Will AI replace claims examiners?

Why AI struggles to replace this job

• Investigating suspicious claims that involve complex, multi-party fraud rings.
• Handling sensitive claims involving death or trauma requires human compassion.
• Evaluating liability in unique or unprecedented legal situations.
• Negotiating settlements in cases where policy language is ambiguous.

Tasks AI could automate

• Verifying that a submitted claim meets the basic requirements of the policy.
• Reviewing photos of vehicle damage to estimate repair costs automatically.
• Checking medical bills against standard fee schedules for accuracy.
• Approving and processing small-dollar, routine property damage claims.

The 10-year outlook

Employment is expected to decline as AI handles the majority of routine claims. Remaining examiners will focus on high-value, complex, or contested cases, requiring more specialized legal and investigative knowledge than in the past.

Common questions