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!

 

Career Level: P3

 

Primary Purpose:
Investigates moderately complex claims, synthesizes evidence, and negotiates settlements within authority. Balances speed, accuracy, and recovery to optimize financial and customer outcomes.

 

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 emergency electrical incidents and other reportable events. 

 

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.
• 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.

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.

 

Required Licenses and Certifications:

• A valid California driver's license is required.

 

Required Knowledge, Skills and Abilities:

• 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.

 

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.