Workers Compensation Case Management Senior I - San Diego, CA

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Career Level: P3

Primary Purpose:
Manages the end-to-end handling of standard workers' compensation claims, applying judgment to resolve issues and maintain compliance. Drives timely resolution and cost control through proactive communication and accurate case evaluation.

Duties and Responsibilities:

• Administers various aspects of the claim file handling of both in-house and third-party administered claims through diligent investigation and assessment.
• Evaluates completed investigation and case facts to determine merits of each claim.
• Performs pre and post binding claim audits as needed and communicate the audit results to appropriate internal and external stakeholders.
• Assesses damages by calculating applicable damages or the range permitted by law; anticipates and understands settlement impacts and proactively addresses issues.
• Negotiates claim settlements using a negotiation strategy established by management as well as using available tools and resources within authority limits.
• Sets and reviews reserves promptly throughout the claims cycle within authority limits, including estimating and validating claim values.
• Reviews and assists subject matter experts with development of testimony, work papers and discovery responses, settlement documents and communications materials.
• Ensures an efficient records maintenance system for workers' compensation claims and related information, data, and activities.
• Performs other duties as assigned.

Required Qualifications:

• Typically requires a 4-year degree in a relevant field, or equivalent combination of relevant education and experience.
• Typically requires 5 years of related experience.

Required Knowledge, Skills and Abilities:

• Ability to coordinate effectively with medical providers and employers.
• Ability to influence outcomes through effective case planning.
• Ability to resolve non-routine claim issues using professional judgment.
• Knowledge of integrated workers' compensation case management frameworks.
• Knowledge of regulatory requirements and claim adjudication principles.
• Skill in evaluating medical, vocational, and functional information.
• Skill in managing moderate-complexity claims independently.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability or protected veteran status.

HYBRID: Work a combination of onsite and remote days each week, typically 4 days per week onsite.

Human Resources

Full-time

Note: SDG&E strives to ensure that employees are paid equitably and competitively. Starting salaries may vary based on factors such as relevant experience, qualifications, and education.

SDG&E offers a competitive total rewards package that goes beyond base salary. This position is eligible for an annual performance-based incentive (bonus) as well as other merit-based recognition. Company benefits include health and welfare (medical, dental, vision), employer contributions to retirement benefits, life insurance, paid time off, as well as other company offerings such as tuition reimbursement, paid parental leave, and employee assistance programs.

Pay Range Pay Range

The estimated pay range for this job. Disclosing pay information promotes competitive and equitable pay.

The actual pay rate will depend on the person's qualifications and experience.

$92,000.00 - $146,000.00 / year

In order to support the Fair Compensation Strategy by the US Govt., HR Dept., clients are required to adhere to "Pay Transparency Law"; in the impacted states; that have mandated the employers to list the salary ranges in Job advertisements or postings for job opportunities and Job promotions.