 | 8% |
| 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. | Routine Cognitive | 85 | 83.2 | 8% |
| Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation. | Routine Cognitive | 90 | 85.2 | 8% |
| Confer with legal counsel on claims requiring litigation. | Non-Routine Interpersonal | 20 | 23.0 | 5% |
| Conduct detailed bill reviews to implement sound litigation management and expense control. | Non-Routine Analytical | 70 | 55.0 | 5% |
| Contact or interview claimants, doctors, medical specialists, or employers to get additional information. | Non-Routine Interpersonal | 25 | 25.0 | 6% |
| Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis. | Routine Cognitive | 90 | 85.2 | 4% |
| Report overpayments, underpayments, and other irregularities. | Routine Cognitive | 85 | 83.2 | 2% |
| Present cases and participate in their discussion at claim committee meetings. | Non-Routine Interpersonal | 15 | 21.0 | 4% |
| Communicate with reinsurance brokers to obtain information necessary for processing claims. | Non-Routine Interpersonal | 25 | 25.0 | 2% |
| Prepare reports to be submitted to company's data processing department. | Routine Cognitive | 90 | 85.2 | 2% |
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