Claims Adjusters, Examiners, and Investigators

Business and Financial Operations Occupations
رمز O*NET-SOC
13-1031.00

Review settled claims to determine that payments and settlements are made in accordance with company practices and procedures. Confer with legal counsel on claims requiring litigation. May also settle insurance claims.

تُعرض أسماء المهن وأوصاف المهام بالإنجليزية كما نُشرت. أما التسميات، ومنها أنواع المهام، فمترجمة.

التعرّض للذكاء الاصطناعي

  • مصدر البيانات: BLSتاريخ النشر: 2026-08

    مرتفع جدًا· نسبي

    منخفضأربع فئات نسبيةمرتفع جدًا

    قيمة على مستوى المجموعة المهنية

    المقياس والأساس والمصدر

    أربع فئات نسبية (منخفض / متوسط / مرتفع / مرتفع جدًا)

    831 مهنة تفصيلية في جدول توقعات التوظيف لدى BLS. وتُسند القيمة على مستوى رمز مصفوفة التوظيف الوطنية (NEM)، فالمهن التي تشترك في الرمز نفسه تأخذ النطاق نفسه

    مجموعة البيانات المصدر (تنزيل ملف XLSX)

  • مصدر البيانات: Anthropicتاريخ النشر: 2026-03

    0.082

    0.000نطاق القيم المعروضة هنا0.745
    المقياس والأساس والمصدر

    مؤشر التعرّض المرصود، 0–1 كما نُشر

    مربوط بمهام O*NET

    منشورة لكل مهنة في SOC 2018؛ وكل مهنة في O*NET تحمل رمز SOC 2018 نفسه تأخذ هذه القيمة

    مجموعة البيانات المصدر (تنزيل ملف CSV)

  • مصدر البيانات: ILOتاريخ النشر: 2025

    0.45

    0.09نطاق القيم المعروضة هنا0.70

    قيمة على مستوى المجموعة المهنية

    المقياس والأساس والمصدر

    مؤشر التعرّض للذكاء الاصطناعي التوليدي، 0–1 كما نُشر

    قيمة منشورة على مستوى مجموعة الوحدة في ISCO-08. رُبطت بهذه المهنة بتطبيق جداول التناظر الرسمية لمكتب إحصاءات العمل الأمريكي (BLS) (من ISCO-08 إلى SOC 2010، ومن SOC 2010 إلى SOC 2018) كما نُشرت، والتناظر كلي أو جزئي

    مجموعة البيانات المصدر (تنزيل ملف PDF)

ما نوع القيمة التي ينشرها هذا المصدر

فئة BLS رتبة نسبية لا مستوى مطلق، وليست قياسًا مباشرًا: فهي تجمع الرتب المئينية للمهنة في عدة دراسات منشورة في أربع فئات. وهي ليست توقّعًا للتوظيف أو الأجور، ولا احتمالًا للتبني، ولا تفرّق بين الأتمتة والتعزيز.

التعرض للذكاء الاصطناعي (معيار OpenAI)

29 مهمة مقيَّمة · 28 مهمة بقيمة β ≥ 0.5 (96.6%)

β = التعرّض المباشر (E1) + 0.5 × التعرّض عند توفر الأدوات (E2)، وفق تعريف المستودع المصدري.

  • وحدة المصدر: مهام O*NET 27.2 ← رمز المهنة في O*NET 31.0
  • جميع المهام المقيَّمة موجودة في قائمة مهام O*NET 31.0.
المصدر
OpenAI "GPTs are GPTs" exposure rubric
الإصدار
gh-main-0471612
الترخيص
MIT License, Copyright (c) 2024 OpenAI

المهام

أوصاف المهام من O*NET® 31.0 Database، والمهام الأساسية أولًا.

المهمةالنوعβ (OpenAI)
Examine claims forms and other records to determine insurance coverage.أساسية0.5
Analyze information gathered by investigation and report findings and recommendations.أساسية0.5
Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.أساسية0.5
Investigate and assess damage to property and create or review property damage estimates.أساسية0.5
Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.أساسية0.5
Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.أساسية0.5
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.أساسية0.5
Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.أساسية0.5
Resolve complex, severe exposure claims, using high service oriented file handling.أساسية0.5
Pay and process claims within designated authority level.أساسية0.5
Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.أساسية0.5
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.أساسية0.5
Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.أساسية1
Refer questionable claims to investigator or claims adjuster for investigation or settlement.أساسية0.5
Collect evidence to support contested claims in court.أساسية0.5
Confer with legal counsel on claims requiring litigation.أساسية0.5
Contact or interview claimants, doctors, medical specialists, or employers to get additional information.أساسية0.5
Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.أساسية0.5
Present cases and participate in their discussion at claim committee meetings.أساسية0.5
Report overpayments, underpayments, and other irregularities.أساسية0.5
Attend mediations or trials.أساسية0
Supervise claims adjusters to ensure that adjusters have followed proper methods.تكميلية0.5
Conduct detailed bill reviews to implement sound litigation management and expense control.تكميلية0.5
Examine titles to property to determine validity and act as company agent in transactions with property owners.تكميلية0.5
Communicate with reinsurance brokers to obtain information necessary for processing claims.تكميلية1
Prepare reports to be submitted to company's data processing department.تكميلية1
Obtain credit information from banks and other credit services.تكميلية0.5
Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.—0.5
Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.—0.5

معلومات مهنية

المصادر والإسناد

This page includes information from the O*NET® 31.0 Database (https://www.onetcenter.org/database.html) by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA). Used under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). O*NET® is a trademark of USDOL/ETA. AI Changing Work has modified all or some of this information: the O*NET-SOC code, title and task statements are reproduced in English without change; task-type labels are shown in the page's language and tasks are listed core first; any Korean occupation title shown on the Korean-language page is AI Changing Work's translation; any KSCO-8 unit groups linked to this occupation were paired with it by AI Changing Work's judgment, and the relation labels and statuses are AI Changing Work's additions. USDOL/ETA has not approved, endorsed, or tested these modifications.

Any AI exposure figures on this page are published by third parties, not by AI Changing Work, and none is part of the O*NET information. OpenAI publishes task-level scores (MIT License) for O*NET 27.2 task statements; each is shown next to the O*NET 31.0 task statement with the same task ID, whose wording can differ from the 27.2 statement that was scored. OpenAI also publishes occupation-level scores for O*NET-SOC codes in the same release, and any such score is shown on the O*NET occupation with the same code. Anthropic publishes an observed exposure index in the Anthropic Economic Index (CC-BY), and the U.S. Bureau of Labor Statistics publishes relative AI exposure categories (public domain); both are published per SOC code, and each value is shown on every O*NET occupation with that code. The International Labour Organization publishes a generative AI exposure index in ILO Working Paper 140 (CC BY 4.0) for ISCO-08 unit groups; AI Changing Work links those groups to O*NET occupations by applying the U.S. Bureau of Labor Statistics ISCO-08 to 2010 SOC and 2010 SOC to 2018 SOC crosswalks as published, without case-by-case selection, and these crosswalks match many groups only in part. Where several unit groups are linked, each group's published value is listed, and any summary shows only the lowest and highest of those values with the number of groups; no exposure figure is averaged or recalculated. Any employment figures are published by the U.S. Bureau of Labor Statistics for the SOC group containing this occupation. Each source is credited where its figures are shown.

O*NET OnLine: 13-1031.00 Claims Adjusters, Examiners, and Investigators

KSCO 코드·명칭: 한국표준직업분류(제8차 개정) — 통계청 고시 제2024-328호 (2024-07-01 고시, 2025-01-01 시행). 저작권법 제7조 제2호의 고시 항목이다. 명칭 표기(가운뎃점·띄어쓰기)는 해설서 2차 정오 반영판의 표기를 따랐으며, 고시 항목표와는 18개 명칭에서 가운뎃점 글리프나 띄어쓰기만 다르다. 통계청은 2025년 10월 국가데이터처로 개편되었다. 이 페이지의 KSCO 연결은 통계청·국가데이터처의 공식 연계표가 아니다.

الإسناد والتراخيص كاملة