Senior Workers' Compensation Claims Adjuster

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

Job summary

Southern California Edison (SCE) is seeking a Senior Workers' Compensation Claims Adjuster to expertly manage a complex caseload, including catastrophic claims, within a self-insured environment. You will coordinate investigations with management, medical providers, workers, and witnesses to determine liability and ensure timely, fair outcomes.

The role emphasizes cost containment, proper reserves, and compliance with California WC laws, AOE/COE, and WCAB proceedings, while safeguarding

Qualifications

• Seven or more years of experience in processing workers' compensation claims.
• Experience evaluating accident reports for regulatory compliance.

Responsibilities

• Manage a complex workers' compensation claim caseload, including catastrophic claims.
• Conduct investigations with management, medical providers, injured workers, and witnesses.
• Administer benefits and control medical costs, ensuring access to quality care.
• Identify fraud and pursue third-party and excess recoveries.
• Manage complex litigation and represent SCE at WCAB proceedings.

Skills

Communication skills

Claims management software

Knowledge of WC laws

Investigation skills

Education

Bachelor’s degree in business or related field

California Workers’ Compensation Claim Adjuster Certification

Self-Insured Certificate

Job description

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?

Responsibilities

• 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 WCAB proceedings.
• Evaluates claims for resolution and negotiates settlements with injured employees or their representatives within the settlement authority. Settlements may include Structured Settlements and MSAs.
• 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 Oxley compliance.
• 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.

Minimum Qualifications

• 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.

Additional Information

• 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 and reside 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.
• Visit our Candidate Resource page to get meaningful information related to benefits, perks, resources, testing information, hiring process, and more!
• Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
• Position will require up to 5% traveling and being out in the field throughout the SCE service territory.
• Relocation does not apply to this position.

About Southern California Edison

The people at SCE don't just keep the lights on. Our mission is so much bigger. We’re fueling the kind of innovation that’s changing an entire industry, and quite possibly the planet. Join us and create a future with cleaner energy, while providing our customers with the safety and reliability they demand. At SCE, you’ll have a chance to grow personally and professionally, making a real impact in Southern California and around the world.

Southern California Edison is a proud Equal Opportunity Employer, including disability and protected veteran status.

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. Please contact us to request accommodations at [e-mail] or [phone] and select option 2.