Complex Workers' Compensation Claims Resolution Specialist
3 weeks ago
At Southern California Edison, we are committed to advocating for our injured employees and helping them recover from workplace injuries. As a self-insured and self-administered employer, we focus on supporting our employees through their recovery process so they can return to work safely and enjoy their lives outside of work.
About the RoleWe are seeking an experienced Complex Workers' Compensation Claims Resolution Specialist to join our team. This role will be responsible for managing a complex workers' compensation claim caseload, including catastrophic claims as assigned.
The ideal candidate will have seven or more years of experience processing workers' compensation claims, evaluating accident reports to determine accuracy and compliance with laws and regulations. They will also have a thorough knowledge of workers' compensation laws, regulations, disability rates, notices for benefits, and the ability to calculate benefits, awards, commutations, and penalties.
Responsibilities- Manage a complex workers' compensation claim caseload, including catastrophic claims as assigned
- Conduct initial/formal investigations with organizational unit management, medical providers, injured workers, and witnesses on complex claims to determine liability
- Administer benefits, contain medical costs, and ensure injured employees have immediate access to quality care while coordinating utilization review to ensure medical treatment is appropriate
- Evaluate claims for resolution and negotiate settlements with injured employees or their representatives within the settlement authority
- Establish reserves based on the ultimate probable cost of the claim and in accordance with the state of California Self Insurance Plans regulations
- Seven or more years of experience processing workers' compensation claims
- Thorough knowledge of workers' compensation laws, regulations, disability rates, notices for benefits, and the ability to calculate benefits, awards, commutations, and penalties
- Demonstrated proficiency in a variety of Claims Management computer programs and systems
The estimated salary for this role is between $110,000 - $140,000 per year, depending on experience and qualifications. This position's work mode is hybrid, with the employee reporting to an SCE facility for a set number of days and working remotely on the remaining days.
About UsSouthern California Edison is a leader in the energy industry, powering the clean energy revolution and creating a better tomorrow. We are committed to ensuring that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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