Senior Worker's Compensation Representative

PG&E•Oakland, CA

8h•Hybrid

About The Position

The Senior Workers' Compensation Representative manages the organization's most complex and high-exposure workers' compensation claims and serves as a subject matter expert in California workers' compensation law, claims strategy, regulatory compliance, and disability management. The position independently investigates, evaluates, and resolves complex litigated and non-litigated claims while ensuring timely benefits delivery in accordance with California Labor Code requirements and company policies. The role develops claim resolution strategies, negotiates settlements, provides technical guidance to less experienced claims professionals, and advises supervisors, managers, labor relations, human resources, legal counsel, and other business partners. It requires advanced analytical, negotiation, investigation, and leadership skills to manage significant financial exposure and operational risk. The role is hybrid, working from a remote office and in person at the Oakland General Office based on business needs or company requirements. The Occupational Health and Mental Wellbeing team supports employee health, safety, and wellbeing through occupational health expertise, mental health and wellbeing programs, employee support resources, and strategic partnerships. The team takes a proactive, employee-centered approach to improving access to support and strengthening individual and organizational resilience.

Requirements

High school diploma or GED.
Five years of workers' compensation claims handling experience or equivalent.
Two years in a career-level Workers' Compensation Representative role or equivalent.
California Self-Insurance Administrator Certification.
Designation as an Experienced Claims Adjuster pursuant to California Code of Regulations, Title 10.
Compliance with continuing education requirements established by the Department of Insurance.
Demonstrated experience managing complex litigated claims and high-exposure workers' compensation matters.
Advanced knowledge of California Workers' Compensation Law and regulations.
Advanced experience conducting AOE/COE investigations and claim compensability determinations.
Advanced knowledge of permanent disability ratings, return-to-work programs, SJDB benefits, and WCAB proceedings.
Strong analytical and strategic thinking capabilities.
Demonstrated ability to negotiate complex settlements and resolve contentious claims issues.
Thorough understanding of medical management, utilization review, disability management, and cost containment principles.
Ability to manage multiple complex assignments with minimal supervision.
Strong coaching, mentoring, and leadership skills.
Excellent written and verbal communication skills.
Proficiency with claims management systems and Microsoft Office applications.
Ability to work effectively with employees at all levels, union leadership, attorneys, medical providers, and senior management.

Nice To Haves

Experience managing large, self-insured California workers' compensation programs.
Experience handling cumulative trauma, psychological injury, catastrophic injury, and complex return-to-work cases.
Knowledge of integrated disability management programs and overlapping employment laws.
Experience delivering formal training, audits, and quality reviews.

Responsibilities

Independently manage complex workers' compensation claims, including compensability disputes, cumulative trauma allegations, permanent disability exposure, psychological claims, catastrophic injuries, litigated matters, and return-to-work challenges.
Conduct and direct investigations to determine AOE/COE, compensability, OSHA recordability, potential fraud, and third-party recovery opportunities.
Develop and execute strategic claim action plans that support regulatory compliance, cost-effective resolution, and appropriate delivery of benefits.
Analyze medical, legal, vocational, and employment records to determine liability, exposure, and settlement value; establish appropriate reserves; and prepare complex claims for closure and resolution.
Develop litigation strategies with defense counsel, prepare defense strategies for WCAB proceedings, represent the company at WCAB hearings when appropriate, and resolve legal and procedural issues affecting claims.
Negotiate settlements within delegated authority and prepare recommendations for settlements requiring higher approval authority.
Manage QME/AME processes and coordinate expert medical evaluations.
Ensure compliance with California Labor Code requirements, Division of Workers' Compensation regulations, self-insurance regulations, and company policies.
Identify systemic claim trends, compliance risks, and opportunities for operational improvement.
Consult with line organizations on injury management, return-to-work programs, and claims-related matters.
Mentor and provide technical guidance to Workers' Compensation Representatives and Associate Representatives on complex claim handling, investigations, litigation strategy, and regulatory compliance.
Deliver training to claims staff, supervisors, and business partners on workers' compensation processes and requirements.
Support leadership initiatives and organizational objectives by promoting best practices and consistent claims management standards.
Assist management with claims audits, quality reviews, and process improvement efforts.
Build productive relationships with injured employees, supervisors, attorneys, medical providers, labor representatives, and regulatory agencies.
Communicate effectively about benefits, claim strategies, settlement options, and return-to-work opportunities; present complex claim and regulatory information to leadership and stakeholders.
Partner with business leaders to address workplace injury trends and reduce operational risk.