Primary Purpose
Administer complex non-litigated and litigated workers’ compensation cases. Integrate the delivery of benefits associated with sickness and long-term disability (LTD) benefits. Provide technical guidance to junior level staff as needed.
Duties and Responsibilities
* Manage workers’ compensation cases, including complex and catastrophic claims, utilizing independent judgment on case strategy and the resolution of cases, while maintaining strict confidentiality regarding employee and company information. Act as an information resource to the claims staff, employees, supervisors, doctors and other external and internal contacts. Promote litigation avoidance through close contact with employees to assure understanding of claims process and benefits integration. Direct employees to resources that will aid in their return-to-work (RTW). Provide technical support and guidance to the claims staff on medical only and workers’ compensation indemnity claims. Act as company witness at Workers’ Compensation Appeals Board (WCAB) hearings.
* Independently interpret and apply 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, Occupational Safety and Health Administration (OSHA) and other administrative laws. Evaluate and determine the appropriate individual case reserve of assigned cases for future financial liability.
* Focus on cost-effective delivery of benefits and resolution of cases. Develop and document plan to resolve cases. Analyze workers’ compensation cases for settlement including need for structured settlement. Settle case within authority and recommend settlements to Employee Care Supervisor – Workers’ Comp. Identify and investigate questionable case, third party, fraud and abuse. Coordinate vocational rehabilitation, reasonable accommodation requests, company RTW programs and work hardening (a rehabilitation program designed to restore functional and work capacities to the injured worker). Advise Attorneys on cost-effective case resolution.
* Review and approve benefits payable to injured employee, invoices including attorney bills, medical provider bills, liens and mileage. Rate employee’s permanent disability. Review and monitor employee medical records to ensure treatment scope and duration are appropriate based on the injury and diagnosis. Seek recovery from third parties. Report appropriate cases to excess insurance and oversee case for appropriate reimbursement.
* Assist with providing training to Region personnel. Travel within the service territory, to visit local bases to discuss case strategy with local management. Foster a team approach with Field Supervisor for delivery of benefits. Support peers and provide leadership to ensure high level of customer service to clients.
* Perform other duties as assigned (no more than 5% of duties).
Qualifications
Education
* H.S. Diploma/GED High School Diploma or GED certificate. Required
* Bachelor’s Degree Bachelor’s degree in Human Resources, Disability Management, related field or equivalent training and experience. Preferred
* Other Must have at least half of your continuing education hours per CA Insurance code section 11761 and CA Code regulations Section 2592. Required
Experience
* 5 years – Workers’ compensation, disability management or closely related experience. Required
* Litigated claims experience. Required
Skills and Abilities
* Basic mathematical skills required for calculations and ratings. Intermediate
* Knowledge and understanding of workers’ compensation claims administration required. Intermediate
* Thorough knowledge of employee care policies and procedures as they relate to the integration of workers’ compensation required. Advanced
* Thorough knowledge of Self-Insurance regulations, Case Law, Labor Code and rules and regulations of OSHA required. Advanced
* Must be well-organized to meet heavy workload and be able to effectively manage multiple demands.
* Must have strong teamwork skills.
* Basic computer skills and basic knowledge of Microsoft Office software required.
* Ability to maintain strict confidentiality regarding employee and company information required.
* Knowledge of collective bargaining agreements of SDG&E and SoCalGas preferred.
* Familiarity with Americans with Disabilities Act (ADA) regulations preferred
* Ability to travel within the service territory, to visit local bases.
Licenses and Certifications
* Self-Insurance Certificate, California Workers Compensation Claims Administration (WCCA) certification and current and ongoing education in WC/disability claims administration. Required
* California Workers Compensation Claims Professional (WCCP) certification highly desirable. Preferred
* Flexible remote work schedule available*
Southern California Gas Company is an EEO/AA Employer
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled