San Diego Gas and Electric
Claims Advisor - Workers' Compensation (Hybrid Schedule)
San Diego Gas and Electric, San Diego, California, United States, 92189
SDG&E is not just an energy company, we are the architects of a brighter, cleaner future. Our employees power everyday life for 3.7 million people - bringing the energy to support their passions, ambitions, and the heartbeat of our community.We call Southern California our home. It's where we chase our dreams and raise our families. That's why the people who live here deserve an energy company unlike any other, and that's why every day, SDG&E employees strive to be at the forefront of innovations to reduce emissions, modernize the electric grid, and enable our customers to make the transition to clean technologies. We're redefining sustainability, advancing zero-emissions solutions, and driving the electric vehicle revolution.It takes the best to build the best - join us!Primary Purpose:
Administers complex non-litigated and litigated workers' compensation cases and integrates the delivery of benefits associated with sickness and long-term disability benefits. Provides senior technical guidance, mentoring and support to the staff.Duties and Responsibilities:
Works independently to manage workers' compensation cases, including complex and catastrophic claims. Focuses on cost effective delivery of benefits and resolution of cases. Develops and documents plan to resolve cases. Analyzes workers' compensation cases for settlement including need for structured settlement. Settles case within authority and recommends settlements to Employee Care Supervisor - Workers' Comp. Identifies and investigates questionable case, third party, fraud and abuse. Coordinates supplemental job displacement voucher, reasonable accommodation requests, company RTW programs and work hardening. Directs attorneys for cost effective case resolution.Independently interprets and applies law to administer workers' compensation claims in compliance with all rules, regulations and reporting requirements of the Labor Code, Division of Workers' Compensation, Self-Insurance Regulations, OSHA, and other administrative laws. Evaluates and determines the appropriate individual case reserve of assigned cases for future financial liability. Reviews cases of workers' compensation staff within authority.Acts as an information resource to the claims staff, employees, supervisors, doctors, and other external and internal contacts. Promotes litigation avoidance through close contact with employees to assure understanding of claims process, and benefits integration. Directs employees to resources that will aid in their return-to-work (RTW). Provides technical support and guidance to the claims staff on medical only and workers' compensation indemnity claims. Acts as company witness at WCAB hearings.Reviews and approves benefits payable to injured employee, invoices including attorney bills, medical provider bills, liens and mileage. Rates employee's permanent disability. Reviews and monitors employee medical records to ensure scope and duration of treatment are appropriate based on the injury and diagnosis. Seeks recovery from third parties. Reports appropriate cases to excess insurance and oversees case for appropriate reimbursement.Assists with providing training to ECS personnel. Visits vendor partners to discuss case strategy with local management. Fosters a team approach with Claims Supervisor for delivery of benefits. Support peers and provides leadership to ensure high level of customer service to clients.Performs other duties as assigned (no more than 5% of duties).Hybrid Schedule:
Although the schedule may vary, typically this will allow the employee to work onsite three days per week and remotely on the remaining workdays.Must reside in Southern California or be willing to relocate upon hire.Required Qualifications:
Other Current and ongoing education in WC/disability claims administration.7 years Workers' compensation or disability management experience.5 years Litigated claims experience.Well-organized to meet heavy workload and ability to effectively manage multiple demands.Strong teamwork skills.Knowledge and understanding of workers' compensation claims administration.Thorough knowledge of Self-Insurance regulations, Case Law, Labor Code and rules and regulations of OSHA.Computer skills and knowledge of Microsoft Office software.Basic mathematical skills required for calculations and ratings.Self-Insurance Certificate is required.Workers' Compensation Claims Administration (WCCA) Certification is required.Must reside in Southern California or be willing to relocate upon hire.Preferred Qualifications:
Bachelor's Degree Human resources, disability management, related field or equivalent training and work experience.Thorough knowledge of Employee Care Services policies and procedures as they relate to the integration of workers' compensation.Knowledge of collective bargaining agreements of SDG&E and SoCalGas.Workers' Compensation Claims Professional (WCCP) is highly desirable.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability or protected veteran status.SDG&E offers a competitive total rewards package that goes beyond base salary. This position is eligible for an annual performance-based incentive (bonus) as well as other merit-based recognition. Company benefits include health and welfare (medical, dental, vision), employer contributions to retirement benefits, life insurance, paid time off, as well as other company offerings such as tuition reimbursement, paid parental leave, and employee assistance programs.
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Administers complex non-litigated and litigated workers' compensation cases and integrates the delivery of benefits associated with sickness and long-term disability benefits. Provides senior technical guidance, mentoring and support to the staff.Duties and Responsibilities:
Works independently to manage workers' compensation cases, including complex and catastrophic claims. Focuses on cost effective delivery of benefits and resolution of cases. Develops and documents plan to resolve cases. Analyzes workers' compensation cases for settlement including need for structured settlement. Settles case within authority and recommends settlements to Employee Care Supervisor - Workers' Comp. Identifies and investigates questionable case, third party, fraud and abuse. Coordinates supplemental job displacement voucher, reasonable accommodation requests, company RTW programs and work hardening. Directs attorneys for cost effective case resolution.Independently interprets and applies law to administer workers' compensation claims in compliance with all rules, regulations and reporting requirements of the Labor Code, Division of Workers' Compensation, Self-Insurance Regulations, OSHA, and other administrative laws. Evaluates and determines the appropriate individual case reserve of assigned cases for future financial liability. Reviews cases of workers' compensation staff within authority.Acts as an information resource to the claims staff, employees, supervisors, doctors, and other external and internal contacts. Promotes litigation avoidance through close contact with employees to assure understanding of claims process, and benefits integration. Directs employees to resources that will aid in their return-to-work (RTW). Provides technical support and guidance to the claims staff on medical only and workers' compensation indemnity claims. Acts as company witness at WCAB hearings.Reviews and approves benefits payable to injured employee, invoices including attorney bills, medical provider bills, liens and mileage. Rates employee's permanent disability. Reviews and monitors employee medical records to ensure scope and duration of treatment are appropriate based on the injury and diagnosis. Seeks recovery from third parties. Reports appropriate cases to excess insurance and oversees case for appropriate reimbursement.Assists with providing training to ECS personnel. Visits vendor partners to discuss case strategy with local management. Fosters a team approach with Claims Supervisor for delivery of benefits. Support peers and provides leadership to ensure high level of customer service to clients.Performs other duties as assigned (no more than 5% of duties).Hybrid Schedule:
Although the schedule may vary, typically this will allow the employee to work onsite three days per week and remotely on the remaining workdays.Must reside in Southern California or be willing to relocate upon hire.Required Qualifications:
Other Current and ongoing education in WC/disability claims administration.7 years Workers' compensation or disability management experience.5 years Litigated claims experience.Well-organized to meet heavy workload and ability to effectively manage multiple demands.Strong teamwork skills.Knowledge and understanding of workers' compensation claims administration.Thorough knowledge of Self-Insurance regulations, Case Law, Labor Code and rules and regulations of OSHA.Computer skills and knowledge of Microsoft Office software.Basic mathematical skills required for calculations and ratings.Self-Insurance Certificate is required.Workers' Compensation Claims Administration (WCCA) Certification is required.Must reside in Southern California or be willing to relocate upon hire.Preferred Qualifications:
Bachelor's Degree Human resources, disability management, related field or equivalent training and work experience.Thorough knowledge of Employee Care Services policies and procedures as they relate to the integration of workers' compensation.Knowledge of collective bargaining agreements of SDG&E and SoCalGas.Workers' Compensation Claims Professional (WCCP) is highly desirable.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability or protected veteran status.SDG&E offers a competitive total rewards package that goes beyond base salary. This position is eligible for an annual performance-based incentive (bonus) as well as other merit-based recognition. Company benefits include health and welfare (medical, dental, vision), employer contributions to retirement benefits, life insurance, paid time off, as well as other company offerings such as tuition reimbursement, paid parental leave, and employee assistance programs.
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