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Senior Workers' Compensation Claims Examiner

Company: SoCalGas
Location: Los Angeles
Posted on: November 23, 2021

Job Description:

Primary PurposeAdministers complex and high profile litigated workers' compensation cases 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 the delivery of benefits associated with sickness and long term disability benefits. Provides technical guidance, mentoring, and support to the junior staff. Assumes coverage of the supervisor desk during supervisor absence. Assists in department special projects as needed.Duties and Responsibilities

  • Manages workers' compensation cases, including complex and catastrophic claims, while maintaining strict confidentiality regarding employee, contractor, and company information. Acts as a technical resource to the claims staff, employees, and other external and internal contacts. Reviews cases of junior staff within authority. Promotes litigation avoidance through close contact with employees to assure understanding of 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 workers' compensation indemnity claims. Acts as company witness at Workers' Compensation Appeals Board (WCAB) hearings. Determines compensability and initial reserves of new cases and assign to appropriate personnel.
  • Provides guidance on 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. Communicates workers' compensation benefit information to non-occupational representatives for the purpose of offsets. Evaluates and determines the appropriate individual case reserve of assigned cases for future financial liability.
  • Focuses on cost-effective delivery of benefits and resolution of cases. Develops and documents plans to resolve cases. Analyzes workers' compensation cases for settlement including need for structured settlement. Settles case within authority and recommends settlements to Employee Care Supervisor - Workers' Comp. Identifies and investigates questionable case, third party, fraud, and abuse. Coordinates vocational rehabilitation, reasonable accommodation requests, company Return to Work (RTW) programs, and work hardening (a rehabilitation program designed to restore functional and work capacities to the injured worker).
  • Reviews and approves benefits payable to injured employee, invoices including attorney bills, medical provider bills, liens, and mileage. Rates employee's permanent disability. Reviews and monitors employee medical records to ensure scope and duration of treatment are appropriate based on the injury and diagnosis. Seeks recovery from third parties. Reports appropriate cases to excess insurance and seek reimbursement. Assumes coverage of the supervisor desk during supervisor absence. Assists in department special projects.
  • Performs other duties as assigned (no more than 5% of duties).QualificationsEducation
    • Bachelor's Degree Bachelor's degree in human resources, disability management, related field or equivalent training and work 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. RequiredExperience
      • 7-8 Workers' compensation or disability management experience. Required
      • 5 Litigated claims experience (included in overall 7-8 yrs). RequiredSkills and Abilities
        • Knowledge of collective bargaining agreements of SoCalGas preferred. Beginner
        • Familiar with Americans with Disabilities Act (ADA) regulations preferred. Intermediate
        • Must have strong teamwork skills and be well-organized in order to meet heavy workload and be able to effectively manage multiple demands. Advanced
        • Knowledge and understanding of workers' compensation claims administration. Advanced
        • Basic computer skills, knowledge of Microsoft Office software, and mathematical skills required for calculations and ratings. Advanced
        • Thorough knowledge of employee care policies and procedures as they relate to the integration of workers' compensation, Self-Insurance regulations, Case Law, Labor Code and rules and regulations of OSHA required. Advanced
        • Ability to maintain strict confidentiality regarding employee, contractor and company information. AdvancedLicenses and Certifications
          • Self-Insurance Certificate, current and on-going education in Workers' Compensation/disability claims administration Required
          • California Workers Compensation Claims Administration (WCCA) certification Preferred
          • California Workers Compensation Claims Professional (WCCP) certification PreferredSouthern California Gas Company is an EEO/AA EmployerEqual Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Keywords: SoCalGas, Los Angeles , Senior Workers' Compensation Claims Examiner, Other , Los Angeles, California

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