Senior Workers' Comp Claims Adjuster — Hybrid

Southern California Edison; Rosemead, Northern (CA, KY); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Southern California Edison is seeking a Senior Workers' Compensation Claims Adjuster to manage a complex caseload in a self-insured environment. This role emphasizes advocacy for injured workers, timely access to medical care, and strategic settlements while complying with California regulations.

The position is hybrid, requiring reporting to an SCE facility with some remote work, and may involve up to 5% travel within the SCE service territory.

Qualifications

• Must have seven+ years of experience processing workers' compensation claims.
• Experience evaluating accident reports for legal compliance and regulatory adherence.
• Experience with complex, litigated WC claims and settlements.

Responsibilities

• Manages a complex workers' compensation claim caseload, including catastrophic claims.
• Conducts investigations with management, medical providers, injured workers, and witnesses.
• Administers benefits, controls medical costs, and coordinates utilization review to ensure appropriate treatment.
• Identifies fraud and pursue third-party recoveries and excess insurance.
• Provides litigation management and represents SCE at WCAB proceedings.
• Evaluates claims for resolution and negotiates settlements within authority, including MSAs and structured settlements.
• Maintains reserves and ensures compliance with California Self Insurance Plans regulations.

Skills

Strong communication skills

Litigation management experience

Proficiency with claims management软件

Education

Bachelor’s degree in business or related field

Self-Insured Certificate

California Workers’ Compensation Claim Adjuster Certification

Tools

Claims management software

Job description

Southern California Edison is seeking a Senior Workers' Compensation Claims Adjuster to manage a complex caseload in a self-insured environment. This role emphasizes advocacy for injured workers, timely access to medical care, and strategic settlements while complying with California regulations.

The position is hybrid, requiring reporting to an SCE facility with some remote work, and may involve up to 5% travel within the SCE service territory.