Charles Taylor is a highly successful global provider of professional services to the insurance industry. We are seeking a seasoned Senior State Claims Examiner to join our team. This is a remote role based in California. 

California residents are encouraged to apply.

Position Summary This position will process insurance claims filed for workers' compensation and authorize payments to claimants in accordance with policy provisions and State regulatory guidelines. This person will report directly to the Supervisor overseeing the account.  

Essential Functions

• Regular, predictable and reliable attendance

• Adjusts workers’ compensation claims for third party clients

  • paying appropriate compensation and medical benefits, and 

  • settling and otherwise resolving workers’ compensation matters

• Handles and closely monitors mail expeditiously

• Reads periodicals, decisions, journals, new regulations and other updates related to insurance matters

• Establishes and monitors computerized diary files

  • reviews and updates daily priorities and projects 

• Operates a computer using claims management and/or client-supplied software.

• Writes letters or memos to doctors, claimants, attorneys and others affiliated with the case(s)

• Reviews and signs off on work completed by claims assistants

• Recommends litigation

• Attends informal conferences in situation where there is no defense attorney on the claim

• Local travel to our Long Beach office or local/state conferences may be required periodically

Additional Duties

• Analyzes claims to determine extent of liability and validity of claim

• Reviews adjusts workers’ compensation claims

• Establishes, monitors and balances reserves for opened claims  

• Determines and evaluates the seriousness of injuries reported

• Communicates with Defense Attorney 

  • interfaces with claimant's attorney regarding disputes and case resolutions

  • prepares cases on calendar for formal trial

  • gathers information for evidence to be presented at a trial

• Prepares certain settlement documents

• Reviews court decisions, ledgers, computerized runs, and letters 

• Balances and calculates temporary and permanent disability

• Communicates with claimants, when claimant is not represented, to negotiate claim

• Assigns cases to investigators

• Calculates compensation rates for Workers' Compensation claims

• Monitors medical treatment to claimants

  • sends medical expenses to medical review company

  • verifies disability of claimant and status for ongoing treatment

  • authorizes or denies treatment, testing and surgery

  • requires second opinion or other options, etc.

• Authorizes payment of legal fees and other vendor bills

• Settles cases within approved settlement authority.

• Reviews all state required forms

• Authorizes payment of awards and benefits, adhering to set deadlines and approval limits

• Reviews all claims periodically

• Processes compensation payments bi-weekly 

• Responds to requests made by clients

Skills & Abilities

• 5 – 10  years experience with California State claims 

• Knowledge of Workers' Compensation Laws of California

• Overall knowledge of insurance regulations

• Successful completion of Self Insurance Administrator’s examination preferred, or ability to pass the exam within 6 to 9 months of hire date

• Basic knowledge of Excel and word processing software, Word for Windows preferred  

• Ability to travel by car and plane

• Ability to maintain confidentiality

• Solve problems and/or employee grievances using existing policies

• High School graduate, Bachelor Degree preferred

Compensation range : $70,000 - $100,000

Charles Taylor offers a competitive salary commensurate with experience and excellent benefits including medical, dental, vision, disability, life insurance and 401(K) with match. If you are seeking a career where you can achieve great things in a supportive and collaborative environment, then we may be the place for you. 

Values At Charles Taylor, our values define our identity, principles and conduct. This person will demonstrate and champion Charles Taylor Values by ensuring Agility, Integrity, Care, Accountability and Collaboration.

Equal Opportunity Employer Here at Charles Taylor, we are proud to be an Inclusive Employer. We provide an environment of mutual respect with zero tolerance to discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex, or sexual orientation.

Our external partnerships and the dedicated work we do in promoting a transparent and fair recruitment and selection process all contribute to the successful, inclusive, and diverse culture and environment which we are proud to be a part of at Charles Taylor.

About Charles Taylor Charles Taylor is an independent, global provider of claims solutions, insurance management services and technology platforms for all property and casualty markets, including commercial property, workers’ compensation, and auto/liability. We offer complex loss adjusting, technical services, third-party administration, and managed care programs with specialization in catastrophic, aviation, energy, and marine claims. With over 100 years of expertise at our core, we offer a comprehensive suite of solutions across all lines of business to help our clients manage risk.