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.
U.S. Workers
305,020
Median Salary
$76,790
10-Year Growth
-5.1%
Annual Openings
21,100
Typical entry: High school diploma or equivalent
16 of 16 tasks have some AI capability
Exposure Trend
This score reflects estimated AI technical capability for tasks in this occupation. It does not predict employment changes, and it does not account for company-specific constraints, regulation, or adoption barriers.
Pay and process claims within designated authority level.
AI: Fully automatable - AI and automated workflows can fully pay and process claims that fall within predefined authority limits via straight-through processing and integrated payment systems.
Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
AI: Fully automatable - Structured data entry and generation of concise file documentation can be fully automated with RPA and AI-driven document understanding and validation workflows with high accuracy.
Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
AI: Fully automatable - Maintaining records, tracking inventories, and indexing settled claims are repetitive, structured tasks that can be reliably automated with document management and workflow systems.
Report overpayments, underpayments, and other irregularities.
AI: Fully automatable - Detection and reporting of overpayments, underpayments, and irregularities are rule- and data-driven tasks that AI can accurately identify and generate reports for.
Prepare reports to be submitted to company's data processing department.
AI: Fully automatable - Generating standardized reports from claims data is routine data-processing work that modern AI systems can fully automate and format for downstream systems.
Supervise claims adjusters to ensure that adjusters have followed proper methods.
AI: Partial - AI can audit adjuster work, flag noncompliance, and provide coaching prompts, but actual supervision, mentoring, and enforcement of methods involve human managerial responsibilities.
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: Partial - AI can investigate and evaluate many claims and recommend settlements, but the human-relations, negotiation, and discretionary judgment needed for fair resolution and regulatory compliance require human involvement.
Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
AI: Partial - AI can compute reserve estimates and generate recommendations consistent with corporate policies using actuarial models, but regulatory, governance, and judgmental sign-off typically require human oversight.
Resolve complex, severe exposure claims, using high service oriented file handling.
AI: Partial - AI can support analysis and propose handling strategies for high-exposure claims, yet resolving complex severe exposures that involve negotiation, litigation risk, and nuanced service remains dependent on human experts.
Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
AI: Partial - AI can examine adjuster files, surface inconsistencies, and run additional automated investigations, but final authorization for questionable claims generally requires human adjudication.
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: Partial - AI systems in 2025 can perform rule-based data verification and statistical/anomaly analysis and flag likely invalid or noncompliant claims, but complex judgment on ambiguous or novel cases still requires human examiners.
Confer with legal counsel on claims requiring litigation.
AI: Partial - AI can prepare briefs, summarize facts, and surface relevant precedents to assist legal discussions, but actual conferring, strategy-setting, and privileged legal judgment remain human responsibilities.
Conduct detailed bill reviews to implement sound litigation management and expense control.
AI: Partial - Automated bill parsing, fee-schedule matching, and anomaly detection are mature, yet applying nuanced litigation management decisions and discretionary expense-control tactics still needs human oversight.
Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
AI: Partial - Routine outreach, scheduling, and standardized questionnaires can be automated and AI can collect factual information, but sensitive, clinical, or complex interviews requiring empathy and professional judgment need humans.
Present cases and participate in their discussion at claim committee meetings.
AI: Partial - AI can generate presentation materials and case analyses for committee meetings, but participating in discussions, defending positions, and making discretionary decisions during meetings require human judgment.
Communicate with reinsurance brokers to obtain information necessary for processing claims.
AI: Partial - AI can automate routine information requests and draft communications to reinsurance brokers, but complex negotiations, relationship management, and bespoke information exchanges typically require human involvement.