Senior Workers' Compensation Claims Adjuster

About the Role

Join Southern California Edison (SCE) as a Senior Workers' Compensation Claims Adjuster and contribute to a culture of care and recovery. As a self-insured and self-administered employer, SCE focuses on helping employees recover from workplace injuries so they can return to work safely. Your work will support our mission to power the planet, reduce carbon emissions, and create cleaner air for everyone.

Responsibilities

• Manages a complex workers' compensation claim caseload, including catastrophic claims as assigned.
• Conducts initial and formal investigations with organizational unit management, medical providers, injured workers, and witnesses to determine liability on complex claims.
• Provides advice on workers’ compensation matters to injured employees, work locations, and safety teams, and directs initial medical treatment.
• Administers benefits, contains medical costs, ensures injured employees have immediate access to quality care, and coordinates utilization review to ensure appropriate medical treatment while moving cases to conclusion.
• Identifies, reports, and pursues fraud, third-party, and excess insurance recoveries.
• Provides complex litigation management, directs outside counsel, and/or represents SCE at Workers' Compensation Appeals Board (WCAB) proceedings.
• Evaluates claims for resolution and negotiates settlements with injured employees or their representatives within settlement authority, including Structured Settlements and Medicare Set-Asides (MSAs).
• Evaluates company liability and establishes reserves based on the ultimate probable cost of the claim, in accordance with California Self Insurance Plans regulations. Reserve estimates require quarterly certification for Sarbanes-Oxley compliance.
• Ensures the protection of the company’s physical, financial, and cybersecurity assets, and properly accesses and manages private customer data, proprietary information, confidential medical records, and other sensitive information with the highest standards of conduct and integrity.

Requirements

• 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 Workers’ Compensation.
• Self-Insured Certificate to adjust/administer WC benefits for a self-insured employer.
• California Workers’ Compensation Claim Adjuster Certification.
• Experience with 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 third-party recovery.
• Demonstrated proficiency in a variety of Claims Management computer programs and systems.
• Strong oral and written communication skills.
• Seven or more years’ experience administering complex, litigated 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.

Schedule

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. The work mode can be changed based on business needs.

This role may require up to 5% traveling and being out in the field throughout the SCE service territory.