Especialista en resolución de reclamaciones

Become a Claims Resolution Specialist at Southern California Edison (SCE) and build a better tomorrow. In this job, you'll work in a fast-paced environment handling a varied caseload of files, including litigated cases. You will be tasked with the recovery of SCE damages caused by third parties and providing investigation support to the Claims Organization.

As a Claims Resolution Specialist, your work will help power our planet, reduce carbon emissions and create cleaner air for everyone. Are you ready to take on the challenge to help us build the future?

Responsibilities

• Manages, with some level of oversight, an assigned caseload of moderately complex claims which consists of pending, ongoing/active and appeal reviews.
• Identifies potential suspicious claims and identifies opportunities for third party subrogation.
• Helps oversee financial processing of assigned claims, as well as security information contained in claims files.
• Plans and conducts detailed investigations to analyze and confirm insurance coverage and to determine liability, compensability and damages of claims.
• Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advises as to proper course of action.
• Assists in resolving claims by approving or denying settlement agreements; ensures that claims payments are issued in a timely and accurate manner.
• Conveys complex information including coverage, decisions, outcomes etc. to all appropriate parties, maintaining a professional demeanor in all situations.
• Monitors and analyzes data to ensure consistency in quality of reserving, strategies, and outcomes. Maintains delegated relationships, provides superior customer service to internal and external business partners.
• Assists in the managing of practices and billing activities of outside and in-house counsel.
• A material job duty of all positions within the Company is ensuring the protection of all its physical, financial and cybersecurity assets, and properly accessing and managing private customer data, proprietary information, confidential medical records, and other types of highly sensitive information and data with the highest standards of conduct and integrity.

Minimum Qualifications

• Three or more years of experience in claims resolution, policies, procedures, regulations and applicable laws.
• Experience conducting investigations to analyze and confirm insurance coverage.

Preferred Qualifications

• Strong background in insurance-related litigation, with experience collaborating with insurers, outside counsel, and claims professionals.
• Extensive experience managing litigation involving insurance carriers, including claims evaluation, settlement negotiations, and dispute resolution.
• Experience in field investigations and small claims attendance.
• Ability to utilize and leverage new and evolving technologies into the role.

Additional Information

• This position's work mode is hybrid. The employee will report to an SCE facility for a set number of days with the option to work remotely on the remaining days. Unless otherwise noted, employees are required to work and reside in the state of California. Further details of this work mode will be discussed at the interview stage. The work mode can be changed based on business needs.
• Visit our Candidate Resource page to get meaningful information related to benefits, perks, resources, testing information, hiring process, and more!
• Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
• Position will require up to 5% traveling and being out in the field throughout the SCE service territory.
• This position has been identified as a NERC/CIP impacted position - Prior to being hired, the successful candidate must pass a Personnel Risk Assessment (PRA) or Background Investigation. Once hired, the candidate must complete specified training prior to gaining un-escorted access to assigned work location and performing necessary job duties.
• Relocation does not apply to this position.