Will AI Replace Claims Adjusters, Examiners, and Investigators?

Examine claims forms and other records to determine insurance coverage.

data analysis — Organizational calculations from given data

Analyze information gathered by investigation and report findings and recommendations.

text generation — Draft legal docs; attorney owns accuracy

Pay and process claims within designated authority level.

data analysis — Payments executed via systems; human authorizes

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.

information retrieval — Legal research strong, judgment and accountability human

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.

data analysis — Cross-checking records against criteria, human spot-checks

Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.

data analysis — Cost estimation from given inputs

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

decision support — Appraisal needs local market judgment and inspection

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

interpersonal — Witness/suspect interviews need human presence

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

interpersonal — Witness/suspect interviews need human presence

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

data analysis — Enter and maintain data in information systems

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

decision support — AI advises on IT solutions; humans implement and validate

Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.

decision support — AI drafts financial guidance; accountability and tailoring human

Confer with legal counsel on claims requiring litigation.

interpersonal — Legal-process meetings carry accountability and live presence

Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.

information retrieval — Legal research strong, judgment and accountability human

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

text generation — Standard financial documents drafted from data

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

text generation — AI drafts reports to managers; human sends

Collect evidence to support contested claims in court.

physical manipulation — Evidence collection is fieldwork with chain of custody

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

interpersonal — Witness/suspect interviews need human presence

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

interpersonal — Business presentations are live persuasive human work

Report overpayments, underpayments, and other irregularities.

text generation — AI drafts reports to managers; human sends

Attend mediations or trials.

information retrieval — Legal research strong, judgment and accountability human

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

interpersonal — Employee supervision is accountability-bearing human work

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

data analysis — Examines records for anomalies; human validates findings

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

decision support — Financial conferral aided; judgment and trust human

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

text generation — Generate operational reports from structured data

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

data analysis — Cross-checking records against criteria, human spot-checks

Obtain credit information from banks and other credit services.

information retrieval — Gather financial records, human verifies authenticity

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

decision support — Eligibility screening against rules, human decides edge cases

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

decision support — Compliance guidance drafted; human verifies and owns