Claims Resolution Senior I

SDG&E•San Diego, CA

4d•Onsite

About The Position

SDG&E is an energy company focused on building a brighter, cleaner future for 3.7 million people in Southern California. The company is committed to innovation in reducing emissions, modernizing the electric grid, and enabling customer transitions to clean technologies, including advancing zero-emissions solutions and driving the electric vehicle revolution. The company is seeking talented individuals to join their team.

Requirements

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.
A valid California driver's license is required.
Claims Investigation - Examining the details of a claim to determine its authenticity.
Case Management and Investigation - The process an organization uses to handle, route, resolve, and report on conflicts or issues.
Claims Processing - Reviewing claim requests for adequate information, validation, justification and authenticity, and upon satisfaction, reimbursing money.
Documentation and Records Management - Creating, distributing, using, maintaining and disposition of recorded information maintained as evidence of business activities and transactions.
Data Analysis - Measuring and managing organization data, identifying methodological best practices and conducting statistical analyses.
Dispute Resolution - The process of resolving disputes between parties.
Claims Reporting - The process of reporting the details of an incident to initiate the claims process that may be covered by an insurance policy.
Liability Analysis - The process of managing and analyzing the use of assets and cash flows to reduce the firm's risk of loss from not paying a liability on time, might involve the application of advanced actuarial methods.
Regulatory Compliance - Ensuring an organization's adherence to laws, regulations, guidelines and specifications relevant to its business processes.
Claims Examination - The process of making a decision or benefits determination in a claim case.

Responsibilities

Conducts and performs onsite, field, or internal investigations to determine the root causes, impacts, and effects of claims and incidents.
Reviews internal and external records, files, and documents regarding incident investigations, liability and damage evaluation, and claims negotiation and settlements.
Processes escalated claims, assesses the reason for the escalation, and provides resolution ensuring smooth operation.
Evaluates and assesses potential risks associated with claims and provides recommendations to mitigate these risks.
Identifies potential suspicious claims and opportunities for third-party subrogation.
Negotiates settlements with claimants or their representatives while balancing the company's financial and reputational interests.
Identifies opportunities to improve the claims handling process and contributes to the development and implementation of best practices.
Frequent, independent driving to meetings, company locations, field locations and/or active incidents sites while maintaining a focus on safety and compliance with traffic laws is essential to this position and cannot reasonably be accomplished via alternative transportation.
Performs other duties as assigned.
Serves as a primary point of contact for emergency and after-hours claim call outs, timely response to incidents, reports of public safety concerns, incident coordination, and claims guidance to support operational, customer, and regulatory needs.
Responsible for regulatory compliance through the assessment, coordination, and timely reporting of CPUC electrical incidents and other reportable events.