JOB REPORT / 13-1031 · 29 TASKS

Claims Adjusters, Examiners, and Investigators.

Can AI do the work of Claims Adjusters, Examiners, and Investigators?

Mostly it works alongside you. Here is what shifts, task by task.

YOUR EXPERIENCE MATTERS

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How many tasks do you use AI to assist with at work?

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The parts of your job AI can already do most of:

Examine claims forms and other records to determine insurance…
Verify and analyze data used in settling claims…
Review police reports, medical treatment records, medical bills,…

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A guided certificate program in AI-assisted Claims Adjusters, Examiners, and Investigators work. It covers the 28 AI-affected parts of your job and ends in a capstone a person reviews.

WHAT WE LOOKED AT

Your job, task by task.

28 of 29 tasks reviewed

This job has 29 core tasks. We went through 28 of them, one at a time.

Task by task, from the work Claims Adjusters, Examiners, and Investigators actually do. How we describe AI use in each task is our own read of it, not a measurement of whether AI can replace the job.

TASK 01
Examine claims forms and other records to determine insurance coverage.
AI DOES
Reads and cross-references claim forms against policy terms to flag coverage matches or gaps
YOU DO
Apply judgment on borderline cases and take responsibility for the final coverage decision
TASK 02
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.
AI DOES
Scans claim documents, cross-checks data against policy rules, and flags errors or mismatches automatically
YOU DO
Apply judgment to gray-area cases and take responsibility for final settlement decisions
TASK 03
Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
AI DOES
Extracts key facts from reports and bills, flags inconsistencies, and summarizes records quickly
YOU DO
Weigh context, credibility, and gray-area facts to decide actual liability
TASK 04
Refer questionable claims to investigator or claims adjuster for investigation or settlement.
AI DOES
Scans claim details and flags unusual patterns or red flags automatically
YOU DO
Apply real-world judgment about fraud signals and decide who handles the case
TASK 05
Conduct detailed bill reviews to implement sound litigation management and expense control.
AI DOES
Scans invoices, flags unusual charges, and compares billing rates to guidelines
YOU DO
Apply judgment about litigation strategy and negotiate disputed charges
TASK 06
Report overpayments, underpayments, and other irregularities.
AI DOES
Scans payment data, spots mismatches, and drafts irregularity reports
YOU DO
Judge whether a flag is a real problem and decide next steps
TASK 07
Prepare reports to be submitted to company's data processing department.
AI DOES
Drafts and formats standard claim reports from structured data
YOU DO
Verify claim details and catch errors before submission
TASK 08
Obtain credit information from banks and other credit services.
AI DOES
Sends data requests, retrieves and formats credit reports automatically
YOU DO
Verify accuracy and handle unusual or disputed credit situations
TASK 09
Pay and process claims within designated authority level.
AI DOES
Checks claim data against policy rules, calculates settlement amounts, and routes standard claims for fast processing
YOU DO
Apply judgment on borderline cases and take legal responsibility for final approval
TASK 10
Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
AI DOES
Auto-fills claim fields, suggests reserve amounts, and drafts file notes from structured data
YOU DO
Verify accuracy, apply case-specific judgment, and approve final entries
TASK 11
Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
AI DOES
Sorts and updates claim records, flags files that need review, and generates status summaries
YOU DO
Decide which complex cases truly need deeper investigation and catch errors AI might miss
TASK 12
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.
AI DOES
Pulls claim data, spots inconsistencies, and drafts settlement recommendations
YOU DO
Apply judgment on fairness, handle sensitive conversations, and make the final call
TASK 13
Investigate and assess damage to property and create or review property damage estimates.
AI DOES
Pulls comparable damage estimates, drafts reports, and flags inconsistencies in submitted claims
YOU DO
Visit the property, use your judgment about real damage severity, and make the final call on a fair payout
TASK 14
Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
AI DOES
Drafts letters, summarizes claim files, and spots inconsistencies in data
YOU DO
Read people, ask follow-up questions, and decide what's truly suspicious
TASK 15
Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
AI DOES
Drafts correspondence, summarizes interview notes, flags missing info, and suggests follow-up questions
YOU DO
Read body language, build rapport, and judge credibility in real conversations
TASK 16
Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
AI DOES
Analyzes claim data, flags reserve mismatches, and drafts recommendations based on past cases
YOU DO
Weigh legal risk, company policy nuance, and case context before approving any reserve change
TASK 17
Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
AI DOES
Scans claim data for red flags, inconsistencies, and fraud patterns
YOU DO
Weigh context, interview claimants, and make the final call on payment
TASK 18
Communicate with reinsurance brokers to obtain information necessary for processing claims.
AI DOES
Drafts emails, summarizes broker responses, and flags missing information
YOU DO
Keep relationships strong and judge when to push back on broker decisions
TASK 19
Examine titles to property to determine validity and act as company agent in transactions with property owners.
AI DOES
Searches public records, flags title defects, and summarizes ownership history
YOU DO
Make final legal calls and represent the company in real property deals
TASK 20
Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.
AI DOES
Drafts verification emails, summarizes background info, and flags missing details
YOU DO
Build trust in conversations and judge whether answers seem credible
TASK 21
Present cases and participate in their discussion at claim committee meetings.
AI DOES
Drafts case summaries, pulls key facts, and flags relevant policy details before the meeting
YOU DO
Lead the room, read the group, and defend your reasoning in real time
TASK 22
Collect evidence to support contested claims in court.
AI DOES
Searches databases, organizes case files, summarizes records, and spots inconsistencies in documents
YOU DO
Visit scenes, interview witnesses, and apply legal and situational judgment to build a credible case
TASK 23
Resolve complex, severe exposure claims, using high service oriented file handling.
AI DOES
Summarizes medical records, flags coverage issues, drafts correspondence, and pulls comparable settlement data
YOU DO
Own the negotiation, read people's credibility, and make the final coverage and settlement call
TASK 24
Supervise claims adjusters to ensure that adjusters have followed proper methods.
AI DOES
Scans claim files for missing steps, policy errors, or compliance gaps
YOU DO
Coach adjusters, read situations, and make judgment calls about people
TASK 25
Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
AI DOES
Drafts interview questions, summarizes call notes, and flags missing information
YOU DO
Lead the actual conversation and read tone and honesty in real time
TASK 26
Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.
AI DOES
Pulls comparable cases, flags coverage rules, and suggests settlement value ranges
YOU DO
Own the negotiation conversation and final settlement decision
TASK 27
Confer with legal counsel on claims requiring litigation.
AI DOES
Summarizes claim history, pulls relevant case law, and drafts talking points before the meeting
YOU DO
Lead the legal discussion and make judgment calls on litigation strategy
TASK 28SOURCE-BACKED TASK
Analyze information gathered by investigation and report findings and recommendations.
AI DOES
Organizes data and drafts initial findings
YOU DO
Judge what the evidence really means
About this analysis
25% · Methodology: exposure-v1 · Analysis date: unavailable · Confidence: medium

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AT A GLANCE

Occupation: Claims Adjusters, Examiners, and Investigators
SOC code: 13-1031
Tasks reviewed: 28 of 29

How we assess

PAY & OUTLOOK

Compare pay by state

Median pay (national): $78,000 · BLS OEWS 2025
Median pay (Colorado): $77,620 · BLS OEWS 2025
Employed (national): 324,230
Employed in Colorado: 5,680
Job outlook: −5.1% by 2034 · ~21,100 openings/yr

Wages from the U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics. National figures cover the United States. Job outlook is national.

How does this fit your work?

Earn a certificate in your job

Your job, task by task.

Examine claims forms and other records to determine insurance coverage.

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.

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

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

Report overpayments, underpayments, and other irregularities.

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

Obtain credit information from banks and other credit services.

Pay and process claims within designated authority level.

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

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

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.

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

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

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

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.

Communicate with reinsurance brokers to obtain information necessary for processing claims.

Examine titles to property to determine validity and act as company agent in transactions with property owners.

Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.

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

Collect evidence to support contested claims in court.

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

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

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

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

Confer with legal counsel on claims requiring litigation.

Analyze information gathered by investigation and report findings and recommendations.

Practice AI.Use your judgment.

Practice AI.
Use your judgment.