Will AI replace Claims Adjusters, Examiners, and Investigators?

AI can do 82% of the work Claims Adjusters, Examiners, and Investigators do at least twice as fast. People already use it for 2 of their 29 tasks, while 21 more are ready but barely used so far. Robots can technically handle 1 physical task. 5 still need a person.

AI is already doing this2 · 10% of time

People already use AI for these tasks in real work, based on Anthropic's analysis of how Claude is used.

  • Examine claims forms and other records to determine insurance coverage.Mostly automated9% of time
  • Prepare reports to be submitted to company's data processing department.Mostly automated1% of time

AI could do this next21 · 72% of time

AI can speed these up by at least half, but real use has not caught up yet. These are next in line.

  • 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.9% of time
  • Analyze information gathered by investigation and report findings and recommendations.8% of time
  • Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.6% of time
  • Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.6% of time
  • 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.6% of time
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.6% of time
  • Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.5% of time
  • Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.5% of time
  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.4% of time
  • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.4% of time
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.3% of time
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.3% of time
  • Confer with legal counsel on claims requiring litigation.3% of time
  • Refer questionable claims to investigator or claims adjuster for investigation or settlement.1% of time
  • Collect evidence to support contested claims in court.1% of time
  • Present cases and participate in their discussion at claim committee meetings.1% of time
  • Conduct detailed bill reviews to implement sound litigation management and expense control.1% of time
  • Report overpayments, underpayments, and other irregularities.1% of time
  • Examine titles to property to determine validity and act as company agent in transactions with property owners.under 1% of time
  • Obtain credit information from banks and other credit services.under 1% of time
  • Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.under 1% of time

Robots can technically do this1 · 5% of time

Physical tasks that today's robots can perform in at least some settings. Robots are cost competitive for very few tasks so far, so this change moves slower.

  • Investigate and assess damage to property and create or review property damage estimates.Robots: structured workplaces5% of time

Still needs a person5 · 13% of time

No real AI use, no proven AI speedup and no robot that can do it yet. This is the part of the job to build on.

  • Pay and process claims within designated authority level.6% of time
  • Resolve complex, severe exposure claims, using high service oriented file handling.4% of time
  • Supervise claims adjusters to ensure that adjusters have followed proper methods.1% of time
  • Attend mediations or trials.1% of time
  • Communicate with reinsurance brokers to obtain information necessary for processing claims.under 1% of time

Your week is not the average

Describe what you actually do and get a personal report: your own tasks, what AI can already do, what stays yours and a 90 day plan.

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What this means

AI can already do almost all of this work at least twice as fast. Real use is still behind at 10 out of 100, so the change here is only getting started. Expect the role to shift toward deciding what to do, checking AI's work and owning the result.

What to do next

  • Do the 2 tasks AI is already handling with AI yourself. Your peers already are, and it is quickly becoming the baseline.
  • Get ahead on the 21 tasks AI could do next. These move as tools improve, so learning them early pays off.
  • Keep an eye on the 1 physical task robots can technically do. Cost keeps most robots out of work today, so this shift is slower.
  • Build on the 5 tasks that stay human. This is where your judgment, skill and relationships matter most.
Insurance Appraisers, Auto Damage73%Online Merchants82%Compliance Officers81%Project Management Specialists83%Management Analysts81%Meeting, Convention, and Event Planners83%

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