What These Numbers Mean for Claims Processing / Adjudication
Based on 11 roles assessed, 68% of the work in this role is automatable — meaning roughly two-thirds of daily tasks can be handled by software rather than people.
What that two-thirds looks like: Data entry, routing claims to the correct queue, checking whether required fields are complete, applying standard coverage rules, generating denial or approval letters, and calculating straightforward payment amounts. These are repetitive, rule-based steps — exactly what automation handles well.
What stays human — the remaining 32%:
- Judgment calls on ambiguous or complex claims where the rules don't clearly apply
- Exceptions and appeals requiring someone to weigh context, not just criteria
- Difficult conversations with claimants who are stressed or disputing outcomes
- Escalations where a wrong decision carries real financial or reputational risk
Given the salary range ($35,000–$48,000) and that current tools are primarily Word and Excel, there's meaningful room to shift staff toward that higher-judgment 32% — which is also where errors are costliest.
Based on 11 postings our engine analyzed · updated .