Specialist, Workers' Compensation

Pilot Company•Knoxville, TN

2d•Onsite

About The Position

The purpose of this Knoxville, TN (on site) job is to investigate and resolve incidents of workers’ compensation claims. This role involves investigating, evaluating, and resolving Medical Only and/or Lost Time employee injury claims. The Specialist will facilitate and coordinate injured team members' medical care, calculate and pay benefits based on statutory guidelines, and manage, document, analyze, negotiate, and settle claims. This position also requires managing claim-related documentation, including Personally Identifiable Information (PII) and Health Insurance Portability and Accountability Act (HIPAA) related information. The Specialist will provide reserve recommendations to Pilot Corporate Management for cases processed by TPA and applicable in-house claims, resolve conflicts with claims in collaboration with senior adjusters, and collaborate with defense counsel on litigation closure strategy. Additionally, the role involves managing litigation to obtain favorable outcomes and resolution, focusing on loss prevention and hazard correction during claim handling, modeling behaviors that support the company’s common purpose, and ensuring all activities comply with rules, regulations, policies, and procedures.

Requirements

High school diploma or equivalent certification required
Intermediate Microsoft Office skills
Strong Excel skills
Strong conflict resolution and problem-solving skills
Ability to handle multiple tasks, meet deadlines and work independently
Professional demeanor when communicating in person, email or phone
Ability to work in a fast-paced environment
Strong attention to detail
Candidates must be legally authorized to work in the United States without employer sponsorship

Nice To Haves

Associate’s degree in business or related field preferred
Minimum three years’ experience in related work experience preferred

Responsibilities

Investigate, evaluate and resolve Medical Only and/or Lost Time employee injury claims
Facilitate and coordinate injured team member’s medical care, calculate and pay benefits based on statutory guidelines
Manage, document, analyze, negotiate and settle claims
Manage and control claim related documentation including Personally Identifiable Information (PII) and Health Insurance Portability and Accountability Act (HIPAA) related information
Provide reserve recommendation to Pilot Corporate Management for cases processed by TPA and applicable in-house claims
Resolve conflicts with claims in collaboration with senior or more tenured adjuster
Collaborate with defense counsel on litigation closure strategy
Manage litigation to obtain favorable outcome and resolution
Focus on loss prevention and hazard correction during claim handling
Model behaviors that support the company’s common purpose; ensure guests and team members are supported at the highest level
Ensure all activities are in compliance with rules, regulations, policies and procedures