Senior Workers' Compensation Claims Adjuster

Join the Clean Energy Revolution

Become a Senior Workers' Compensation Claims Adjuster at Southern California Edison (SCE) and build a better tomorrow. At Southern California Edison, advocating for our injured employees is at the heart of what we do in our Workers’ Compensation department. As a self-insured and self-administered employer, we focus on helping our employees recover from workplace injuries so they can return to work safely and enjoy their lives outside of work.

If you are passionate about providing exceptional support and advocacy for injured workers, we invite you to join our team and contribute to a culture of care and recovery .

As a Senior Workers' Compensation Claims Adjuster, your work will help power our planet, reduce carbon emissions and create cleaner air for everyone. Are you ready to take on the challenge to help us build the future?

• Manages a complex workers' compensation claim caseload. May handle catastrophic claims as assigned.
• May conduct initial/formal investigations with organizational unit management, medical providers, injured workers, and witnesses on complex claims to determine liability. Provides advice on workers’ compensation matters to injured employee, work locations, safety and directs initial medical treatment.
• Administers benefits, contains medical cost,ensuring injured employees have immediate access to quality care while coordinating utilization review to ensure medical treatment is appropriate while moving cases to conclusion.
• Identifies reports, and pursues fraud and 3rd party and excess insurance recoveries.
• Provides complex litigation management and directs outside counsel and/or represents SCE at WCABproceedings.
• Evaluates claims for resolution and negotiates settlements with injured employees or their representatives within the settlement authority. Settlements may include Structured Settlements andMSAs.
• Evaluates the Company liability and establishes reserves based on the ultimate probable cost of the claim and in accordance with the state of California Self Insurance Plans regulations. Reserve estimates require quarterly certification for Sarbanes Oxleycompliance.
• A material job duty of all positions within the Company is ensuring the protection of all its physical, financial and cybersecurity assets, and properly accessing and managing private customer data, proprietary information, confidential medical records, and other types of highly sensitive information and data with the highest standards of conduct and integrity.

• Seven or more years of experience in processing workers' compensation claims, evaluating accident reports to determine accuracy and compliance with laws and regulations.

Preferred Qualifications

• Bachelor’s degree in business, or a related technical field; or an equivalent combination of education, training, and experience in the field of Workers’ Compensation.
• Self-Insured Certificate to adjust/administer WC Benefits for a self-insured employer
• California Workers’ Compensation Claim Adjuster Certification
• Experience with a self-administered and self-insured programs
• Thorough knowledge and experience with Permanent Disability Rating, AOE/COE Investigations, and WCAB Hearing Representation.
• Experience with written/recorded statements, Medical/Disability programs, and 3rd Party Recovery.
• Demonstrated proficiency in a variety of Claims Management computer programs and systems. Strong oral and written communication skills are required.
• Seven or more years’ experience administering complex, litigated workers' compensation claims.
• A thorough knowledge of workers' compensation laws, regulations, disability rates, notices for benefits, and the ability to calculate benefits, awards, commutations, and penalties.

• This position’s work mode is hybrid. The employee will report to an SCE facility for a set number of days with the option to work remotely on the remaining days. Unless otherwise noted, employees are required to work andreside in the state of California. Further details of this work mode will be discussed at the interview stage.
  
  The work mode can be changed based on business needs.
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