Senior Workers' Compensation Claims Examiner
Location: Los Angeles
Posted on: November 23, 2021
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
- 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
- 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
- Performs other duties as assigned (no more than 5% of
- 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.
- 5 Litigated claims experience (included in overall 7-8 yrs).
RequiredSkills and Abilities
- Knowledge of collective bargaining agreements of SoCalGas
- Familiar with Americans with Disabilities Act (ADA) regulations
- Must have strong teamwork skills and be well-organized in order
to meet heavy workload and be able to effectively manage multiple
- Knowledge and understanding of workers' compensation claims
- Basic computer skills, knowledge of Microsoft Office software,
and mathematical skills required for calculations and ratings.
- 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
- Self-Insurance Certificate, current and on-going education in
Workers' Compensation/disability claims administration
- California Workers Compensation Claims Administration (WCCA)
- California Workers Compensation Claims Professional (WCCP)
certification PreferredSouthern California Gas Company is an EEO/AA
EmployerEqual Opportunity Employer Minorities/Women/Protected
Keywords: SoCalGas, Los Angeles , Senior Workers' Compensation Claims Examiner, Other , Los Angeles, California
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