Claims Adjusters, Examiners, and Investigators

Business and Financial Operations Occupations
Código 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.

Los nombres de las ocupaciones y las descripciones de tareas se muestran en inglés, tal como se publicaron. Las etiquetas, incluidos los tipos de tarea, están traducidas.

Exposición a la IA

  • Fuente de datos: BLSPublicado: 2026-08

    Muy alto· relativa

    BajoCuatro bandas relativasMuy alto

    Valor por grupo ocupacional

    Escala, base y fuente

    Cuatro bandas relativas (Bajo / Moderado / Alto / Muy alto)

    831 ocupaciones detalladas de la tabla de proyecciones de empleo de BLS. El valor se asigna por código de la National Employment Matrix (NEM), de modo que las ocupaciones que comparten un código NEM reciben la misma banda

    Conjunto de datos de origen (descarga XLSX)

  • Fuente de datos: AnthropicPublicado: 2026-03

    0.082

    0.000Rango de los valores aquí recogidos0.745
    Escala, base y fuente

    Índice de exposición observada, 0–1 tal como se publica

    Mapeado sobre tareas de O*NET

    Publicado por ocupación SOC 2018; toda ocupación O*NET con el mismo código SOC 2018 recibe este valor

    Conjunto de datos de origen (descarga CSV)

  • Fuente de datos: ILOPublicado: 2025

    0.45

    0.09Rango de los valores aquí recogidos0.70

    Valor por grupo ocupacional

    Escala, base y fuente

    Índice de exposición a la IA generativa, 0–1 tal como se publica

    Publicado por grupo primario ISCO-08. Vinculado a esta ocupación, total o parcialmente, aplicando tal como se publicaron las tablas de correspondencia de la U.S. Bureau of Labor Statistics (ISCO-08 a SOC 2010, SOC 2010 a SOC 2018)

    Conjunto de datos de origen (descarga PDF)

Qué tipo de cifra publica esta fuente

La categoría de BLS es un rango relativo, no un nivel absoluto, y tampoco es una medición de primera mano: agrupa en cuatro bandas los rangos percentiles de la ocupación en varios estudios publicados. No es una previsión de empleo ni de salarios, no es una probabilidad de adopción y no distingue entre automatización y aumento.

Exposición a la IA (rúbrica de OpenAI)

29 tareas evaluadas · 28 tareas con β ≥ 0,5 (96.6%)

β = exposición directa (E1) + 0,5 × exposición con herramientas disponibles (E2), según la definición del repositorio de origen.

  • Unidad de origen: tareas de O*NET 27.2 → código de ocupación de O*NET 31.0
  • Todas las tareas puntuadas figuran en la lista de tareas de O*NET 31.0.
Fuente
OpenAI "GPTs are GPTs" exposure rubric
Versión
gh-main-0471612
Licencia
MIT License, Copyright (c) 2024 OpenAI

Tareas

Descripciones de tareas de la O*NET® 31.0 Database, primero las tareas principales.

TareaTipoβ (OpenAI)
Examine claims forms and other records to determine insurance coverage.Principal0,5
Analyze information gathered by investigation and report findings and recommendations.Principal0,5
Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.Principal0,5
Investigate and assess damage to property and create or review property damage estimates.Principal0,5
Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.Principal0,5
Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.Principal0,5
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.Principal0,5
Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.Principal0,5
Resolve complex, severe exposure claims, using high service oriented file handling.Principal0,5
Pay and process claims within designated authority level.Principal0,5
Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.Principal0,5
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.Principal0,5
Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.Principal1
Refer questionable claims to investigator or claims adjuster for investigation or settlement.Principal0,5
Collect evidence to support contested claims in court.Principal0,5
Confer with legal counsel on claims requiring litigation.Principal0,5
Contact or interview claimants, doctors, medical specialists, or employers to get additional information.Principal0,5
Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.Principal0,5
Present cases and participate in their discussion at claim committee meetings.Principal0,5
Report overpayments, underpayments, and other irregularities.Principal0,5
Attend mediations or trials.Principal0
Supervise claims adjusters to ensure that adjusters have followed proper methods.Complementaria0,5
Conduct detailed bill reviews to implement sound litigation management and expense control.Complementaria0,5
Examine titles to property to determine validity and act as company agent in transactions with property owners.Complementaria0,5
Communicate with reinsurance brokers to obtain information necessary for processing claims.Complementaria1
Prepare reports to be submitted to company's data processing department.Complementaria1
Obtain credit information from banks and other credit services.Complementaria0,5
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

Información ocupacional

Fuentes y atribución

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.

Atribución y licencias completas