Claims Advisor (Claims Resolution Senior I)

SDG&E is not just an energy company, we are the architects of a brighter, cleaner future. Our employees power everyday life for 3.7 million people – bringing the energy to support their passions, ambitions, and the heartbeat of our community.

We call Southern California our home. It’s where we chase our dreams and raise our families. That’s why the people who live here deserve an energy company unlike any other, and that’s why every day, SDG&E employees strive to be at the forefront of innovations to reduce emissions, modernize the electric grid, and enable our customers to make the transition to clean technologies. We’re redefining sustainability, advancing zero-emissions solutions, and driving the electric vehicle revolution.

It takes the best to build the best – join us!

 

Job Family: Legal Support

Job Function: Claims Resolution

Career Level: P3

 

Primary Purpose:
Oversees claims operations that involve customer contact, investigation and settlement of property and personal damage claims for and against the organization. Approves all claim settlements both for and against the organization. Works with insurance companies, contractors, repair facilities, internal and external legal staff, law enforcement agencies and collection services in the settlement of claims. Coordinates and conducts site investigations to determine the causes of damage and the extent and method of restitution to customer. Initiates procedures for billing and collection of money owed to the organization for damage to organization equipment and/or property

Duties and 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.
• Performs other duties as assigned.

Qualifications

Required Qualifications:

• 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 CA Driver’s license or the ability to obtain a valid CA Driver’s License prior to the first day of employment.

• Must be able to accept required responsibility of after-hours first responder on-call duty watch on nights, weekends and holidays.

 

Knowledge, Skills, and Abilities:

• Claims Investigation - Examining the details of a claim to determine its authenticity.
• Case Management & 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 & 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 analyzes.
• 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 met