Senior Worker's Compensation Representative

Pacific Gas And Electric Company•Oakland, CA

18h•$98,000 - $146,000•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 delivery of benefits in accordance with California Labor Code requirements and company policies. The representative 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. The role involves 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 delivers services addressing physical and psychological health, including occupational health services, employee assistance resources, crisis and critical incident support, prevention and early intervention, and resilience programs.

Requirements

High school diploma or GED.
5 years of workers' compensation claims handling experience or equivalent.
2 years in a career-level Workers' Compensation Representative role or equivalent.
California Self-Insurance Administrator Certification required.
Designation as Experienced Claims Adjuster pursuant to California Code of Regulations, Title 10.
Demonstrated experience managing complex litigated claims and high-exposure workers' compensation matters.
Compliance with all continuing education requirements established by the Department of Insurance.
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 all levels of employees, 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 involving compensability disputes, cumulative trauma allegations, permanent disability exposure, psychological claims, catastrophic injuries, litigated matters, and return-to-work challenges.
Conduct and direct advanced investigations to determine AOE/COE, compensability, OSHA recordability, potential fraud, and third-party recovery opportunities.
Develop and execute strategic claim action plans to ensure regulatory compliance, cost-effective claim resolution, and appropriate delivery of benefits.
Analyze medical, legal, vocational, and employment records to determine liability, exposure, and settlement value.
Establish and maintain appropriate reserves based on probable ultimate claim exposure.
Prepare complex claims for closure and resolution.
Lead litigation strategy development in partnership with defense counsel and prepare defense strategies for WCAB proceedings.
Represent the company at WCAB hearings when appropriate.
Negotiate settlements within delegated authority and prepare recommendations for settlements requiring higher approval authority.
Manage QME/AME processes and coordinate expert medical evaluations.
Resolve legal and procedural issues affecting claim outcomes.
Ensure compliance with California Labor Code requirements, Division of Workers' Compensation regulations, self-insurance regulations, and company policies.
Serve as a subject matter expert on workers' compensation, OSHA recordability, disability management, and overlapping employment issues including FEHA, ADA, FMLA, and bargaining unit considerations.
Identify systemic claim trends, compliance risks, and opportunities for operational improvement.
Provide consultation and technical guidance to 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 in claims audits, quality reviews, and process improvement efforts.
Build productive relationships with injured employees, supervisors, attorneys, medical providers, labor representatives, and regulatory agencies.
Provide effective written and verbal communication regarding benefits, claim strategies, settlement options, and return-to-work opportunities.
Partner with business leaders to address workplace injury trends and reduce operational risk.
Present complex claim and regulatory information to leadership and stakeholders.