O*NET-SOC 13-1031.00

Claims Adjusters, Examiners, and Investigators

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.

From O*NET 30.3

Tasks

From O*NET 30.3, by importance, as O*NET OnLine lists them

Free · O*NET 30.3

Examine claims forms and other records to determine insurance coverage.Core21417
Analyze information gathered by investigation and report findings and recommendations.Core21418
Pay and process claims within designated authority level.Core21426
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.Core21423
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.Core21428
Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.Core21419
Investigate and assess damage to property and create or review property damage estimates.Core21420
Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.Core21421
Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.Core21422
Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.Core21429
Resolve complex, severe exposure claims, using high service oriented file handling.Core21425
Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.Core21424
Confer with legal counsel on claims requiring litigation.Core21432
Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.Core21427
Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.Core21434
Refer questionable claims to investigator or claims adjuster for investigation or settlement.Core21430
Collect evidence to support contested claims in court.Core21431
Supervise claims adjusters to ensure that adjusters have followed proper methods.Supplemental21436
Contact or interview claimants, doctors, medical specialists, or employers to get additional information.Core21433
Conduct detailed bill reviews to implement sound litigation management and expense control.Supplemental21437
Communicate with reinsurance brokers to obtain information necessary for processing claims.Supplemental21440
Present cases and participate in their discussion at claim committee meetings.Core21435
Report overpayments, underpayments, and other irregularities.Core21439
Attend mediations or trials.Core21443
Prepare reports to be submitted to company's data processing department.Supplemental21441
Examine titles to property to determine validity and act as company agent in transactions with property owners.Supplemental21438
Obtain credit information from banks and other credit services.Supplemental21442
Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.21444
Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.21445

Technology Skills

From O*NET 30.3, 73 examples in 21 categories, 9 Hot Technology

Free · O*NET 30.3

Computer aided design CAD software

4n6xprt Systems StiffCalcs
ARSoftware WinSMAC
CAD Zone Insurance
MapScenes Evidence Recorder
MapScenes Pro
PhotoModeler
Visual Statement Investigator Suite

Enterprise resource planning ERP software

ADP software
CCC Pathways Appraisal Quality Solution

Document management software

Agency Management Systems AMS 360
AutoClaims Direct DirectLink
Automatic Data Processing Autosource
Automatic Data Processing Claims Manager & Dispatch
BCCORP Burkitt W5
BCCORP W5 for Adjusters
Bramerhill ClaimsTech
Bridium Claims 3
Brightwork Alyce Claims Systems
Captiva InputAccel
Castek Insure3 Claims
CCC Pathways Image Management Solution
CCC TL2000 Solution
CGI INSideOUT
Clear Technology Tranzax
Covansys ClaimConnect
Datanex ClaimTrac
Document management system software
Hyland OnBase Enterprise Content Management
InSystems Calligo Document Management System

Internet browser software

Apple SafariHot Technology
Mozilla FirefoxHot Technology

Financial analysis software

Automatic Data Processing Estimating
CSC Colossus
Property damage, bodily injury, and liability estimation software
QwikQuote software
Simsol for Adjusters
Turtle Creek Software Goldenseal Architect

Expert system software

Axonwave Fraud and Abuse Management System
CCC GuidePost Decision Support
CSC Fault Evaluator
Fair Isaac SmartAdvisor
First Notice Systems ClaimCapture
Hummingbird Legal Bill Review
IBM Fraud and Abuse Management System
ISO ClaimSearch
ISO NetMap for Claims
LexisNexis RiskWise
StrataCare StrataWare eReview

Billing and invoicing software

Bill review software

Office suite software

Business software applications
Microsoft Office softwareHot TechnologyIn Demand

Access software

CCC EZNet electronic communications network
CSC Automated Work Distributor AWD

Information retrieval or search software

CGI-AMS BureauLink Enterprise

Data base user interface and query software

Claims processing administration and management software
Fair Isaac Claims Advisor
Microsoft AccessHot Technology
Tropics Claims Reserve Management
Xactware XactimateIn Demand

Interactive voice response software

Computerized voice stress analyzer CVSA software

Data base reporting software

Corporate Systems ClaimsPro

Medical software

Healthcare common procedure coding system HCPCS
Medical condition coding software
Medical procedure coding software

Analytical or scientific software

Injury Sciences EDR InSight
Insurance claims fraud detection software
Magnify Predictive Targeting System

Spreadsheet software

Microsoft ExcelHot TechnologyIn Demand

Electronic mail software

Microsoft OutlookHot TechnologyIn Demand

Presentation software

Microsoft PowerPointHot Technology

Desktop publishing software

Microsoft Publisher

Word processing software

Microsoft WordHot Technology

Video conferencing software

ZoomHot Technology

Detailed Work Activities

From O*NET 30.3, under their work activities; open one for the AI skills Workforce Automation maps to it

Free · O*NET 30.3

Getting Information

Collect evidence for legal proceedings.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet
Investigate legal issues.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet
Gather financial records.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet
Interview witnesses, suspects, or claimants.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Judging the Qualities of Objects, Services, or People

Appraise property values.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Processing Information

Verify accuracy of records.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet
Verify application data to determine program eligibility.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Evaluating Information to Determine Compliance with Standards

Examine financial records.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Analyzing Data or Information

Calculate data to inform organizational operations.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Making Decisions and Solving Problems

Estimate costs of goods or services.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 5 of 15 AI skills mapped to this activity, by automation level
- Augments 11
- Informs 4
- saas-pricing-engine:pricing-modelersaas-pricing-engineAugments
- Token tamer ai api cost controlclaudeskills.infoAugments
- Affiliate marketingclaudeskills.infoAugments
- French business assistantclaudeskills.infoAugments
- Cpq buildercustomware-ai/skills1,231 installsAugments
  Gen Agent Trust Hub Pass
  Snyk Pass
  Socket Pass
  ZeroLeaks Pass
Implement financial decisions.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Thinking Creatively

Apply information technology to solve business or other applied problems.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Documenting/Recording Information

Prepare financial documents.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 2 of 2 AI skills mapped to this activity, by automation level
- Augments 2
- Harvest automationclaudeskills.infoAugments
- Latex documentndpvt-web/latex-document-skill317 installsAugments
  Gen Agent Trust Hub Fail
  Runlayer Fail
  Snyk Warn
  Socket Pass
  ZeroLeaks Pass
Maintain data in information systems or databases.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 5 of 23 AI skills mapped to this activity, by automation level
- Replaces 3
- Augments 17
- Supports 2
- Informs 1
- Agent memory architectureclaudeskills.infoReplaces
- Prismic automationclaudeskills.infoReplaces
- Contentful automationclaudeskills.infoReplaces
- Knowledge opsaffaan-m/everything-claude-code8,594 installsAugments
  Gen Agent Trust Hub Pass
  Snyk Warn
  Socket Pass
  ZeroLeaks Pass
- Google sheetsclaudeskills.infoAugments
Prepare legal or investigatory documentation.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet
Prepare operational reports.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Communicating with Supervisors, Peers, or Subordinates

Report information to managers or other personnel.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet
Meet with individuals involved in legal processes to provide information and clarify issues.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Communicating with People Outside the Organization

Present business-related information to audiences.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Resolving Conflicts and Negotiating with Others

Negotiate agreements to resolve disputes.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 1 of 1 AI skills mapped to this activity, by automation level
- Supports 1
- Mercado libreclaudeskills.infoSupports

Performing for or Working Directly with the Public

Resolve customer complaints or problems.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Coordinating the Work and Activities of Others

Confer with others about financial matters.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 4 of 4 AI skills mapped to this activity, by automation level
- Supports 3
- Informs 1
- Affiliate marketingclaudeskills.infoSupports
- Google workspaceclaudeskills.infoSupports
- Founder osclaudeskills.infoSupports
- Pricingcoreyhaines31/marketingskillsInforms

Guiding, Directing, and Motivating Subordinates

Supervise employees.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Providing Consultation and Advice to Others

Advise others on legal or regulatory compliance matters.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet
Advise others on financial matters.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Performing Administrative Activities

Pay charges, fees, or taxes.
WFA · Part of the paid plan when accounts open
WFA (Workforce Automation) analysis: 0 of 0 AI skills mapped to this activity, by automation level
- No tools yet
- Not mapped yet

Job Zone

From O*NET 30.3

Free · O*NET 30.3

Job Zone Four: Considerable Preparation Needed

Workforce Automation analysis, not part of the source

WFA coverage: AI skills for this job

WFA · Part of the paid plan when accounts open

Pilot mapping: these skill links come from our seed list and haven’t been reviewed yet. Expect them to change as each one is checked.

DWAs covered by an AI skill5 of 26

Distinct tools43

Level mix

Replaces 3
Augments 30
Supports 6
Informs 6

Equivalents

NICE work roles, with their DCWF equivalents

Mapped to this job by the ETO-CSET NICE/O*NET crosswalk (2024); roles from NICE Framework Components v2.2.0, DCWF equivalents from DoD DCWF Tool v5.3 (2026-09-25)

Free · NICE Framework Components v2.2.0 and DoD DCWF Tool v5.3 (2026-09-25)

No NICE work role maps to this job.