Southern California Gas Company – Claims Advisor, Workers’ Compensation

Southern California Gas Company

Employee Care Services – Claims Advisor – Workers Compensation

Primary Purpose:

Administers complex workers’ compensation claims and integrates the delivery of benefits associated with workers’ compensation cases.  Provides technical guidance, mentoring, and support to junior level staff.  Supports Supervisor and Compliance Administrator.

Duties/Responsibilities:

Manages litigated and non-litigated cases with complex issues. Focuses on cost effective delivery of benefits and resolution of cases.  Develops and documents plan to resolve cases.  Assigns and directs defense counsel.  Analyzes cases for settlement and resolution including the need for structured settlement.  Resolves cases within authority and recommends settlement to Supervisor/Compliance or Manager.  Identifies and investigates questionable cases, third party, fraud and abuse. Coordinates vocational rehabilitation, reasonable accommodation requests, company RTW programs and work hardening.

Acts as an information resource to the claims staff, employees, supervisors, doctors, and other external and internal contacts.  Promotes litigation avoidance through close contact with employees to assure understanding of the claims process and benefits integration.  Directs employees to resources that will aid in their return-to-work.  Provides technical support and guidance to the claims staff on medical-only and indemnity claims.  Provides coaching and mentoring for development of skills and coordinates training with Compliance Administrator.

Interprets and applies law to administer workers’ compensation claims in compliance with all rules, regulations and reporting requirements of the Labor Code, Division of Workers’ Compensation, Self-Insurance Regulations, OSHA, and other administrative laws.  Integrates and administers the delivery of long term disability, sickness allowance, pregnancy-illness benefits and other company/State requirements, such as FMLA with workers’ compensation benefits.  Evaluates and determines the appropriate individual case reserve of assigned cases for future financial liability

 

Provides training to Region staff and visits local bases to discuss return to work and case strategy with local management. Fosters a team approach with the field Supervisor for the delivery of benefits.  Support peers to ensure high level of customer service to clients. Participates and testifies in grievances, arbitration and WCAB hearings as required.

 

Qualifications:

Must effectively communicate, both verbally and written, with employees, supervisors and external providers; strong client focus with diplomacy and clear explanation of decisions; must educate and counsel on complex and sensitive issues; basic mathematical skills required for calculations and ratings; must be well-organized to meet heavy workload and be able to effectively manage multiple demands; must have strong teamwork skills.

 

Self-Insurance Certificate is required with current and ongoing education in Workers’ Compensation/Disability Management.  Typically requires 5 to 10 years of workers’ compensation and/or disability management experience.  Complex litigated claims handling experience required.  WCCA certification required; WCCP is highly desirable.  Must have a strong knowledge and understanding of workers’ compensation claims administration; thorough knowledge of Employee Care Services policies and procedures as they relate to the integration of workers’ compensation benefits. Must have a good working knowledge of Union/ Collective Bargaining agreements.  Basic computer skills and basic knowledge of Microsoft Office software required.  Thorough knowledge of Self-Insurance regulations, Case Law, Labor Code and rules and regulations of OSHA required.  Strong leadership skills and customer-focused team building skills. Consistent file reviews, training and development of Sr. Examiners/Examiner I/I and Claims Associate.

 

If you consider yourself the best candidate for this position on our team, please apply online at: www.socalgas.com/careers, be sure to include all asked for / required information.

 

Southern California Gas Company, a Sempra Energy Utility

Equal Opportunity Employer

CSIA is one of our favorite conferences as not only are we able to spend time with our current clients, we are able to meet new prospective clients as well.  The members are genuinely open to new ideas we have to share with them about new and existing services we offer.  Additionally, the exhibitors are friendly and supportive of each other in our respective service offerings.

Sharon Douglas
CEO
RWI

Event Highlights

2017 Annual Meeting and Educational Conference

Our 2017 Annual Meeting and Educational Conference was a tremendous success. We had 400 workers' compensation professionals in attendance, and our Exhibitor and Sponsor opportunities sold out well in advance of the conference.

CSIA will return to the Disneyland Hotel in Anaheim, CA for our 2018 Annual Meeting and Educational Conference. The conference will be held on March 19 - 20, 2018. If you want to know what is on the radar for the largest California employers, this conference is a must.