Claims Resolution Senior I

Sempra

Screened

San Diego, California

Posted 1 week ago

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About the role

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

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.

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. Qualifications

Required Education

Typically requires a 4 year degree in a relevant field, or equivalent combination of relevant education and experience.

Required Experience

Typically requires 5 years of related experience.

Required Knowledge, Skills and Abilities

Ability to evaluate complex claim facts using multiple sources of information.
Ability to exercise independent judgment in ambiguous or non-standard situations.
Ability to provide guidance to less experienced professionals without formal authority.
In-depth knowledge of claims investigation methods, liability analysis, and settlement evaluation.
Knowledge of related disciplines such as legal support, risk management, and insurance practices.
Skill in identifying root causes, patterns, and risk implications within claims.
Skill in influencing outcomes through professional negotiation and explanation.

Required Licenses and Certifications

A valid California driver's license is required.

About this listing

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