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4 Jan 2023

Full-Time Claims Advisor – Workers Compensation (Hybrid) (#22-66442)

San Diego Gas & Electric – Posted by San Diego Gas & Electric San Diego, California, United States

Job Description

SDG&E is an innovative San Diego-based energy company that provides clean, safe and reliable energy to better the lives of the people it serves in San Diego and southern Orange counties. The company is committed to creating a sustainable future by providing its electricity from renewable sources; modernizing natural gas pipelines; accelerating the adoption of electric vehicles; supporting numerous non-profit partners; and, investing in innovative technologies to ensure the reliable operation of the region’s infrastructure for generations to come. SDG&E is a subsidiary of Sempra Energy (NYSE: SRE).

Our highly trained and responsive employees with their diverse skills, talents and ideas are the reason we can deliver on our commitment and are building America’s best energy company. They are also the reason why we have been recognized with the industry’s most coveted awards. Our employees undertake challenging work, and receive highly competitive compensation and benefits. As one of the region’s largest employers, we’re always searching for talented and bright people to join our team. After all, it takes the best to build the best. Learn more about benefits HERE.

Diversity and inclusion are core values of SDG&E. Empowering our employees to be their whole selves at work is our competitive advantage. This is where new ideas come from and meaningful collaboration gets an authentic start. By bringing together people with different perspectives, diverse backgrounds and real commitment to their own individuality, we have built a stronger business. Learn more about our commitment to diversity and inclusion HERE.

For more information, visit or connect with SDG&E on Twitter (@SDGE), Instagram (@SDGE) and Facebook.


Primary Purpose
Administers complex non-litigated and litigated workers’ compensation cases and integrates the delivery of benefits associated with sickness and long-term disability benefits. Provides senior technical guidance, mentoring and support to the staff.

Duties and Responsibilities

  • Works independently to manage workers’ compensation cases, including complex and catastrophic claims. Focuses on cost effective delivery of benefits and resolution of cases. Develops and documents plan 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 supplemental job displacement voucher, reasonable accommodation requests, company RTW programs and work hardening. Directs attorneys for cost effective case resolution.
  • Independently 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. Evaluates and determines the appropriate individual case reserve of assigned cases for future financial liability. Reviews cases of workers’ compensation staff within authority.
  • 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 claims process, and benefits integration. Directs employees to resources that will aid in their return-to-work (RTW). Provides technical support and guidance to the claims staff on medical only and workers’ compensation indemnity claims. Acts as company witness at WCAB hearings.
  • 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 oversees case for appropriate reimbursement.
  • Assists with providing training to ECS personnel. Visits vendor partners to discuss case strategy with local management. Fosters a team approach with Claims Supervisor for delivery of benefits. Support peers and provides leadership to ensure high level of customer service to clients.
  • Performs other duties as assigned (no more than 5% of duties).


Required Qualifications

  • 7 years Workers’ compensation or disability management experience
  • 5 years Litigated claims experience
  • Other Current and ongoing education in WC/disability claims administration
  • Well-organized to meet heavy workload and ability to effectively manage multiple demands
  • Strong teamwork skills
  • Knowledge and understanding of workers’ compensation claims administration Advanced
  • Thorough knowledge of Self-Insurance regulations, Case Law, Labor Code and rules and regulations of OSHA
  • Computer skills and knowledge of Microsoft Office software
  • Basic mathematical skills required for calculations and ratings
  • Self-Insurance Certificate
  • Workers’ Compensation Claims Administration (WCCA) Certification
  • Must reside in Southern California or be willing to relocate upon hire.
  • We offer a hybrid work environment. Although the schedule may vary, typically this will allow you to work from the office two to three days per week and work remotely on the remaining workdays.

Preferred Qualifications

  • Bachelor’s Degree Human resources, disability management, related field or equivalent training and work experience
  • Thorough knowledge of Employee Care Services policies and procedures as they relate to the integration of workers’ compensation
  • Knowledge of collective bargaining agreements of SDG&E and SoCalGas
  • Workers’ Compensation Claims Professional (WCCP) highly desirable Preferred


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.


Work Schedule
HYBRID: Work a combination of onsite and remote days each week, typically 2-3 days per week.
Salary Range
$81,600.00 – $122,400.00

How to Apply


Job Types: Full-Time. Salaries: 80,000 - 100,000.

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